Three years have passed, and she says it would be possible to forget, were it not for the telephone calls.

Each years, around the anniversary of her son's birth, she receives a call from one of the District of Columbia's city maternal and child helath clinics reminding her to bring him in for his shots.

Each year the woman must remind the clinic employee that her son died two hours after his birth.

That the city's health burcaucracy fails at so seemingly simple a task as removing a dead infant's record from it active files gives a hint of why the District of Columbia has been unable to make any significant progress in the last 10 yearts in lowering its infant mortality rate-a rate higher than that in any comparably sized urban area in the nation.

At a time when infant mortality rates are dropping all over the nation. Washington's has remained virtually constant, rising, in fact, for blacks. In 1970 the District of Columbia ranked 14th among major cities in non-white infant mortality. In 1976 the city ranked fourth.

The task force on health and welfare appointed by Mayor-elect Marion Barry has called infant mortality the city's No. 1 health problem, a problem that must receive Barry's personal attention if there is to be any success in reducting what the task force co-chairman, Dr. Arthur Hoyt, termed a "public embarrasment."

The city's fight against infant mortality has been a leaderless one, according to observes, with virtually no coordination of the public and private sectors, no coordination of public programs, too few clinics, improperly located clinics and with much time and attention given to the validity of statisties, rather than to getting pregnant women into clinics.

Infant mortality is not simply a series of numbers, for each of the numbers represents a human tragedy.

The women whom the clinic calls each year is but one of the mothers of the 283 babies who died in Washington in 1975.

There are others, like one young woman who has three times lost a baby. She says she still "dreams about them I dream they're doing what [babies their age, had they lived] would be doing, I dream about going places with them and doing things. Just going out together."

On some weeks, more babies die in Washington than in all 14 major cities of New England combined. On an average week, four or five infants die here prior to the first anniversary of their birth, the deunition of infant mortality.

Anyone vaguely connected with the delivery of public health care in Washington has been painfully aware of this problem for more than a decade.

Dr. Paul Cornely, former chairman of Howard University's department of community medicine and a past president of the American Public Health Association, remembers expressing his concern to the Medical Society of the District of Columbia a dozen years ago.

"I said I tell the society had some responsibility and something should be done about the infant mortality rate," said Cornely. "We should launch a campaign. They said it was a nice talk. But nothing was done. There has not been a concerted approach to the problem. There has not been leadership from either the mayorhs office or the City Council."

Dr. William Washington, health adviser to Mayor E. Washington and DHR director Albert P. Russo, said he did not have enough knowledge of the problem to discuss it with a reporter.

"It's not the area I would have the most knowledge about," said William Washington. "Part of it is that it has been a high rate for a long time. I'm not familiar with it enough to know why it has remained so high."

For the greater part of this decade Washington has, at various time served as director of D.C. General Hospital Health and Hospitals Administration and as health advisor to Russo and his predecessor Joseph Yeldell.

Russo, who suggested that a reporter talk to Washington to get a good picture of the state of the city's public health, announced recently that the city's infant mortality rate rose 9.6 percent betwen 1976 and 1977, from 24.9 deaths per 1,000 live births, to 27.3 deaths. Additionally, preliminary figures show that the nonwhite infant mortality rate which was 29.52 in 1970 was 29 last year.

During the same period, Boston's nonwhite infant mortality rate dropped form 36.83 to 16.2 deaths per 1,000 births.

Leaders of the city's health community not only express outrage over the situation, they also admit to being puzzled that it has been allowed to continue so long.

"It's just bizarre that this city should tolerate such a high infant mortality rate without a crash program." said Dr. Frederick Green, associate director of Children's Hospital National Medical Center and a former HEW child health official.

Green, and others in the field, see the need for an immediate crash program, beginning with an effort to attract pregnant women into the city's five existing maternal and child health clinics.

Infant mortality rates are often said by experts in health care to be the best single indicator of the state of public health because of what the rates suggest about the health of the young women giving birth as well as the health-probably poor-of many surviving babies.

City health officials are quick to say that infant mortality is a complex and difficult problem. They say the situation is particularly difficult in poor inner-city areas because of the state of housing, nutrition, health care and the general environment.

During this decade such cities as Los Angeles, Detroit, Cleveland, Newark and Boston have made remarkable progress in lowering their infant mortality rates at a time when the District of Columbia has been standing still.

Boston, for example, cut its nonwhite rate in half through the intersive use of almost three dozen neighbourhood health centers, all of them linked to hospitals.

Boston accomplished this remarkable lowering of infant death at a time when its nonwhite birth rate dropped only 3.5 percent, Washington, which experienced a 37.7 decline in nonwhite births between 1970 and 1976, only experienced a 5 percent decline in nonwhite infant mortality.

