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Background and Methods: We examined data from a cohort of births that occurred in the period 2004–08 in the SEWA-Rural project area, covering a population of ∼175000, in Gujarat, India, to assess the trends and risk factors for neonatal mortality.Results: In this population living in 168 villages, there has been a significant declining trend in infant and neonatal mortality, more marked in the tribal population, in whom this paralleled a rise in the proportion of women delivering in hospitals. The more important risk factors for neonatal mortality risk to emerge from multivariate analysis are low birth weight, prematurity, young age of mother, older mother and high birth order.Conclusion: Although community based interventions along with promotion of hospital birth has an impact in reducing neonatal deaths in this community, sustaining this momentum may demand more long-term policy interventions to promote better living standards and better reproductive health. [ABSTRACT FROM PUBLISHER]