Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants.

Key content Millennium Development Goal 4 (MDG4) set targets to reduce by two‐thirds the number of deaths of children aged <5 years by 2015 compared with 1990. In 2010, 7.7 million of these children died. Progress is accelerating but many countries will not meet targets. Stillbirths account for 2.65 million deaths but are not addressed in international targets. Possible solutions including ‘kangaroo mother care’, neonatal resuscitation and breastfeeding are identified; a difference can be made with basic training and resources. Political leadership is required to make significant health gains. The evidence for improving peri‐ and neonatal mortality exists. The challenge is in the implementation. Learning objectives To understand MDG4 and the variation in pregnancy outcomes for neonates globally. To increase knowledge of simple interventions and key barriers to improve peri‐ and neonatal mortality. To help UK doctors understand the health background of inward migrants. Ethical issues The increasing divide in health outcomes between rich and poor, both within and between countries. Gender inequalities may contribute to poor access to care. Resource limitations are compounded by external factors such as the ‘brain drain’ of health workers.