Background: Low Birthweight (LBW) is a significant risk factor for neonatal mortality globally. LBW neonates have a higher risk of death from illness and complications compared to normal weight newborns. This paper examined the perceptions and management of low-birth-weight newborns in two large urban slums in the southern part of Ghana. Methods: The data used for this paper comes from a concurrent mixed methods cross sectional study conducted in (Ashaiman and Sodom and Gomorrah) in Accra, Ghana. The quantitative survey was conducted among 279 randomly sampled mothers aged 15-49 years with live neonates 0 - 28 days old. Focus group discussions (14) and In-depth interviews (13) were conducted with women of reproductive age with live newborns aged 0-28 days, slum based traditional birth attendants, care givers, community leaders and public health managers who were purposively sampled. Descriptive analyses was conducted to describe care practices for low birthweight newborns. Bivariate and multiple logistic regression analyses were used to assess factors associated with health seeking for low birthweight at a 95% confidence level. Qualitative interviews were tape-recorded, transcribed, coded, and analysed thematically. Results: Prevalence of low birth weight in the slums was high at 30%. Generally 2.5% of the babies were very large, 9.7% were larger than average and 77.8% were of average weight. About 9% were smaller than average while 1.1% were very small. The median weight at birth was lower for Sodom and Gomorrah at 2.9 (2.5,3.2), than Ashaiman 3.0 (2.6,3.2). Perceptions of small for gestational age and low birthweight babies were varied. While some believed the babies were cursed, others said their mothers were promiscuous, either attempted an abortion or ate foods that were prohibited during pregnancy. Yet, others perceived them to be possessed with evil spirits an must be exorcised. In a binary logistic regression, mothers with no ANC visits (COR: 9.82, 95% CI: 4.24-22.73, p<0.001), and those who had attained between 1-4 ANC visits (COR: 5.61, 95% CI: 2.94-10.72, p<0.001), were significantly more likely to give birth to babies with low birth weight compared to those mothers who made 4 or more ANC visits. Again, mothers who did not receive iron folate supplementation during pregnancy were two times significantly more likely to give birth to low-birth-weight babies (AOR: 2.39, 95% CI: 1.01-5.63, p<0.05), compared to mothers who received iron folate tablets. Similarly, mothers who were not counselled on newborn danger signs during pregnancy were 2.9 times significantly more likely to give birth to low-birth-weight babies (COR: 2.87, 95% CI: 1.64-5.03, p<0.001) compared to those who were counselled on newborn danger signs. Conclusion: Prevalence of low birthweight (roughly 30.5%) was high in the slums. Interestingly, none of these newborns received prolonged skin-to-skin care. Addressing low birth weight in Ghana’s urban slums requires strengthening ANC services and improved counselling during ANC services and home visits.