A city with about 70,000 fewer residents than Washingtonl in 1975, Boston has 32 neighborhood health centers-one in every neighborhood-compared to 15 in Washingtom.

Each of the centers in Boston is officially linked to one of the city's hospitals, with residents at the hospitals spending one day a week in the clinics.

Washington has no such arrangement.

Because residents from the hospitals-most of the clinics are connected to Boston City Hospital, although some are affiliated with the Harvard Medical School teaching hospitals-spend time in the clincs, they get to know the clinic patients and their problems before the patients enter the hospitals to give birth.

The pysicals in the clinics have privileges in the affiliated hospitals, and can care for their patients there. No such arrengement exists in Washington.

A messenger from Boston City Hospital drives to all its affilaited clinics each evening and returns to the hospital with the records of all pregnant women being cared for in the clinics if a woman delivers during the night, her records are already in the hospital. No such arrangement exists in Washington.

Boston City Hospital has special programs for drug-addicted mothers alcoholic mothers and mothers who have given birth to a child who died, all of whom are considered a high risk of having an unsuccessful pregnancy. D.C. General has no such programs.

The Intensive Care Nursery at Boston City Hospital is staffed by two neonatologists, one fully-trained pediatrician getting further training as a neonatologist-specialist in the care of new born-and six other pediatricians, D.C. General does not have a single fully certificated neonatolosist.

"Out philosophy is you put your money where your need is," said Jeff Gould, chief of neonatology at Boston City Hospital. "Around 1970 approximately 50 percent of the patients at City Hospital had no prenatal care. For 1977 only 3 percent of our patients didn't have prenatal care."

It is not that such improvements are impossible in Washington. Lost year, 75 percent of the premature babies born at D.C. General weighing between 1.4 and 2.2 pounds died. At Columbia Hospital for Women, just a few miles away, 70 percent of the babies in the same category lived.

After these statistics were brought to his attention by The Washington Post, Dr. Stanford Roman, D.C. General's new medical director and formet outpatient director of Boston City Hospital, hired a neonatologist who will start at D.C. General in July.

Dr. John Scanlon, chief of neonatology that the infant mortality rate can easily be lowered with an infusion of dollars. It can't be taken to zero, say Scanlon, "but if you implement the right programs, you could see a lowering of the rate in 18 months." And says Scanlon, if mortality is decreased, so is illness, which is generally thought to be proportional to death.

Scanlon says that part of the problem is that the poor who have children only use the health care system infrequently, and do not have the economic and political clout to force improvements in it.

"They aren't aware of the services available to them," he said.

One thing that can be easily done, said Scanlon, is an effort to improve the resusciation of sick newborns in the delivery room, where he says some of the mortality occurs unnecessarily. "There shouldn't be any write-offs. This (commonly held belief that babies under 2.2 pounds are) nonviable is a self-fullfilling prophecy."

Scanlon believes political leaders in Washington have continually ducked the infant mortality problem because "it's an intrinsically loaded issue ... Politicians are smart. They don't want to turn the issue loose because they can get clobbered. An there are tremendous racial overtones: If you're black, you have three times the chance to having a lousy outcome" to a preganncy.

In fact, while the District of Columbia had the highest nonwhile urbant infant mortality rate in 1976, it had the lowest white rate.

Asked what the city is doing to lower infant mortality rates, DHR officials point to the Improved Pregnancy Outcome project, a federal effort begun late last year.

The IPO program here, part of a nationwide effort to lower the infant mortality rate in areas where it is particularly high will provide the city with $5 million over five years.

The first IPO goal of Distrist of Columbia officials is to lower by 10 percent to teenagers. A recent study shows this will save 3.4 babies.

City health officials defend their stress on teenage pregnancy by pointing out that about 25 percent of the babies born here each year are born to teenagers.

Several prersons familiar with the local IPO program say it has already disintegrated into yet another series of committees studyings and discussing the problem. "They're inventing the wheel all over again," said a member of one of the committees.

Another effort cited by Dr. Raymond Standford, chief of the city's public health system, is the District of Columbia's use of the U.S. Agricultural Department's supplemental foods program to improve the diets of pregnant women and young children.

Within the past year it was revealted that food intended for that program had been sitting in city warehouses for so long that it had spoiled.

And in September 1976 the federal General Accounting Office reported that the city had spent $8.470 in U.S. funds earmarked for the maternal and child health program to lease to air-conditioned cars, one of which was being personally used by then DHR director Joseph P. Yeldell.

Yeldell said at the time: "I'm running a department of 10,000 people and spending $400 million a year and somebody's going to quibble about my having a car assigned to me? Anybody of cabinet rank ought to have a car assigned to him." CAPTION: Chart, no caption, The Washington Post