OBJECTIVES. Reduced options for fertility control over the past decade have increased the rates of unwanted pregnancy. We evaluated whether a woman's negative attitude toward her pregnancy increased the risk of perinatal mortality, in a large, prospective cohort study. METHODS. The association between attitude toward the pregnancy and perinatal mortality was evaluated in a longitudinal cohort study of 8823 married, pregnant patients enrolled from 1959 to 1966 in the Child Health and Development Studies. RESULTS. Women who reported during the first trimester of prenatal care that the pregnancy was unwanted were more than two times more likely to deliver infants who died within the first 28 days of life than were women reporting accepted pregnancies. A positive attitude toward pregnancy was not associated with fetal death or post-neonatal death. CONCLUSIONS. These data, collected when induced abortions were illegal, may have important implications for the 1990s. If maternal attitude toward the pregnancy is associated with neonatal mortality and abortion laws change such that access is restricted, infant mortality may increase because a greater proportion of births will be unwanted.