A report is given of a visit to an Indian village community project which is supported by a small Swedish foundation. The project was started about 40 years ago by a female relative of Mahatma Gandhi. The community is a small village of about 2000 inhabitants and consists of an irrigated agricultural project, a school through 10th grade, a small hospital, a home for 140 poor or orphan girls and a nursery. The program employs 12 community health workers who have some healthcare training. Each worker cares for 200-250 households and usually knows his/her families well. Primary emphasis is on care of children which includes help with nutrition and a vaccination program. For every 4 community health workers there is an auxiliary nurse midwife who has 3 years special training following 10th grade. The midwives check up on pregnant women once a month through the 7th month, 2 visits in the 8th month and once/week in the 9th month. Undernourishment and anemia are the most common problems of pregnancy. Children are often born in the parents' home without any trained obstetric help. In spite of this, maternal mortality is very low. Even infection from childbirth is extremely rare. The visitor was particularly impressed by the respect and affection everyone in the village showed for children and for each other.
The article presents a model for organized prenatal care in a district of 45,000 people. General practitioners, midwives and an obstetrician share responsibility for pregnant women in the region. The general practitioners have primary responsibility for the prenatal care, but all the pregnant women are offered consultation with the midwife twice and with the obstetrician once during the pregnancy. The midwives give general information on pregnancy and birth, and also take part in the ultrasonographic screening program. The obstetrician provides individual care to women with risk pregnancies, or in the event of complications. This system offers similar prenatal care to all pregnant women in the area without interfering with their personal wishes.
Mental disorders are common during the perinatal period and expose mother and child to major risks. Almost all women in Sweden attend maternal and child health care centers regularly before and after birth. This constitutes a unique opportunity to detect women with early signs of mental disorder or at risk of recurrence of prior illness. Identified women need fast access to diagnostic and treatment providers with specialized knowledge on perinatal mental disorders. As perinatal mental disorders can have severe consequences for mothers and their children a tight cooperation between caregivers is often needed.