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Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide
Open accessAbstract
On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.
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Metadata
- Authors
- Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., Diaz, V., Geller, S., Hanson, C., Langer, A., Manuelli, V., Millar, K., Morhason-Bello, I., Castro, C. P., Pileggi, V. N., Robinson, N., Skaer, M., Souza, J. P., Vogel, J. P., & Althabe, F.
- Affiliations
- University of California, San Francisco (US)
- Centro Rosarino de Estudios Perinatales (AR)
- Instituto de Efectividad Clínica y Sanitaria (AR)
- University of Illinois Chicago (US)
- Karolinska Institutet (SE)
- Harvard University (US)
- University of Ibadan (NG)
- Universidade de São Paulo (BR)
- Harbor–UCLA Medical Center (US)
- World Health Organization (CH)
- Corresponding author
- Miller, Suellen
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 388
- Issue
- 10056
- Pages
- 2176-2192
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2519393586
- Cited by
- 1,181
- References
- 137
- Citations by year
- 2026: 95 · 2025: 112 · 2024: 128 · 2023: 116 · 2022: 146 · 2021: 168 · 2020: 161 · 2019: 114 · 2018: 81 · 2017: 47 · 2016: 11
- FWCI
- 14.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- CONICET Digital (CONICET) (submittedVersion, cc-by-nc-sa)
- Funders
- Bill and Melinda Gates Foundation
- John D. and Catherine T. MacArthur Foundation
- World Health Organization
- Karolinska Institutet
- Medical Research Council (MR/K012126/1)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- respectful maternity care, evidence-based clinical guidelines, prenatal care, intrapartum care, postpartum care, maternal health equity, maternal mortality, disrespect and abuse in childbirth, middle-income countries, facility births, maternity care quality
- MeSH terms
- Female, Humans, Maternal Health Services, Maternal Mortality, Pregnancy, Global Health, Practice Guidelines as Topic, Evidence-Based Medicine, Health Status Disparities
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