Relative to the countries of northern Europe, the United States has a high crude infant mortality rate. We compared the United States' fetal and infant mortality rates with those of Norway, a nation that is internationally recognized for having a low infant mortality. Norwegian birth-weight-specific rates were applied to the US birth populations, yielding adjusted rates. The adjusted rates, which are the crude rates that would have resulted in the United States if the Norwegian birth-weight-specific rates had been in force, were generally higher than the US rates that were actually observed. Thus, the major reason for the United States' poor international rank is probably its unfavorable birth-weight distributions, and any major improvement in the United States' international standing will likely await a reduction in the proportion of high-risk, low-weight births. (JAMA 1982;247:987-991)