Abstract
Objective: To assess the knowledge, performance, and barriers related to Emergency Obstetric Care (EmOC) among doctors in Khyber Pakhtunkhwa-Pakistan, focusing on consultants and Woman Medical Officers (WMOs) to identify gaps and challenges affecting maternal health outcomes.
Methodology: This cross-sectional survey was conducted from July 2017 to December 2020, and included 153 doctors, (41 consultants and 112 WMOs), working in various healthcare facilities in Khyber Pakhtunkhwa. Data were collected through a structured questionnaire. Statistical analysis was performed to compare knowledge and performance between the two groups.
Results: Significant disparities were observed in EmOC knowledge between consultants and WMOs, with consultants demonstrating superior understanding of EmOC population, complications, C-sections, and mortality, while WMOs excelled in the birth domain. Performance gaps were evident in key signal functions, with consultants outperforming WMOs in the use of oxytocin, anticonvulsants, manual placental removal, blood transfusion, and antibiotics. Significant resource and infrastructure barriers were identified including staff deficiencies, transport availability, and weak salary structures. Geographical challenges, such as working in remote areas, and institutional issues, including lack of political support, were also highlighted as barriers to effective EmOC.
Conclusion: Our study reveals critical gaps in EmOC knowledge and performance among healthcare providers in Khyber Pakhtunkhwa. Improving maternal health outcomes requires targeted, competency-based training for both consultants and WMOs. Addressing resource deficits, strengthening rural healthcare infrastructure, and enhancing institutional support are vital to optimizing EmOC and reducing maternal mortality in Pakistan.

Key words: Emergency obstetric care (EmOC), health care providers, challenges, barriers, maternal mortality, doctors.