The World Health Organization estimates that globally over 9 million infants die annually either before birth or in the first few weeks after birth. The majority of these deaths occur due to complications of pregnancy or child birth. Despite these enormous losses, perinatal care has been largely neglected in national health policy considerations in the developing world and this paper explores this important public health issues in a developing country. Perinatal morbidity and mortality in Pakistan remains high and largely unexplored. This study undertook a comprehensive analysis of perinatal health in Pakistan, by defining the burden of perinatal health problems; using qualitative methods to identify barriers to an appropriate health systems response; and developing a justification for the inclusion of perinatal health interventions within the Pakistani health system. The lack of knowledge about perinatal health issues and misperceptions as to the scope and nature of perinatal interventions amongst policy and decision makers revealed a major reason for the lack of specific attention to this public health issue. On the other hand community perceptions clearly link perinatal outcome and health of the newborn with maternal health, but are also cognizant of the poor quality care for both in the public sector. There is little evidence that the current health delivery infrastructure and policy framework is addressing perinatal health problems.