Background: Neonatal mortality rate (NMR) is very high in Afghanistan. It is ranked as the fifth highest NMR in world. There is limited information about the immediate causes and underlying factors for high neonatal mortality. Objectives: The objectives of this study is to explore the causes of neonatal mortality, describe the strengths and limitation of neonatal health care system and provide practical solutions to reduce neonatal mortality in Afghanistan. Method: It is a descriptive study based on literature review. Findings: The main immediate causes of neonatal mortality in Afghanistan are preterm birth (35%), intrapartum related complications causing asphyxia (26%), pneumonia (15%) and sepsis/meningitis/tetanus (16%). Various underlying factors contribute to neonatal mortality such as lack of access of people to MNH information and low attendance rate to formal education, the existence of sociocultural harmful practices against women and neonates and poor health seeking behaviour among households and communities. Shortage of professional health providers e.g. SBAs, distance to health facilities, disparity in distribution of health services are among main factors that limit access to health services. Low quality of MNH services reflects the inadequate performance of health system. Poverty, insecurity, sociocultural norms (e.g. violence against women and gender disparity) and religion are considered the basic causative factors. Conclusion: Neonates are the most vulnerable population in Afghanistan. Policies alone cannot bring changes until they are implemented. Strong advocacy is needed to encourage the Afghan MoPH to formulate, implement and monitor appropriate, evidence-based policies on neonatal health.