Congenital anomalies, or structural birth defects, constitute a significant component of the knowledge base and technical expertise of surgeons and anesthetists in all the subspecialties of pediatric surgery. The reality is that such sub-specialty expertise is severely under-represented in lower and middle income countries (LMIC's) where more than 90% of all babies with birth defects are born and where access to even the most basic evaluation and surgical treatment services may be limited.1 Birth defects account for almost 9% of all under-5 mortality, worldwide2 and those who survive often face a life of disability, stigma, isolation and even physical abuse. The resulting impact on the lives of children and families from premature death or lifetime disability can be profound. What can be done to bring equity in access to care and treatment to ensure that all children born with a birth defect, anywhere in the world, can reach their maximum health and life potential? What are the barriers to equitable care, and are there examples of potential solutions? The aim of this paper is to provide a discussion of the challenges posed by these questions followed by examples of models and coalitions that are improving access to diagnosis and care globally.