Although numerous health care interventions have been implemented in Pakistan, the high maternal and neonatal mortality rates still remain a challenge. Developed countries have reduced maternal and neonatal mortality rates by improving the skill and knowledge levels of nurse-midwives. This paper reviews maternal and neonatal health issues, challenges in current midwifery education, and the role of government and international agencies in Pakistan. The exact maternal and neonatal mortality rates in Pakistan are unknown; a census has not occurred since 1998, and data provided in more recent studies were presented in summary format. A number of factors that contribute to the high mortality rate could easily be controlled by using competent nurse-midwives throughout all levels of the Pakistani health care system. A reduction in the maternal mortality rate is likely to occur if the Pakistan government and international agencies work together to implement specific recommendations in maternal and neonatal health. These recommendations include: 1) holding an invitational conference; 2) strengthening the existing midwifery and Lady Health Visitor curricula; 3) pilot testing an expanded midwifery program; and 4) advocating for and obtaining political commitments and resources for midwifery education.