Objectives To describe specific causes of the high rates of stillbirth, neonatal death and early child childhood death in Zambia. Methods We conducted a household-based survey in rural Zambia. Socio-demographic and delivery characteristics were recorded, alongside a maternal HIV test. Verbal autopsy questionnaires were administered to elicit mortality-related information and independently reviewed by three experienced paediatricians who assigned a cause and contributing factor to death. For this secondary analysis, deaths were categorized into: stillbirths (foetal death ≥28weeks of gestation), neonatal deaths (≤28days) and early childhood deaths (>28days to <2years). Results Among 1679 households, information was collected on 148 deaths: 34% stillbirths, 26% neonatal and 40% early childhood deaths. Leading identifiable causes of stillbirth were intrauterine infection (26%) and birth asphyxia (18%). Of 32 neonatal deaths, 38 (84%) occurred within the first week of life, primarily because of infections (37%) and prematurity (34%). The majority of early childhood deaths were caused by suspected bacterial infections (82%). HIV prevalence was significantly higher in mothers who reported an early childhood death (44%) than mothers who did not (17%; P<0.01). Factors significantly associated with mortality were lower socio-economic status (P<0.01), inadequate water or sanitation facilities (P<0.01), home delivery (P=0.04) and absence of a trained delivery attendant (P<0.01). Conclusion We provide community-level data about the causes of death among children under 2years of age. Infectious etiologies for mortality ranked highest. At a public health level, such information may have an important role in guiding prevention and treatment strategies to address perinatal and early childhood mortality. © 2011 Blackwell Publishing Ltd.