akistan has high maternal and neonatal mortality rates. A vast majority of these deaths are preventable with timely interventions. Inequalities (gender, minorities, reproductive health) that affect outcomes must be addressed.

It is important to understand that neonatal health is largely dependent on maternal health during pregnancy, delivery and post-delivery phase. Complications during any stage can lead to long term illness or death. The role of primary care physicians in improving health outcomes must be recognised. Published literature from 2019 shows that having more primary care physicians per 10,000 population was associated with reduced infant deaths. Maternal health conditions like diabetes, high blood pressure and infections, especially if poorly controlled, during pregnancies are linked to low birth weight in newborns. Rural and marginalised populations are more adversely affected. Poverty, high fertility rates, social constraints and environmental factors, including pollution exacerbate health issues.

Prevention and early identification of risk factors for cardiovascular conditions, obesity, fatty liver disease and patient education are required to deal with the growing pre-existing medical problems, particularly in older mothers. Such conditions predispose to problems during pregnancy like preeclampsia, gestational diabetes etc and adverse foetal outcomes.

Pregnant females can feel anxious and vulnerable. This can affect their mental well-being. Domestic abuse can begin during pregnancy or an existing abuse can get worse. Mothers suffering abuse can have issues like poor nutrition, mental health problems and adverse neonatal outcomes.

In order to improve maternal and child health, it is crucial to step up countrywide primary care services through primary care physicians (family physicians or general practitioners). This not only includes improving access to such services along with having an established referral system/ information sharing mechanism but also ensuring structured trainings of physicians providing quality services are in place. Consequently, we can effectively control maternal mortality due to pregnancy related complications and prevention of life long pregnancy related disabilities.

The unique needs of an individual can be identified through a well-organised primary care with trained primary care physicians having patient-centred consultation skills for both face-to-face and remote/ virtual consultations. Assessment and management of physical symptoms during pregnancy like headache, chest pain, abdominal pain and breathlessness can be difficult. Good communication and consultation skills can elicit important points in history and become the basis of identification, management of serious conditions and appropriate referrals to specialists. Trained primary care physicians can provide continuity of care in antenatal period, management of common illness (skin, respiratory infections), medication management, identification of emergency conditions during pregnancy like appendicitis, ectopic pregnancy. Similarly, in the post-natal period they can offer immunisations, screening for maternal mental health problems, family planning services, breast feeding advice and 6-8-week child health check-ups which can pick up congenital defects like hip and heart problems.

Provision of such services through primary care can lead to better health outcomes and reduced maternal and neonatal mortality. Review of existing strategies and development of evidence-based recommendations is the need of the time. Studies have shown that regions with higher ratio of primary care physicians to population had better health outcomes. The efforts to improve primary care must be integrated in the overall health services plan. Initiatives taken for primary care must not be temporary projects but sustainable and embedded in mainstream health system. We must equip the future primary care physicians with adequate skills and knowledge required to manage patients independently, competently and safely in the community.

The writer is an associate professor in family medicine at Health Services Academy, Islamabad.