Motherhood and apple pie. These are the watchwords of politicians, marketing executives and media moguls. We want to believe that mothers and children all look like pictures out of a Norman Rockwell painting.

Sad to say, that is not at all the case in the United States. Nearly 40,000 babies die every year before their first birthday. Many hundreds of thousands more are born with physical or developmental problems, which they will live with the rest of their lives.

So many, many tragedies in life cannot be avoided. Yet to a great extent the tragedy of these infant deaths and disabilities can. It is a twisted sense of logic that causes our country to lack the societal commitment and political will to change this situation.

If you take cost as an issue, the answer is quite clear. Preventive health care for women and children saves lives as well as dollars. Prenatal care is the best bargain around.

For what it costs to save one high-risk baby in an intensive care nursery (up to $100,000 or more), 50 or more pregnant

women can receive prenatal care. Yet approximately 25 percent of women in this country still do not receive early, adequate prenatal care.

If you make common sense the issue, again the answer is quite clear. No silver bullet needs to be discovered to provide quality preventive care for women and infants. We know how to do it and have known since the earliest documentation of our health care practices in the 1920s. All the old public health notions of seeing a health care provider early in pregnancy, eating properly, not smoking and generally caring for one's body are needed.

Yet preventive health care is not universally available to those who need it. This is often because people can not afford it, find it or figure out how to apply for it (try filling out the form that allows you to receive free or low-cost services from your city or state).

If you make international comparisons an issue, most resoundingly the answer is quite clear. The United States should be overwhelmingly embarrassed that it ranks 18th among industrialized nations in how well its children survive. A baby born in Singapore has a better chance for survival than does a baby born in the U.S.

A hearing I conducted at the United Nations on international infant mortality comparisons showed that countries far poorer than the United States do far better in caring for their most precious citizens. Often, it's just a matter of national leadership and focus that can make the difference.

For instance, in Japan, each expectant mother is issued a prenatal care "passport," in which she notes when she saw the doctor, when she went for checkups, when the baby got immunized, and more. This passport becomes a cherished part of a family's history and is passed from generation to generation as a treasured item.

In Costa Rica, the president and minister of health have made the well-being of children a top priority and, with very little money and few technological resources, they have lowered their infant mortality rate to nearly that of the United States, just by making it a national priority.

In England, all new mothers are checked by a health visitor who goes to the home and visits with the mother and new baby to talk about well-baby care and preventive infant health practices.

I am concerned that we are forgetting what counts in this country. We talk about the need for a balanced budget, the need for improved school systems, the need for a fair sense of international trade. But the simplest notion of having the citizens of our country born with the best possible start in life is "assumed," not attended to -- or assured.

The opportunity to solve a critical social problem is in our grasp. If everyone demanded of the politicians they elect and of the people who make decisions in this country that they keep the health and welfare of children as the top priority, an instant change could be felt.

This is not a public or a private-sector issue. It is not a Democratic or a Republican issue. It is not a rich or a poor issue. It is a universal issue that demands immediate and decisive action.

Please join me and my commission in our intensive efforts to have all pregnant women and infants get the care they need and deserve.

Remember, caring for our children is caring for our future.

Sen. Lawton Chiles (D-Fla.) is chairman of a congressionally formed commission charged with developing a national strategy to reduce infant mortality.

Second Opinion is a forum for points of view on health policy issues.