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Too little, too late

A lack of access to good, timely care is referred to in the Lancet Maternal Health Series as too little, too late”. The term covers inadequate access to services, resources, or evidence-based care in a timely manner.  “Too little, too late” care happens everywhere in the world where social or demographic inequality exists. It is found not only in low-income countries, but also among deprived populations in high-income countries.

It is one extreme of maternity care, with “too much, too soon at the other extreme end. “Too much, too soon” means care before, during and after childbirth that encourages or forces women into unnecessary medical procedures. While both of these problems have many causes, they can both be addressed by adhering to guidelines for health care that are based on evidence.

Weak health systems in low-income countries

Despite improvements in the past 25 years, preventable maternal deaths are still too common in low-income countries, especially in sub-Saharan Africa and south Asia. In sub-Saharan Africa, a woman’s risk of dying in pregnancy or childbirth is 1 in 36—compared with 1 in 4,900 in high-income countries.

While the causes are complex, they are often based on weaknesses in health systems such as health facilities without enough staff with the needed skills; equipment, supplies, or drugs; weak or missing referral systems; and emergency care that is poor or lacking completely. This prevents healthcare providers from delivering even the simplest and cheapest care.

These problems are made worse by a lack of skilled healthcare providers, incoherent guidelines for care, and poor training. These can be a problem even when supplies are available.

Women’s vulnerabilities

Women everywhere are affected by geographical, social, and economic barriers that prevent them from accessing proper care in time. There are huge differences in care within countries, and most maternal illness and death happens to the most vulnerable women. Even in countries that are generally highly developed, vulnerable groups still experience inequalities in maternal health.