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Birth Companionship Programme, Tamil Nadu
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Subject Area="First Referral Units." Objective="Scope and quality of First Referral Units."
Details for Reform Option "Birth Companionship Programme, Tamil Nadu"

Background: Relatives were banned from maternity wards in Government institutions across the State, leaving women to deliver without any support from someone they knew. Studies have shown that allowing a woman to be comforted, reassured and praised during childbirth has many benefits including the following: (i) Shorter labour (ii) Less pain medication (iii) Fewer medical procedures (iv) Decreased rates of Caesarean section (v) Increased satisfaction with birthing experience and less postpartum depression. (vi) Early initiation and continuation of breast feeding. Action: After a pilot scheme in two Emergency Obstetric Care Centres in Corporation of Chennai, a Government Order was passed in July 2004 allowing one female companion to be admitted to the labour ward in all Government hospitals in the states with the expectant mother. The birth companion must have: (i) undergone labour herself (ii) agreed to wear clean clothes, an identification tag and to attend the whole labour (iii) agreed not to interfere in the work of the hospital staff and the treatment procedures or with any other woman undergoing labour in the same ward (iv) be free of communicable diseases. The order applies to all teaching hospitals, district and sub district hospitals in the State. The practice was already being informally carried out in Primary Health Centres and Health Sub Centres and this is to be continued. A one-day training/sensitisation programme was carried out at each hospital for the labour ward staff nurse and doctors in an effort to overcome opposition to the scheme. The pilot scheme found that most opposition was overcome once the doctors and nurses saw the benefits for themselves. Results: First documentation of the results of the programme was just beginning in February 2006. These will be posted once they are finished. Nodal officers have been appointed at each institution to monitor the scheme, looking at the number of Caesarean sections and the number of new mothers breastfeeding. They have also conduct exit polls of mothers to gauge satisfaction with the service.

Cost State level workshop to draw up action plan: INR 60,000 Training film: INR 20,000 District level training: INR 9,000
Place All Government hospitals in Tamil Nadu from August 2004.
Time Frame Two month pilot scheme. One month to provide training/orientation at each institution.

Low-cost: International studies have shown that a birth companion can reduce the number of Caesarean sections and pain control needed (see documents below). Increased patient satisfaction: improves the birthing experience for the mother. Health benefits: leads to less postpartum depression and increased breast feeding.


Possible opposition: from doctors and nurses who fear relatives will interfere with the birthing process.


Government Order. Action plan. Training/orientation material.

Who needs to be consulted

State government: specifically the director of Medical and Rural Health Services, the director of Medical Education, the director of Family Welfare, the director of Public Health. Obstetricians, gynaecologists and staff nurses at Government hospitals.



The programme is extremely low cost. It has already been implemented successfully for four years at the CMC Hospital, Vellore.

Chances of Replication

If there is enough political will to bring about a Government Order there is no obvious reason why this scheme cannot be easily replicated.




Submitted By

Clare Kitchen, Research Consultant, ECTA, New Delhi. September 2004. Updated Februray 2006.

Status Active
Reference Files
Note on Birth Companionship Programme.doc Summary note on Birth companionship programme.
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