The Millennium Development Goal 5 (MDG 5) aims to improve maternal and reproductive health outcomes by: (a) reducing the maternal mortality ratio by 75%; and (b) achieving universal access to reproductive healthcare, by 2015. Current estimates suggest that only 23 countries out of 181 are likely to reduce maternal mortality by 75%. The adoption of the Paris Declaration on Aid Effectiveness in 2005 represented a global agenda to improve aid management and delivery, partly in order to address the slow progress towards the MDGs. In 2008, the Principles set out in the Paris Declaration to guide changes in international aid were re-affirmed in the Accra Agenda for Action.
Methods and Results
The review involved a comprehensive search of the literature to identify studies that met specific criteria. The studies had to address maternal and reproductive health in developing countries, had to concern activities funded by international aid, and had to provide evidence of the impact of the aid on maternal and reproductive health. By using broad criteria on the MDG 5 indicators and broad definitions of aid we made the review as inclusive as possible. An initial yield of 209 reports was screened using clearly defined inclusion and exclusion criteria to produce a total of 30 causal and correlation studies for synthesis and analysis. The review identified discernible gaps in the evidence base about the impact of aid on MDG 5, which are of concern if these targets are to be met by 2015. The studies suggest that aid-funded health care interventions, whether delivered using the Paris Principles or not, might be associated with better health outcomes. However, these findings should be interpreted with caution due to methodological limitations associated with the study designs. The data do not allow for a meaningful comparison of outcomes between aid delivered according to the Paris Principles and aid delivered outside this framework.
Conclusions and Recommendations
- On systematic reviews and research methodology:
There was considerable variation in the design and objectives of the studies included. Impact evaluation literature asserts that studies based on experimental design (e.g. randomised control trials) present the most plausible evidence of impact. A more flexible approach to evaluating the impact of aid is required in order to capture contextual factors affecting how aid works.
- On evaluating on aid effectiveness:
Future primary studies seeking to explore the impact of aid on outcomes in specific sectors need to provide full information about the aid intervention. Likewise studies on aid effectiveness and aid modalities need to go further in providing robust data for evaluating outcomes.
- On interventions in maternal and reproductive health:
Before claims about cause and effect can be made, we need robust baseline data to couple with later data. Most of the studies reviewed had a strong emphasis on healthcare interventions. Other factors that affect maternal and reproductive health, such as gender politics, income and class are neglected by robust research, which if undertaken, could add significant insight into our understanding of the interactions that shape maternal and reproductive health in developing countries and consequently our efforts to improve outcomes and assess our interventions.
Hayman, R.; Taylor, E. M.; Crawford, F.; Jeffery, P.; Smith, J.; Harper, I. The impact of aid on maternal and reproductive health. A systematic review to evaluate the effect of aid on the outcomes of Millennium Development Goal 5. EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK (2011) 165 pp. ISBN 978-1-907345-23-4