The safety, efficacy and acceptability of task sharing tubal sterilization to midlevel providers: a systematic review.

BACKGROUND Task sharing is an important strategy for increasing access to modern, effective contraception for women and reducing unmet need for family planning. OBJECTIVE The objective was to identify evidence for the safety, efficacy or acceptability of task sharing tubal sterilization to midlevel providers. SEARCH STRATEGY We searched PubMed, Cochrane and Popline for articles in all languages using the following key words: task sharing, tubal sterilization, midlevel providers, task shifting. SELECTION CRITERIA All studies reporting on any measure of safety, efficacy or acceptability of tubal sterilization performed by any cadre of midlevel providers. DATA COLLECTION AND ANALYSIS Data were independently abstracted by two authors and graded using the United States Preventive Services Task Force rating for evidence quality. Heterogeneity of outcome measures precluded a meta-analysis. MAIN RESULTS Nine studies of fair to poor quality reported on safety and acceptability outcomes. Generalizability of findings is limited by inadequate sample size and lack of statistical comparisons. No study reported on long-term efficacy outcomes. CONCLUSIONS Well-designed clinical trials, of adequate sample size, are urgently needed to establish the safety, efficacy and acceptability of task sharing tubal sterilization to midlevel providers.