A newborn dies every 10th second; a pregnant woman dies during labour every minute. Four of ten under-5-deaths occur the first four weeks of life. To achieve UN's fourth millennium goal on reduction of child mortality, neonatal mortality has to be markedly reduced. The article covers causes of and steps needed to reduce neonatal mortality.The article is based on literature identified through non-systematic searches in Medline, publications by WHO, UNICEF and Partnership for Maternal, Newborn & Child Health and the author's experience from neonatal medicine in Africa.Neonatal mortality has declined slowly since 1990, and many countries have no measurable progress. 99 % of the deaths occur in poor countries. More than a half of neonatal deaths occur after home delivery without a skilled birth attendant. Poor countries with poorly developed health care systems have more than a 10-fold higher neonatal mortality rate than the developed part of the world. Infections, birth asphyxia and preterm birth are the causes of death in almost 90 % of cases.Simple and inexpensive interventions before, during and after delivery may reduce mortality with more than 50 % globally. Substantial investments are needed for building health clinics that can assist during pregnancy and birth, and provide support for the neonate. Education has to be improved; at least one million new health care workers are needed to meet the challenges.