Household coping strategies during maternal and child health shocks in Lao People's Democratic Republic (PDR) are analysed in this paper. Vulnerability was the consequence of high and immediate medical costs, which forced households to borrow money or sell off assets, and also of poor access to health care as a result of these costs. This, in turn, resulted in income loss and health deterioration. Weaknesses in the health system contributed to vulnerability through low and unstable access to preventive services and limited monitoring of the conditions that threatened the health of women and children. Even when households received timely care, they could face long-term economic impacts as a consequence of their coping strategies. Copyright © 2014 John Wiley & Sons, Ltd.