Ethical governance in maternal and child health institutions: a systematic review

Background Maternal and child health is a key priority under China's national goals for high-quality population development. However, rapid advances in reproductive medicine, maternal-fetal intervention, and artificial intelligence pose ethical challenges that existing governance frameworks struggle to address. Methods Literature from 2016 to 2026 was searched in PubMed, Web of Science, and Scopus. Data on ethics committee structure, research ethics review processes, ethical dilemmas, and governance innovations were independently extracted. Thematic synthesis was used to identify recurring patterns and challenges. Chinese and international evidence were analyzed separately and distinguished. Results Limited empirical evidence from Chinese institutions suggested that while ethics committees were widely established, significant gaps exist between regulatory requirements and actual implementation, particularly in follow-up research ethics review, committee capacity, and training. International evidence identifies additional governance strategies, such as competency-based training, quality assessment systems, and dynamic oversight mechanisms that may be relevant to the Chinese context. Specific ethical dilemmas in maternal-fetal medicine revealed unique governance needs, including tensions between maternal autonomy and fetal interests, and unresolved issues regarding embryo status and equitable access to fertility preservation. Conclusion This review synthesized international ethical governance principles and strategies that may inform the development of ethical governance systems in Chinese maternal and child health settings. Key strategies identified include regional ethics collaboration networks, standardized quality assessment systems, and competency-based training programs. These findings required further validation through China-specific empirical research. The review highlighted the need for strengthened empirical investigation of ethical governance practices in Chinese maternal and child health institutions. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261440509 , identifier: CRD420261440509.