This study describes the epidemiology of injuries due to falls from horses in New Zealand. There were 54 fatalities from 1977 to 1986 (0.17 per 100,000 persons per year). There were 773 hospitalisations in 1987 (23.7 per 100,000 persons per year). Head injuries were predominant among both fatal and nonfatal injuries. The incidence of nonfatal head injury in the 10 to 19 age group was significantly higher than the incidence in all older groups (P = 0.003). Young people, particularly females, were the segment of the population most affected by the problem of falls from horses. Reference to data on horse-riding participation rates, however, did not indicate that young people were overrepresented in the series studied. Reference to the same data showed that the rate of hospitalisation due to falls from horses is comparable to the rate for injuries from playing rugby. The magnitude and severity of the problem indicates that there is a need need for helmet use, safe-riding practices, and further research.