title: The safety, efficacy and acceptability of task sharing tubal sterilization to midlevel providers: a systematic review.
abstract: 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.
  
  
  METHODS
  We searched PubMed, Cochrane and Popline for articles in all languages using the following key words: task sharing, tubal sterilization, midlevel providers, task shifting.
  
  
  METHODS
  All studies reporting on any measure of safety, efficacy or acceptability of tubal sterilization performed by any cadre of midlevel providers.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Oregon Health & Science University Department of Obstetrics & Gynecology. Electronic address: rodrigma@ohsu.edu.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Rodriguez
authors.affiliation: Marie Stopes International.
authors.forename: Cristin
authors.initials: C
authors.lastname: Gordon-Maclean
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006176:Gynecology; D006301:Health Services Needs and Demand; D006801:Humans; D008880:Midwifery; D009741:Nursing Staff, Hospital; D017060:Patient Satisfaction; D010823:Physician Assistants; D013246:Sterilization, Tubal / Q000009:adverse effects* / Q000451:nursing; D013647:Task Performance and Analysis; D016387:Women's Health; D000078329:Workforce
keywords: Female sterilization; Midlevel provider; Task sharing; Task shifting; Tubal ligation