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CHILD SURVIVAL ACTION NEWS. 1988 Apr; (9):1-2.Present thinking regarding the control of neonatal tetanus (NT) suggests that the accepted protocol in the past, i.e., immunizing pregnant women with tetanus toxoid (TT) during antenatal care, is not sufficient in countries where antenatal care may be unavailable. Current control strategies, experts, and official World Health Organization (WHO) recommendations now indicate that efforts should reach beyond immunization of pregnant women and the training of traditional birth attendants in hygienic cord care practice to immunization of all women of childbearing age. Babies continue to die form NT because it is so difficult to reach women during pregnancy for immunization. Lack of commitment to expanding immunization programs as Who recommends stems in part from failure at both national and local levels to acknowledge the extent of the neonatal tetanus problem. NT is vastly underreported for several reasons: cultural practices often include the seclusion of women and their babies during the period after birth; people in developing countries have a fatalistic attitude because so many children die within the 1st year of life; newborns are rarely taken to health centers for treatment; health workers may fail to report NT for fear that their superiors will blame them for failure to immunize or for poor care of the umbilical cord; Western medicine and research has a curative rather than a preventive focus; and gathering information on NT by asking mothers to recall deaths of newborns with symptoms of NT is difficult because many women are ashamed or otherwise unwilling to report the event. The WHO believes that conventional reporting systems in developing countries identify only 2-4% of actual NT cases. Without sound documentation of the problem, it is difficult to gain financial and political commitment to eradicating NT. The VIII International Conference on Tetanus that occurred in Leningrad during 1987 outlined WHO's recommendation for a mixed strategy to control and eliminate tetanus: immunize all women of childbearing age, with special emphasis on pregnant women and women known to belong to high risk groups; assure hygienic delivery and umbilical care through training and supervision of birth attendants; and investigate cases to determine what action could have prevented them.