The maternal mortality ratio in Pakistan remains high at between 350 and 500 per 100 000 live births, while the neonatal mortality ratio is 50 per 1000 live births. This paper examines the trends in maternal and neonatal mortality in Pakistanand looks at why slow progress has been made in attempts to achieve safe motherhood. Despite numerous initiatives, it is uncertain whether Pakistan will achieve Millennium Development Goals 4 and 5 by 2015.