The past two decades have seen dramatic increases in women occupying positions of political power. Such developments have been welcomed as a means of achieving better outcomes for women in their everyday lives. We interrogate this proposition, developing a "gendered accountability" framework to the delineate conditions under which female representation should have its desired effects. Our empirical analysis applies this framework to sub-Saharan Africa, home to the largest increase in women's political representation in recent years. We find that having more women in the legislature is robustly associated with reduced infant and child mortality as well as greater spending on health. The effect on infant mortality is magnified when women are more active in civil society, and constrained to countries that have gender quotas and a proportional electoral system. We do not, however, find consistent evidence that maternal mortality and access to clean water respond to female representation.