The role WHO plays as an actor in maternal health is a complex one. Now that some insight as to how WHO functions in relation to maternal health has been gained it is possible to assess how effective it has been. Assessing the effectiveness of WHO in the area of maternal health is not as easy as it may first appear. This is the case for a number of reasons. First is the question of exactly how to measure the effectiveness of WHO. Should WHO’s effectiveness be measured against the MDGs, against the WHO constitution or against the functions outlined in Eleventh General Programme of Work 2006-2015? Second is the question of which level any assessment should focus on. Should assessment of WHO’s effectiveness be focused on the international, regional or national levels or should any accurate assessment of WHO’s functionality take in all three? Complicating the situation further is the fact that WHO itself admits that acquiring accurate data in relation to maternal morbidity and mortality is difficult[75], though the acquisition of data is improving[76] it is still the case that any judgment passed on WHO’s effectiveness as an actor has the potential to be grossly inaccurate. This paper will assess WHO’s performance in relation to maternal health using two frameworks. These frameworks will both focus on WHO at an international level. The reason for this is simple, as a scholar of international relations the international level is the most relevant. One framework will focus on the MDGs and the other will focus on WHO’s Eleventh General Programme of Work 2006-2015 and the functions WHO has defined for itself in this report. These two approaches whilst by no means exhaustive serve to illustrate the difficulties in accurately assessing the performance of an organization as multidimensional as WHO. WHO, Maternal Health and the Achievement of the MDGs Assessing WHO’s performance using the achievement of the MDG 5 targets discussed above as a benchmark does not paint a pretty picture. Put bluntly WHO will fail to achieve these targets. Data published in 2005 indicates that few low and middle income countries will achieve the 75 percent reduction in the maternal mortality ratio that the first target of MDG 5 demands[77]. Worse still, the African region has gone backwards with the maternal mortality ratio widening from 870 deaths per 100,000 live births in 1990 to 1,000 deaths per 100,000 live births in 2001[78]. However there is still cause for cautious optimism. Though, at a regional level, none of the regions have achieved the yearly percentage decline in the maternal mortality ratio required to achieve the 75 percent target, some, most notably East Asia are close to doing so[79]. Moreover the global maternal mortality ratio is slowly declining[80]. Another point of progress is the increase in number of births attended by a skilled assistant with the percentage of births attended worldwide increasing by 14 percent in the 16 year period from 1990 to 2006. Data related to the second MDG target of achieving universal reproductive health and its indicators is far more difficult to come by which in itself suggests that it is unlikely that this target will be met. The available data indicates that some progress has been made particularly in the area of access to and use of contraception however this progress is patchy at both the international level and within states[81]. Progress in this area, especially within states is tightly linked to socio-economic status and other markers of development[82]. As noted above it is difficult, if not impossible to assess progress towards the achievement of any one of the eight MDGs in isolation. Progress or lack thereof in achieving any one of the eight goals has effects on progression towards achieving the others. This is especially true of MDG 5. Perhaps more than any of the other goals the achievement of MDG 5 will require progress towards achieving at least some of the targets and indicators of almost every other MDG. This is because the improvement of maternal health is so closely interlinked with other aspects of development. The eradication of extreme poverty and hunger will mean that women’s bodies will be better able to tolerate the physiological stress that even uncomplicated pregnancy causes[83]. Improved education and gender equality will result in fewer pregnancies in the very young and fewer unwanted pregnancies among women of all ages[84]. Uncontrolled HIV/AIDS, Malaria and other infectious diseases are in large part responsible for the increasing maternity mortality ratios in Africa[85] as such it stands to reason that combating these diseases will result in a fall in the maternal mortality ratio in the region. It also stands to reason that the development of global partnerships for development will undoubtedly have positive consequences for maternal health.