Although important gains have been made over the past two decades in child survival, progress in reducing newborn mortality (deaths in the first month of life) have lagged substantially. As a result, neonatal deaths now account for 43% of child deaths world-wide. To achieve progress toward Millennium Development Goal (MDG) 4, an organized and focused initiative must be implemented to address the global burden of newborn mortality. The leading causes of newborn mortality include complications of preterm birth, intrapartum related complications and neonatal infections. Even in the poorest nations, a high proportion of these conditions are preventable and treatable with basic, affordable, and practical solutions, particularly during childbirth and the first days after birth. Scale up of evidence-based strategies is achievable, focused on delivery of essential childbirth and newborn care and management of complications, such as the use of antenatal corticosteroids for preterm labour, resuscitation of the asphyxiated newborn, and improved care of the preterm infant including Kangaroo Mother Care and prevention and management of neonatal infections.