Objective This study examined the differences in neonatal mortality rates between urban and rural areas in China.

Methods and Results Data were taken from a database collected by the Chinese surveillance network for mortality of children under 5 years of age. The risk ratio of neonatal mortality for rural versus urban areas was between 2.2 and 2.7 for 1996–2006 and it declined to 2.0 in 2005–6. Pneumonia, birth asphyxia and preterm birth or low birth weight were the major contributors to the urban–rural differences in neonatal mortality, together with a relatively high proportion of home delivery and a relatively lower proportion of hospital treatment in rural areas.

Conclusion The urban–rural differences reflect the gap between the developed and the underdeveloped regions in China at that period. The neonatal mortality rate in China's rural areas could decrease further if continuous efforts are successful to increase the rates of hospital delivery in rural areas.