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This Special Issue highlights Healthy Start, one of the nation’s earliest programs designed to help reduce high rates of infant mortality in U.S. communities. Healthy Start is a federally-funded, community-driven program dedicated to reducing disparities in maternal and infant health, and a critical component of the maternal and child health safety net (SACIM 2013). Healthy Start works in communities with infant mortality rates at least 1.5 times the national average, and high rates of low birth weight, preterm birth, and maternal morbidity and mortality. In 2016, Healthy Start celebrated its 25th year of Federal funding. Authorized by Congress in 1991, Healthy Start has grown from a demonstration program in 15 communities, to a network of 100 Healthy Start programs in 37 states and the District of Columbia (HRSA/MCHB 2017). Over its first 25 years, Healthy Start has evolved from a program focused primarily on improving pregnant women’s access to prenatal care to a developmentally focused program seeking to improve women’s and children’s health from preconception to early childhood, creating the foundation for optimal infant and young child health and development (Kotelchuck 2012). Healthy Start serves women of reproductive age, pregnant women, mothers who have just given birth, and infants and families from birth to the child’s second birthday. Healthy Start involves fathers and supports couples with reproductive life planning. On an individual level, Healthy Start strives to ensure access to community-based, culturally sensitive, familycentered and comprehensive health and social services to women, infants, and their families. Healthy Start programs provide: referral and ongoing health care coordination for well-woman, prenatal, postpartum, and well-child care; supportive/enabling services including; outreach, case management, home visiting, father involvement, child development education and parenting support, linkage to housing assistance, adult education, and job training programs; and health education and support related to breastfeeding, safe sleep, perinatal mood disorders, substance use, and intimate partner violence. At the community level, Healthy Start participates in community action networks (CANs) that mobilize community residents, healthcare and social service providers, as well as other local organizations to coordinate and integrate services, and steer local action to address social determinants of health related to poor birth outcomes (National Healthy Start Association (NHSA) 2010). This Special Issue includes original research articles from Healthy Start grantees across the nation, in urban, rural, and border communities, as well as articles focusing on the program as a whole. This collection of papers showcases defining characteristics of Healthy Start, including its simultaneous focus on supporting individuals and strengthening communities, its commitment to bringing the consumer voice to efforts to improve maternal and infant health, its embrace of a community-driven systems development approach to improving local service networks, its early adoption of community health workers as part of the program team, and its use of data to guide program improvements. Healthy Start provides a forum for the community/consumer voice, actively soliciting input from the women and families served and using this information to identify service needs and gaps. The paper by Roman et al. describes the perspectives of Healthy Start participants seeking, using and navigating prenatal, postpartum and interconception * Johannie G. Escarne [email protected]