Reducing the burden of poor maternal, neonatal, and child health ill-health requires improvements in both the supply and use of effective maternal, newborn and child health (MNCH) services. The financial costs of treatment are known globally to be a major barrier to accessing essential care, potentially imposing considerable burdens on households. To find out what was known about the scale and impact on families of out-of-pocket expenditures in accessing MNCH care in the Asia-Pacific region, this study undertook a systematic review of the global and regional evidence. The findings show that despite significant progress in improving coverage in the region, millions of families in the region continue to face financial barriers to accessing essential MNCH care, and experience significant financial hardships as a result of out-of-pocket payments. It points to areas where the research needs to be improved both methodologically and in terms of geographical coverage, and where better policies might make a difference.