Only recently adequate attention has been given to the state of neonatal health in developing countries.Out of approximately 10.6 million children under five who die each year worldwide, close to 4 million are newborn infants. Almost the same number of pregnancies (3.2 million) results in a stillbirth. More than 98% of these deaths take place in developing countries. The main reasons for neonatal deaths worldwide are infections (36%), prematurity/LBWA
(28%) and birth asphyxia (23%). The higher the NMR, the higher is the overall proportion of these three main causes within the number of neonatal deaths. 50% occur on the first day, 75% during the first week of life. Within the group of stillbirths, almost 1 million occur at the time of delivery, and about the same number of neonatal deaths is related to hypoxemic events during delivery. Black and colleagues showed that the relative proportion of neonatal deaths increases as U5MR decreases. Over the last decades, neonatal mortality has not decreased to the same extent as infant or under-five mortality. These findings indicate that current maternal and child health programs have not focussed enough on the neonate. This is a public and individual health tragedy as many effective interventions are known and available at low cost which could prevent up to 65 percent of neonatal deaths in developing countries. Several authors convincingly argue that MDG 4, the reduction of U5MR by two thirds between 1990 and 2015, will not be achievable if NMR will not be reduced significantly worldwide.Tanzania is one of the severely affected countries. Due to its large number of births (among the 20 countries with the highest absolute numbers) and a NMR of 32/1000, it is among the 20 countries with the highest absolute numbers of neonatal deaths. In addition, almost the same number of pregnancies leads to stillbirths, resulting in a PMR of 42/1000.Thus there is enough reason to analyze the medical and structural causes, including risk factors, underlying cultural, socioeconomic issues and health systems aspects, of neonatal deaths
and stillbirths, and to look at the strategies which Tanzania is about to implement as effective interventions on the population level to reduce perinatal and neonatal mortality significantly. This essay is an attempt to do so.