What do we want to know and why?
There is international consensus that international aid should adhere to a set of principles that encompass: ownership, with developing countries setting their own development strategies; alignment of external support with internal development strategies and local delivery systems; harmonisation of activities undertaken by donor countries and organisations; managing for results by focusing on producing and measuring results; and mutual accountability, where donors and developing countries are accountable for development results. These principles form the basis of the Paris Declaration on Aid Effectiveness, adopted in 2005.
One of the Millennium Development Goals (MDGs) focuses on improving maternal and reproductive health, with internationally agreed targets for 2015. This raises the question of whether delivering aid in line with the Paris Principles is effective in moving towards the 2015 targets; and how this compares with aid delivered in other ways.
What did we find?
No studies could be found that compared different types of international aid for maternal health. There is a small literature source of studies that evaluate health service interventions supported by international aid and which explicitly describe how the aid was delivered. This literature includes: quasi-experimental studies used to test a causal hypothesis (causal studies); observational studies which test an association between the intervention and the outcome recorded (correlation studies); and qualitative or descriptive studies which presented possible associations between aid and outcomes (process studies).
This small literature found moderate and poor quality evidence of the effects of some aid supported interventions on better outcomes in maternal health: lower maternal mortality; more attended births; greater contraceptive use; better antenatal care coverage; and greater use of family planning.
No clear difference can be seen between the effects of interventions supported by aid aligned with the Paris Principles and the effects of interventions supported by aid not clearly aligned with the Paris Principles.
This lack of a clear difference arises because the studies were of moderate or poor quality for assessing impact, often with poor reporting of the details of international aid; and a complete lack of studies that directly compare the effects of maternal health service interventions delivered using different aid methods.
What are the implications?
There is no existing research which allows us to distinguish between aid delivered in line with the Paris Principles, and other aid, in terms of its impact on maternal and reproductive health.
How did we get these results?
A systematic search found two causal and eight correlation studies of the impact of maternal health service interventions delivered using aid which conformed with the Paris aid effectiveness principles; and nine causal and 11 correlation studies of the impact of interventions delivered using aid without clear alignment with the Paris Principles. The quality of each study was assessed, and the findings reported in a synthesis structured by Millennium Development 5 indicators.
The EPPI-Centre reference number for this report is 1916.
This report should be cited as: Hayman R, Taylor EM, Crawford F, Jeffery P, Smith J (2011) 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. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.