The sediment load of the Loess Plateau has shown a sharp decreasing trend in the past decades. This paper gives a comprehensive review of the driving factors of the sediment decrease with respect to human activities, including soil and water conservation, dam construction, and vegetation restoration. Also presented is an overview of the main achievements of soil and water conservation and the main soil erosion control programmes implemented in the Loess Plateau. The paper concludes with suggestions for further policy modifications that could move management towards ecological sustainability and will be greatly beneficial to the regional water resources management and restoration of an eco-environmental system in the Loess Plateau.