The United States was so strong that they held swim-offs to determine who would swim in the final. The Soviet team posted the fastest time heat one with the Americans leading heat two with their B team. The final started with Cathy Ferguson, 100 metre backstroke gold medalist, taking a small lead over Japan's Satoko Tanaka. On the breaststroke leg, Soviet Svetlana Babanina put them into the lead by inches, but Sharon Stouder swam the third butterfly leg for the US and opened a 2½-bodylength lead. Kathy Ellis had no trouble maintaining it on the anchor as the USA won the gold medal in the world record time of 4:33.9. The Soviets could not maintain their position on the final two legs, as Ada Kok put the Netherlands into second on the third leg, and Erica Terpstra brought it home for them to win silver, the Soviet Union holding onto the bronze medal.
World Rekord: United States (Cathy Ferguson, Cynthia Goyette, Martha Randall, Kathleen Ellis) 4:34.6 Los Angeles, United States 28th September 1964
Olympic Rekord: United States (Lynn Burke 1:09.0, Patty Kempner 1:20.9, Carolyn Schuler 1:08.9, Chris von Saltza 1:02.3) 4:41.4 Rome, Italy 2nd September 1960