The Millennium Ecosystem Assessment was called for by United Nations Secretary-General Koffi Annan in 2000 in his report to the UN General Assembly, We the Peoples: The Role of the United Nations in the 21st Century. Governments subsequently supported the establishment of the assessment through decisions taken by three international conventions, and the MA was initiated in 2001. The MA was conducted under the auspices of the United Nations, with the secretariat coordinated by the United Nations Environment Programme, and it was governed by a multistakeholder board that included representatives of international institutions, governments, business, NGOs, and indigenous peoples. The objective of the MA was to assess the consequences of ecosystem change for human well-being and to establish the scientific basis for actions needed to enhance the conservation and sustainable use of ecosystems and their contributions to human well-being. This report presents a synthesis and integration of the findings of the four MA Working Groups (Condition and Trends, Scenarios, Responses, and Sub-global Assessments). It does not, however, provide a comprehensive summary of each Working Group report, and readers are encouraged to also review the findings of these separately. This synthesis is organized around the core questions originally posed to the assessment: How have ecosystems and their services changed? What has caused these changes? How have these changes affected human well-being? How might ecosystems change in the future and what are the implications for human well-being? And what options exist to enhance the conservation of ecosystems and their contribution to human well-being?