Abstract
ObjectiveTo assess the effectiveness and safety of task shifting for the delivery of injectable contraceptives, contraceptive implants, intrauterine devices (IUDs), tubal ligation and vasectomy in low- and middle-income countries.MethodsMultiple electronic databases were searched up to 25 May 2012 for studies which had assessed the delivery of contraceptives by health workers with lower levels of training, compared to delivery by health workers usually assigned this role, or compared to no organized provision of contraceptives. We included randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. Data were extracted using a standard form and the certainty of the evidence found was assessed using GRADE.ResultsWe identified six randomized controlled trials published between 1977 and 1995 that assessed the safety and effectiveness of task shifting for the delivery of long-term contraceptives. Two studies assessed IUD insertion by nurses compared to doctors, two assessed IUD insertion by auxiliary nurse-midwives compared to doctors, one assessed tubal ligation by midwives compared to doctors, and one assessed the delivery of vasectomy by medical students compared to doctors. In general, little or no difference was found in contraceptive outcomes between cadres. Study design limitations and the low number of eligible studies, however, allow only limited conclusions to be drawn.ConclusionsThe findings indicate that task shifting for the delivery of long-term contraceptives may be a safe and effective approach to increasing access to contraception. Further research is needed because the certainty of the evidence identified is variable.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-015-0002-2) contains supplementary material, which is available to authorized users.
Highlights
Increasing people’s access to modern contraceptive methods is seen as a highly effective way to protect the health and well-being of women and children [1,2]
Increasing the number of health workers who deliver contraceptives is a key component of increasing access to contraceptive methods, and in many low- and middle-income countries (LMICs) task shifting has been used for decades to achieve this [8]
This study suggests that there may be little or no difference for this outcome when intrauterine device (IUD) are inserted by nurses compared to doctors (RR 0.93, 95% CI 0.57 to 1.52, p = 0.7786, low certainty evidence)
Summary
Increasing people’s access to modern contraceptive methods is seen as a highly effective way to protect the health and well-being of women and children [1,2]. The global shortage of health workers has had a severe impact on family planning services. Task shifting is one potential strategy to address the problems associated with the shortage and maldistribution of health workers and to help achieve the UN Millennium Development Goals 4 and 5 for maternal and child health [5,6]. Increasing the number of health workers who deliver contraceptives is a key component of increasing access to contraceptive methods, and in many LMICs task shifting has been used for decades to achieve this [8]. Task shifting initiatives may be relevant when increasing access to contraceptives among vulnerable groups such as young and poor women, unmarried women, migrants, and those living in rural areas
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