The historical separation and divergence of political institutions across the two Bengals over six decades enables us to explore the determinants of maternal and child health of this ‘natural experiment’. West Bengal and Bangladesh have both made impressive strides in improving health outcomes over the past few decades. An examination of data on maternal and child health shows that despite having a lower GDP per capita and lower levels of female literacy Bangladesh performs better than West Bengal in the provision of immunization and oral rehydration therapy. West Bengal on the other hand does better in indicators related to antenatal care and institutional delivery. This essay explores the potential impact of the structure and organization of the health delivery system among various factors including economic development and female empowerment in explaining these differences in health indicators. Further research is needed to establish definitively the roles of each of these determinants in explaining the observed outcomes.