Despite being subject to intensive research and public interest many populations of dolphins, porpoises, and other toothed whales (small cetaceans) continue to decline, and several species are on the verge of extinction. We examine small cetacean status, human activities driving extinction risk, and whether research efforts are addressing priority threats. We estimate that 22% of small cetaceans are threatened with extinction, with little signs of improvement in nearly thirty years. Fisheries and coastal habitat degradation are the main predictors of extinction risk. Contrary to popular belief, we show that the causal impact of small-scale fisheries on extinction risk is greater than from large-scale fisheries. Fisheries management strength had little influence on extinction risk, suggesting that the implementation of existing measures have been largely ineffective. Alarmingly, we find research efforts for priority threats to be vastly underrepresented and so a major shift in research focus is required. Small cetaceans are among the lower hanging fruits of marine conservation; continued failure to halt their decline bodes poorly for tackling marine biodiversity loss and avoiding an Anthropocene mass extinction.