Non-marital births present serious social and economic issues to American communities. This study examined attitudes and behaviors of low income unmarried young parents toward paternity establishment and the role of health care professionals in promoting paternity establishment. One hundred twenty-six matched dyads of young, impoverished unmarried fathers and mothers with a child age one year or less participated in face-to-face interviews, focusing on family, peer and community influences on paternity decision making. The representative sample was derived from a metropolitan county's AFDC and paternity files in Minnesota. While less than one-third of fathers lived with the mother and child, two-thirds were present at the child's birth. Eighty-five percent of fathers acknowledged fathering the child, 80% provided care and nurturance of the baby, and 86% indicated that the father's name on the birth certificate was important. Only 29% of White fathers and 20% of African-American fathers regarded marriage to the mother as a possibility, and less than one-third sought to establish paternity through the courts. Nonetheless, 52% of White and 63% of African-American fathers had signed the Declaration of Parentage at the hospital, although presentation of the Declaration by health personnel was haphazard. Presentation of the Declaration should become standard procedure within health settings, with paternity establishment removed from the court setting and permitted through signing of the Declaration. This would capitalize on the high level of interest in paternity establishment expressed by fathers, other than through formal court procedures, around the time of the baby's birth.