For nearly 15 years, the targets of the Millennium Development Goals (MDGs) have been a bellwether for progress, particularly for maternal and child health (MCH)—a two-thirds reduction in under-five mortality in MDG 4 and a three-quarters reduction in the maternal mortality ratio in MDG 5. After more than a decade of effort, these goals have proved difficult to attain and are unlikely to be achieved by 2015.

Interventions that may improve maternal and child health are numerous and spread across many development sectors. Even when such interventions are known to be effective in controlled conditions, however, questions remain about implementation, delivery, and uptake. This review gathers impact evaluation evidence of fielded interventions that aim to improve skilled birth attendance and reduce maternal and child mortality rates. To aid policy makers, it reviews effectiveness evidence from multiple sectors on the distal causes of maternal and child mortality, complementing the body of effectiveness evidence from reviews specific to the health sector (such as the Lancet series on maternal and child health) that focus on proximate interventions for intermediate outcomes.

This systematic review by the Independent Evaluation Group (IEG) is a learning exercise that looks beyond World Bank experience. In doing so, it draws on impact evaluations other than those conducted by the Bank or on Bank projects. It is intended to be used a reference for practitioners in the Bank and elsewhere with an interest in interventions that have demonstrated attributable improvements in skilled birth attendance and reductions in maternal and child mortality. This review also identifies important gaps in the impact evaluation evidence for interventions that may be effective in reducing maternal and child mortality but whose impacts have not yet been tested using robust impact evaluation methods.

Download the database of the AAA, AA and A-graded studies, prepared for the report