Abstract: Low-status women typically have poorer maternal and child health outcomes. In northern Nigeria, we piloted alternative models for engaging vulnerable women and facilitating an improvement in their maternal health outcomes. We assess the net impact of an integrated health system improvement model focusing on ensuring emergency obstetrical services for clusters of affiliated primary health care clinics, on the relative additional impact of alternative community engagement (CE) strategies. Analysis of baseline to endline survey data (2009- 2013) showed that proportions of women making antenatal care (ANC) visits and who delivered with a skilled birth attendant doubled. Maternal and infant mortality also declined. Greater improvements with more ANC visits and skilled birth attendance were associated with being non-poor, owning a cell-phone, being less socially excluded, being satisfied with improvements in the clinic, and participating more in CE activities. Efforts to increase participation in CE activities can further enhance outcomes for the vulnerable women. Keywords: heath systems research; community engagement; maternal and child health;