This IDEAS study of interactions between families and frontline workers and coverage of critical interventions for mothers and newborns was conducted between May-June 2012 and May-June 2015 across four regions of Ethiopia. The aim was to estimate changes in maternal and newborn health care in areas where implementation projects funded by the Bill & Melinda Gates Foundation were operating. In 2012 the study methods were defined to include a sub-set of areas where the Last Ten Kilometers (L10K) project was operating, run by John Snow Incorporated. Over the last two decades maternal, newborn and child survival has improved from very high levels of mortality. The maternal mortality ratio declined from an estimated 1,400 maternal deaths per 100,000 live births in 1990 to 420/100,000 in 2014, although this falls short of the 2015 target of 350/100,000. Child mortality rates declined from 204 child deaths per 1,000 live births in 1990 to 59/1,000 in 2015, meeting 2015 targets. And neonatal mortality declined from 61 deaths in the first 28 days of life per 1,000 live births in 1990 to 28/1,000 in 2015. The country has set ambitious goals to build on these gains even further. Key Messages -While improvements are still needed, access to antenatal and intrapartum health care has increased on a large scale in Ethiopia. Simultaneously, there have been improvements in the readiness of the health system to provide quality care – The data collection period coincided with a period of remarkable activity in the Ethiopian health system with government led health system strengthening being implemented throughout the country – Across the continuum of care we observe large gains in coverage of life saving interventions being made amongst the most poor women, with coverage among all sub-groups increasing – Yet, coverage of postnatal checks for the mother and the newborn remain extremely low and represent a problem needing urgent attention.