For many countries which currently have poor levels of access to maternal health services reaching the target of 80 % coverage, even at national level, will be challenging. For other countries this target is not challenging enough and the target of true universal coverage – 100 % for all groups – should be set in order to drive access forward further. It has been shown that in many countries with good overall national coverage the poor and the rural residents are still left behind. Ensuring universal coverage is achieved for the poorest and those living in rural areas is a challenge that will require sustained commitment from Governments, donors and international policy makers, although there is little evidence about the best ways to do this. Lessons must be carefully gathered, learnt and disseminated from countries that have made fast and equitable progress in order to effectively focus efforts and resources. The 80 % target overall is a positive step to drive the UHC agenda, but needs to be carefully managed and measured in order that progress with equity across all groups is achieved.