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The death of a newborn child has always been tragic to the mother, her family, health care providers and a concern in clinical practice. Neonatal mortality (NM) remains a challenge worldwide, particularly in developing countries. A need to understand contributing factors to NM is crucial for addressing appropriate mother and child health. Nurses are in close contact with mothers during pregnancy, intra-partum and during postpartum periods; hence their perceptions regarding factors contributing to NM are significant. The purpose of this study was to explore and describe perceptions of midwives regarding factors contributing to NM in a district hospital, Hammanskraal, South Africa. A qualitative, exploratory and descriptive design was used. Ten midwives working in labour and neonatal units were interviewed. Purposive sampling was used to select participants for the study. The findings revealed that midwives perceived patient factors, obstetric complications, mother’s condition in relation to pregnancy, lack of resources and organisational factors as contributing to NM. The findings of this study will assist the district hospital in planning for women and child care in an effort to reduce NM.