Availability of a range of essential life-saving medical devices is central to safe and effective perinatal care. However, many medical devices which are manufactured for use in high-income countries are inappropriate, ineffective and dangerous when used in low-resource settings. Suitable, appropriate-technology devices are becoming available for a range of perinatal applications, including fetal heart rate monitoring, neonatal resuscitation and oxygen delivery and monitoring. Unless the major financial, logistical and educational challenges are overcome to ensure that suitable medical devices are made widely available, improvements in global perinatal care will be severely constrained.