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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
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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.

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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

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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
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

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