Multiple barriers may prevent access to safe abortion care (termination of pregnancy or management of miscarriage). Even when legal, access to safe services is often restricted by the lack of trained providers,1 particularly in nonurban settings. Many countries have policies that limit the provision of services to physicians or physician specialists (obstetrician gynaecologists), thereby limiting the number of available providers and further restricting women’s access.
Improving maternal health is one of the eight Millennium Development Goals,2 and an estimated 13% of all maternal deaths are caused by unsafe termination of pregnancy.3 Task shifting termination of pregnancy care services to mid-level providers (MLPs), a heterogeneous group of various nonphysician healthcare providers, such as nurses, midwives and physician assistants, has become a key strategy to achieve this goal.4 Task shifting can broaden the provision of safe termination of pregnancy to the primary care level and thus has the potential to expand access to services.
To assess whether the provision of termination of pregnancy services by providers other than physicians could be performed with similar levels of safety, efficacy and acceptability as when performed by physicians, we undertook a systematic review of this topic.