Care of women in primary health care (editorial)

Obstetric and gynecologic care is an appropriate function for general or family medicine programs. In the United Kingdom Holland and the Scandinavian countries it is an accepted part of primary care but in Spain the situation varies in different health centers and autonomous communities. The past loss of prestige of primary level services was an important factor in the transfer of responsibility for womens reproductive health care to specialists. Lack of training of family doctors in obstetrics and gynecology lack of coordination between the primary and hospital levels of care and lack of firm support from health authorities contribute to the continuing reliance on specialists for routine reproductive health care. The situation could be largely corrected by adding services for women at the primary level improving postgraduate training of family physicians in reproductive health care and defining the competencies of the primary level in the areas of obstetrics and gynecology. Existing maternal-child health programs such as that in Andalusia demonstrate the efficacy and advantages of offering womens health services in programs coordinating primary and specialized levels of care. Future family and community doctors should be trained in womens health care during their practice in the health centers with specialists participating in the training as they do in other medical specialties. But many health centers accredited for teaching do not offer such services. Preventive activities that are appropriate for the primary level include prenatal care and delivery in low-risk pregnancies family planning cancer screening and care during the menopause. Appropriate curative services include treatment of cervicovaginitis sexually transmitted diseases prolapse menstrual disorders breast disorders and abnormal bleeding.