A cohort of 356 live births (LBs) in 12 villages in Pondicherry during 1988 was followed from birth to age 5 years to determine the impact of maternal and child health (MCH) services upon child survival in a low income, rural community. 54% of the children were from families living in poverty. All mothers of the cohort were registered antenatally and immunized against tetanus, and more than 98% of the children had been immunized with BCG, DPT (3 doses), and OPV (3 doses). 82% of the children were immunized against measles. The infant mortality rate declined from 201/1000 LBs in 1967 to 64/1000 in 1989, while the child death rate decreased from 29.4/1000 children aged 1-4 years in 1970 to 18/1000 in 1992. No death occurred due to neonatal tetanus or measles. Levels of neonatal and post-neonatal mortality were 35/1000 LBs and 29/1000, respectively. 58% of the neonatal deaths were due to non-infective causes such as prematurity, birth asphyxia, birth injuries, and congenital anomalies, while 80% of post-neonatal deaths were due to infections. The child survival index was 91.27%. These findings demonstrate how the provision of good MCH services can improve child survival in low income populations.