The perinatal mortality rate of 63–92/1000 births as reported from two provinces of Pakistan is unacceptably high. A vast majority of births and neonatal deaths occur at home and remain unregistered. In spite of a number of child survival programmes of proven efficacy in place, the impact on perinatal health is poor.

Conclusion: Initiatives such as behaviour change communication, skill-based training of birth attendants and reaching the un-reached may be the key future strategies to reduce perinatal losses.