Sir: Of the estimated 130 million infants born each year worldwide, four million die in the first 28 days of life. Three quarters of neonatal deaths occur in the first week, and more than one quarter occur in the first 24 hours. Neonatal deaths account for 40 percent of deaths under the age of five years worldwide. Two thirds of the world’s neonatal deaths occur in just 10 countries, mostly in Asia. Unfortunately, Pakistan is number three among these countries. There are three topmost causes for this mortality: prematurity, birth asphyxia and infections. Prematurity (when the baby is born before term, which is 37 weeks) accounts for about 26 percent of the deaths of infants, hence it is at the top among the three causes. There are many health-related and social issues that lead to the delivery of a premature baby. For example, mothers being unable to get proper antenatal care including regular checkups, nutrition guidance, early age at pregnancy, chronic illness, etc. Malnutrition is amongst the most common problems in the rural areas of Pakistan, resulting in the birth of infants with depressed immune systems and immaturity of all the major organs of the body, e.g. lungs, progressing to respiratory distress and, ultimately, death. The second most common problem in our set up is birth asphyxia, which is the lack of oxygen due to failure of initiation of breathing. This accounts for approximately 25 percent of deaths of infants. This is usually related to prematurity, low birth weight and improper delivery techniques. More than 65 percent of women in Pakistan deliver their babies at home, mostly assisted by untrained traditional birth attendants or ‘dais’ (midwives), with increased risk of birth complications, especially in the rural areas of Pakistan. Infections, the third common cause, account for 23 percent of deaths of infants. Infections mostly occur in premature infants, low birth weight infants, infected deliveries, etc. The neonatal mortality rate in Pakistan is 49 per 1,000 live births in reported cases (2012). It is high time to seek out where the fault lies. We must find out what steps must be taken to prevent this incredible loss. Health is a basic human right and the government should accept this as a priority. The government should formulate and implement an effective patient-friendly health policy to improve the overall health situation in Pakistan. All political parties must include health issues in their manifestoes with clear commitment in this regard. The allocated budget of health should be increased and all basic health facilities, including dispensaries, must be made functional. Guidelines for antenatal and maternal care should be given to every pregnant woman. Lady doctors (gynaecologists) should be available round the clock and provided with all essential facilities for deliveries. Health education of the people, particularly belonging to the rural areas, should be promoted in the entire country so that the people are able to adopt healthy behaviour and are able to avail the best choices for the betterment of their families. DR SAQIB RAZA Hyderabad