newborns die during this time period each year and world-wide neonatal mortality makes up 40 % of the total child mortality [1, 2]. With an annual number of births in the world reaching 130 million this means that the overall neonatal mortality rate is about 30/1000. This is a level that has gone basically unchanged for the past fifty years, despite minor improvements [3]. In contrast to the tremendous improvements that have been achieved in overall under-5 survival this stagnant development is remarkable. The reasons why the children most at risk are left behind are not easy to comprehend. However in recent years there has been an increasing focus on the neonatal period among researchers and policy makers, calling for action [4, 5], as well as some evidence of an accelerating improvement during the past few years [6]. In order to improve child survival further, measures to reduce neonatal mortality must be taken. Causes of neonatal death Official health statistics usually refer to the causes of neonatal death simply as “neonatal causes”, without any further explanation, which could be one reason the neonatal period has not been targeted. The causes of death during the neonatal period are different compared to the causes of death later in childhood, and are to a large extent connected to the hazardous transition at delivery and the adaptation to life ex-utero. But these causes are nonetheless well defined and specific measures can be taken to avert them. In a global perspective the direct causes of neonatal deaths are infections, including tetanus and diarrhea (36 %), preterm birth (28 %), and asphyxia (or intrapartum-related causes) (23 %) (Figure 1) [1, 7, 8]. The contributing causes are numerous and have strong relationships with social structures, such as access to health care, education, and traditional beliefs. For example, half of all deaths during the first four weeks occur at home, and in subSaharan Africa 60 % of all deliveries happen without professional or trained assistance. In South Asia, the figure is even higher, with 70 % of deliveries 14 taking place at home without a midwife or similar [9]. Apart from lack of medical resources and geographical inaccessibility, there is also a reluctance to seek care when care quality is often low [10]. Strengthening and developing health services must therefore go hand in hand with education and the adequate dissemination of information to prospective parents. Another important factor affecting neonatal mortality is low birth weight (< 2500 grams), which is an underlying cause in 40-80 % of neonatal deaths. This is especially important in South Asia where the proportion of children with low birth weight in certain places is one-third [11]. Tetanus 7% Diarrhoea 3% Prematurity 27% Asphyxia 23% Other 7% Sepsis/Pneumonia 26% Malformations 7% Figure 1. Causes of neonatal death [7] Inequity in survival Another reason for the stagnant development in neonatal survival might be found in global inequity. While Sweden and the rest of the industrialized sector maintain a neonatal mortality rate of 2-3/1000, it is not uncommon that this rate reaches over 60/1000 in the poorer segments of the world [6]. Ninety-nine percent (99 %) of all children who die during the first week of life are doing so in the poorer parts of the world, especially in sub-Saharan Africa and South Asia [7]. In fact, most children die in India, accounting for nearly a third of total global neonatal mortality. This is partly due to India’s large population, but foremost a result of a lack of resources and poor dissemination of knowledge. If you were to compare this with China, which has a population in parity with India, half as many children die during the neonatal period, indicating that societal and structural factors in China play an essential role in neonatal survival. This is further emphasized by 15 calculations indicating that the cost of improving neonatal survival is modest, and that measurable mortality reductions could be achieved through implementation and scaling up of effective interventions [12]. It is a common misunderstanding that the interventions to save newborn are expensive including a need for high-tech solutions. However, history tells us that many countries in the Western world achieved a reduction in neonatal mortality rate down to 15/1000 long before the advent of today’s specialized care [13, 14]. Moreover, one can now see examples of countries, such as Vietnam, Nicaragua and Moldova, which show that a country's GDP is not always correlated with the neonatal mortality [4]. That almost 4 million newborn children die every year constitutes an enormous mental and social trauma for the families affected. Morally, it is of course totally unacceptable when adequate interventions are known and applicable, however, neonatal death also represents a great problem socioeconomically. In one respect, it is considered as a waste of resources; on the other hand, the uncertainty within the area of reproductive health to address neonatal death as a serious issue creates a reluctance to invest emotionally and economically in the newborn. Winch and co-workers who have studied the problem from a social-anthropological perspective in Bangladesh point to the fact that there is a great deal of fatalism involved when it comes to the health and survival of the newborn, both among