How did the goal, targets and indicators for Millennium Development Goal 5 (improve maternal health) impact on development practice and discourse? This paper places what happened to MDG 5, and sexual and reproductive health and rights more broadly, into the context of the development model that was encoded in the MDGs. It argues that not only did the MDGs reduce the broad sexual and reproductive health and rights agenda to the relatively depoliticized domain of maternal health but that they caused a shift away from the development discourse of the 1990s which advocated for social change and shifts in power relations. Many issues that transcend health sector interventions, such as gender-based violence, were left off the agenda and pushed to the periphery of global discourse. The paper also argues that as the MDG targets focused on aggregate advances, rather than disparities, equity concerns were overlooked. Furthermore the structure of the MDGs encouraged the placing of women’s roles as child-bearers and caretakers at the centre of the agenda rather than their empowerment as independent social citizens with rights. In looking forward, the new development framework should include a strong narrative of social transformation. The process of setting targets and indicators should be recognised as far from neutral and should not be permitted to overtake or restrict the broader aims of advancing social, political, and gender justice.