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Mediterranean-type climates are defined by temperate, wet winters, and hot or warm dry summers and exist at the western edges of five continents in locations determined by the geography of winter storm tracks and summer subtropical anticyclones. The climatology, variability, and long-term changes in winter precipitation in Mediterranean-type climates, and the mechanisms for model-projected near-term future change, are analyzed. Despite commonalities in terms of location in the context of planetary-scale dynamics, the causes of variability are distinct across the regions. Internal atmospheric variability is the dominant source of winter precipitation variability in all Mediterranean-type climate regions, but only in the Mediterranean is this clearly related to annular mode variability. Ocean forcing of variability is a notable influence only for California and Chile. As a consequence, potential predictability of winter precipitation variability in the regions is low. In all regions, the trend in winter precipitation since 1901 is similar to that which arises as a response to changes in external forcing in the models participating in phase 5 of the Coupled Model Intercomparison Project. All Mediterranean-type climate regions, except in North America, have dried and the models project further drying over coming decades. In the Northern Hemisphere, dynamical processes are responsible: development of a winter ridge over the Mediterranean that suppresses precipitation and of a trough west of the North American west coast that shifts the Pacific storm track equatorward. In the Southern Hemisphere, mixed dynamic-thermodynamic changes are important that place a minimum in vertically integrated water vapor change at the coast and enhance zonal dry advection into Mediterranean-type climate regions inland.