The framework for Quality Maternal and Newborn Care on which the Lancet Midwifery Series is based, signals a welcome shift in the perspective that should guide planning, implementation, and assessment of maternal newborn health services: the analysis starts with what women need and want during pregnancy and childbirth. From this perspective, quality is not the last step in a chronological sequence of actions to expand coverage of clinical interventions to reduce mortality and morbidity; rather, quality must be a priority from the start. Yet, as Wim van Lerberghe and colleagues have put it, managing quality will entail addressing the “blind-spot” of respectful, women-centred care.