Guardian Global Development

A simple goal that seems so distant

The first thing that struck me about Orissa was the heat - over 50C. I watched astonished as heavily pregnant women pulled water from deep wells and worked in the fields with their husbands. They believed hard manual work made the births less painful.

Most women in this tribal region cannot afford transport to get to hospital and many have no help during the birth of their baby. Two of the women I met gave birth alone, one in the woods behind her hut while she herded her goats.

I visited a nearby health centre where the doctor had to deliver babies with a flashlight because there is often no power. The conditions were appalling: broken vials and needles littered the floors and listless patients lined the filthy halls. If I were a mother here I might prefer to give birth in the comfort of my mud hut, too.

Fortunately, not all health facilities are so frightening. I visited one hospital about an hour away, in Dhenkanal, where the tools and hygiene were rudimentary by Western standards but the staff were knowledgeable and the hospital was clean.

All mothers at the very least need a competent health worker to assist at the birth and with transport in case of emergency. If Noorjahan Begum had not got to the hospital in Dhenkanal, her baby would have died. I watched as an oxygen tube and skilled attendants saved his life.

I'm sure everyone can agree that all women should have access to basic maternity care. But here, where there is a lack of the basic things in life - clean water and education - you realise how these things are interlinked and how poverty must be addressed, too.

It's a distant goal, yet one that seems so simple.

· Ami Vitale (American) is currently based in Spain. She was a World Press winner in 2003 and 2005 and runner-up in the prestigious POY International in 2005. Her work from Europe, Asia, Africa and the Middle East has been published widely in the US, including Discovery, Geo, National Geographic Adventure, Newsweek, the New York Times magazine and Time, as well as internationally.

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