Louisiana ranks forty-ninth nationally in birth outcomes indicators such as infant mortality and in the percentage of low birth weight and very low birth weight babies. This article describes the formation of the Birth Outcomes Initiative, a statewide targeted investment to reduce poor birth outcomes. It describes how the initiative is a result of the convergence of the triad of well-defined problems, a credible array of potential solutions, and favorable political process. It then describes the Birth Outcomes Initiative in Louisiana, a targeted program to improve health indicators for reproductive-aged women and reduce the incidence of prematurity, low birth weight, and infant mortality.