Safety Outcomes of Task-Shifted Antenatal Care Delivery Models

Abstract

Antenatal care systems in resource-constrained settings, and increasingly in high-income systems reorganizing scope of practice, rely on delegating specific antenatal tasks from physicians and specialists to nurses, midwives, community health workers, and other non-physician cadres. This article synthesizes the literature on the safety of these task-shifted antenatal care delivery models, spanning delegated counseling supported by job aids, midwife-led continuity-of-carer arrangements, group antenatal care, community-level screening and first-response treatment for hypertensive disorders of pregnancy, and non-physician-performed emergency obstetric surgery. Across these models, delegation accompanied by structured training, job aids, supervision, and defined referral pathways is consistently associated with maternal and perinatal safety outcomes comparable to, and on several measured dimensions better than, more specialist-intensive comparator care, with the community-level pre-eclampsia trials and associate-clinician caesarean-section literature offering the most direct evidence because they were designed around composite morbidity and mortality outcomes rather than intermediate process measures alone. The evidence is less complete on longer-horizon sustainability of the training and supervision infrastructure these models depend on, on the specific contribution of emerging digital decision-support tools, and on the behavioral and trust-related pathways through which task shifting can affect care-seeking independent of clinical competence. Read together, the literature supports task-shifted antenatal care as a safety-preserving strategy under demonstrated conditions rather than as an unconditional property of delegation itself.