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Lancet. 2016 Oct 29;388(10056):2176-2192. doi: 10.1016/S0140-6736(16)31472-6. Epub 2016 Sep 16.

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

Author information

1
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA. Electronic address: suellen.miller@ucsf.edu.
2
Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina.
3
Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
4
Center for Research on Women and Gender, University of Illinois, Chicago, IL, USA.
5
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
6
Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA.
7
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
8
University of Ibadan, Ibadan, Nigeria; London School of Hygiene & Tropical Medicine, London, UK.
9
GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
10
Harbor-UCLA Medical Center, Los Angeles, CA, USA.
11
Safe Motherhood Program, San Francisco, CA, USA.
12
GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
13
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

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.

PMID:
27642019
DOI:
10.1016/S0140-6736(16)31472-6
[Indexed for MEDLINE]

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