This paper describes pregnancy outcomes and identifies their determinants in a Russian region, in the year 2000. It includes all births and perinatal deaths recorded as occurring in Tula oblast. The socio-economic correlates of adverse outcomes are explored using logistic regression; outcomes and their determinants are compared with other countries. Perinatal mortality in Tula in 2000 was 16.8/1000 births. The frequencies of low birthweight, low ponderal index and preterm birth were higher in Tula than in other industrialised countries. Mean birthweight increased with increasing education and was higher in married than in single mothers, and higher in ethnic Russians than in others. Survival in the perinatal period was substantially lower at all birthweights than in Sweden, which has the lowest neonatal mortality rate in Europe. There are wide inequalities in fetal development in Russia, especially in relation to maternal education, and the adverse outcomes appear to reflect a combination of adverse fetal development (implying the need for policies that improve the health of prospective mothers) and poor survival (implying the need for more effective care for newborn infants).