The two indicators for Millennium Development Goal 5-reduction of the Maternal Mortality Ration and increased use of skilled birth attendance-reflect the present challenges for Ethiopia. With an early 1990s’ estimate of the MMR at 871, Ethiopia is unlikely to reach the MDG 5 target for 2015 of 218 given that the 2005 estimate is 673; the MMR continues to be persistently hi8gh. Over the decade prior to 2005, use of skilled birth attendance remained low at 6% the only relevant indicators with improvement in that period are the fertility decline from 6.4 to 5.4 and an increased contraceptive prevalence to 15% Barriers are many stating with geographical vastness, unavailability of transport, low women’s education, early marriage, high fertility, and gender-biased decision-making, preference for com-munity solutions to manage ill health and low availability and use of maternal health services. The paper reviews the available literature on the two MDG5 indicators. The challenges to address the goal of MDG 5- improved maternal health- remain daunting in Ethiopia.