It is estimated from community-based surveys in 1981–1982 in India that between 230,000 and 250,000 children die each year from neonatal tetanus. Hospital data from India reveal that more than 90 per cent of neonatal tetanus cases and deaths occur in the first two weeks of life. They also show that the male to female ratio of cases ranges from 1·3 to more than 10 and these cases peak in August and September. In controlling this disease, two approaches should be emphasized: (i) increasing the immunization coverage of women of childbearing age, especially pregnant women, with tetanus toxoid; and (ii) improving maternity care, especially increasing the proportion of deliveries attended by a trained person. The incidence of neonatal tetanus should serve as an index of the quality and the degree of utilization of the maternal health services, of the impact of immunization programmes and of the progress being made in developing primary health care.