This document presents an executive summary of three safe motherhood demonstration projects designed to evaluate interventions to improve essential and emergency obstetric care. The projects in Ghana and Vietnam focused on evaluating the effectiveness of training clinicians at primary and referral-level health facilities in life-saving skills to improve obstetric management. On the other hand the project in Ecuador sought to reduce the rate of unwarranted cesarean deliveries by requiring a second medical opinion. The projects were also designed to be complementary providing both overlap and independence of approaches and aimed to augment the potential to generalize the projects findings. In each study the cost effectiveness and costs associated with the project interventions were assessed in comparison to a control group. The clinical management of institutional deliveries that received appropriate treatment as the result of project intervention was assessed. The document summarizes the design methodology evaluation key results conclusions and recommendations made based on the findings.