objective To review progress with the implementation of intermittent preventive treatment (IPT) for the control of malaria in pregnancy in sub-Saharan Africa (SSA), in order to identify facilitating factors and operational challenges for scaling up IPT delivery. methods Information on the status of IPT policy, programme and coverage indicators was extracted from published sources. Information on country experiences from both published and unpublished literature was supplemented with semi-structured interviews with malaria programme managers. results Whilst countries in SSA have made important progress with IPT implementation, coverage levels remain low. High antenatal clinic (ANC) attendance alone is not suf?cient to ensure high IPT coverage. Staff shortages, poor drug supply, poor ANC access and poor health worker practices are some of the operational challenges in delivering IPT. conclusion Country experiences show that IPT can be introduced and scaled up relatively quickly and effectively where there is political will, effective integration between malaria and reproductive health programmes, adequate funding and drug supply, high ANC attendance and community receptiveness. There is however urgent need to better document best practices and lessons as a basis for developing simpli?ed guidelines for dissemination to countries embarking on IPT implementation.