Worldwide, all countries are committed to “elimination” of maternal and neonatal tetanus (MNT), i.e. a reduction of neonatal tetanus incidence to below one case per 1000 live births per year in every district. All women of of childbearing age, either during pregnancy or outside of pregnancy, should be vaccinated against tetanus to protect themselves and their newborn babies. Neonatal tetanus is almost always fatal and is completely preventable by ensuring that pregnant women are protected through vaccination. Benefits of vaccinating pregnant women usually outweigh potential risks when the likelihood of disease exposure is high, when infection would pose a risk to the mother or fetus, and when the vaccine is unlikely to cause harm. This should be assessed on a case-by-case basis.