In a hospital-based case control study (108 and 285 infants) on risk factors for early neonatal death in Nicaragua, an analysis was performed on the possible association with characteristics of the mother and her environment, her reproductive history and contact with antenatal services as well as characteristics of the child. Antenatal medical supervision was associated with a lower risk for neonatal death, even when adjusting for parents’ literacy. This association disappeared if birth weight or gestational age was entered into the analysis. There was an interaction between mortality and the mother’s versus the father’s literacy, showing the highest risk if the mother was illiterate and the fater was literate (odds ratio, OR 7.0, CI 2.6–19.3), while illiteracy of both parents was associated to a lower risk (OR 4.2, CI 1.0–18.3). The strong association between maternal literacy and early neonatal death is striking. Is maternal empowerment the important factor?