Objective: To examine international rates of preterm birth and potential associations with stillbirths and neonatal deaths at late preterm and term gestation. Design Ecological study. Setting: Canada, USA and 26 countries in Europe. Population All deliveries in 2004. Methods Information on preterm birth (<37, 32-36, 28-31 and 24-27 weeks of gestation) and perinatal deaths was obtained for 28 countries. Data sources included files and publications from Statistics Canada, the EURO-PERISTAT project and the National Center for Health Statistics.