To examine trends in incidence of multiple births (MB) and their survival in infancy, we used population-based, longitudinal data derived from the Health and Demographic Surveillance System in Matlab, Bangladesh, from 1975 to 2002. Logistic regression was applied to determine the impact of a number of variables on mortality among MB in the first year of life. MB averaged 2% of all live births, but contributed 10% to all infant deaths. Infant mortality among MB was more than five times higher than among singletons. Mortality among MB declined by 27% in 1975-2002, considerably less than the 51% mortality decline among singletons in the same period. Infant mortality among twins and triplets was particularly high among children who were born to young mothers (<20 years), who were the first live birth, who were born after a short birth interval (<24 months) and whose mothers were unschooled. Mortality of MB was lower in the area with easy access to high-quality maternal and child-care services. Thus, good maternity and newborn care will improve the survival of MB.