[Objective] The effects of ridge and furrow planting on crop water use efficiency (WUE) and yield were systematically evaluated, and the main driving factors that affect the yield increase effect of ridge and furrow planting were studied, in order to provide scientific basis and theoretical basis for the promotion and reasonable application of ridge and furrow planting in arid and semi-arid rainfed agricultural areas in Northern China. [Methods] Using flat cultivation as a control and ridge-furrow cultivation as the treatment, a systematic analysis was conducted of 68 published studies from 1980 to 2023. The Meta-analysis methods was utilized to quantitatively analyze the effects of three typical ratios of ridge width (R) to furrow (F) (the higher with R/F > 1; the medium with R/F=1; the lower with R/F < 1) on crop WUE and yield. The comprehensive impact of the main driving factors of ridge-furrow cultivation on crop WUE and yield was also investigated, with considering climatic factors (i.e., annual average precipitation, annual average temperature), soil factors (soil density, soil nutrients), and human management factors (fertilizer use, crop types). [Results] Compared with traditional flat cultivation, all three ridge-furrow ratios significantly increased crop WUE and yield, with significant differences observed among the different ratios. Under high, medium, and low ridge-furrow ratios, crop WUE was significantly increased by 34.9%, 27.48%, 32.4%, respectively, and yield was increased by 39.94%, 25.98%, 34.93%, respectively. The high R/F ratio (>1) was applicable in regions with an annual average rainfall of less than 400 mm and an annual average temperature of less than 8 ℃, while the low R/F ratio (<1) was more effective in increasing crop WUE and yield in regions with an annual average rainfall of more than 600 mm and an annual average temperature above 10 ℃. The high R/F ratio (>1) had a higher yield-increasing effect under conditions of low soil bulk density and high soil total nitrogen (TN) content, while the low R/F ratio (<1) was more suitable under conditions of high soil bulk density and low soil available nitrogen (AN) and available phosphorus (AP) content. Intensive fertilizer input significantly reduced the yield-increasing effect of ridge-furrow cultivation, whereas low fertilizer application rates (nitrogen fertilizer application rate of 0 to 150 kg/ha, phosphorus fertilizer application rate of 0 to 75 kg/ha) resulted in the most significant increases in crop WUE and yield. [Conclusion] The increase in crop WUE and yield due to different ridge-furrow ratios was influenced by a combination of climatic factors, soil factors, and human management factors. Ridge-furrow cultivation was more suitable under natural conditions of scarce rainfall and low soil fertility. Applying low amounts of chemical fertilizers can optimize the yield increase and water conservation benefits of ridge-furrow cultivation.