CoChat
Sign Up
Cited by 1,181Maternal and Perinatal Health InterventionsGlobal Maternal and Child HealthMaternal and fetal healthcare

The DOI matches its Crossref record; 129 of the 137 references it cites were found in a registry or an index.

Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide

Open access
Miller, Suellen, Abalos, Edgardo, Chamillard, Monica, Ciapponi, Agustin, Colaci, Daniela, Comandé, Daniel, Diaz, Virginia, Geller, Stacie, Hanson, Claudia, Langer, Ana, Manuelli, Victoria, Millar, Kathryn, Morhason-Bello, Imran, Castro, Cynthia Pileggi, Pileggi, Vicky Nogueira, Robinson, Nuriya, Skaer, Michelle, Souza, João Paulo, Vogel, Joshua P, Althabe, Fernando·2016·The Lancet
DOI 10.1016/s0140-6736(16)31472-6
Open this paper in CoChat — free accountOpen PDF

Abstract

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.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(16)31472-6

Cites

129 of 129 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Show all 137 references

Research works printed but not linked: 3

  1. Gibbons, 2010, The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage, World Heal Rep Backgr Pap, 30, 1
  2. Souza, 2014, On labor and childbirth: the importance of quaternary prevention, Cad Saude Publica, 30, S1
  3. 2014, Births: preliminary data for 2013, Evol Heal Dis, 63, 1

Cited by

Sorted by citations

Items 401–500 of 999

Related

See all

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
DOI
10.1016/s0140-6736(16)31472-6
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
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review