Currently, in Mexico City, 57% of deaths from traffic crashes are pedestrian injuries. The purpose of this study was to identify and analyse the magnitude, trends, risks, and geographic distribution of fatal pedestrian injuries during the period 1994-1997. A cross-sectional study design was used, based on the death certificates of persons who were in Mexico City during 1994-1997 and died due to pedestrian injuries. Mortality rates, trend analysis, standard mortality ratios (SMRs), and potential years of life lost index (PYLLI) were calculated by gender, age groups and region (these correspond to "delegations", which are political divisions of the city). Rates were derived according to place of occurrence and place of residence. A total of 3687 pedestrian fatalities were reported, and 71% of these were to Mexico City residents. The rate for males was 10.6/100000 with a slight decrease in rate from 1994 to 1997. For females, the rate was 4.0/100000, with an increase in rate during the same years. The present study allowed identification of the target population as well as regions with a high risk of fatal pedestrian injuries. From these data we have developed or recommended specific interventions for prevention and control of fatal pedestrian injuries in Mexico City.