Maternal health is an area of prime concern in India. National Rural Health Mission (NRHM) has fast forwarded the progress in improving maternal health through initiatives like promoting institutional deliveries and improving access to reproductive health services etc. However, glaring differences exist between different states and also among the districts within each state. In Odisha, even though overall picture indicates that the state is on the road-map to achieve the target for institutional deliveries, a lot more is desired in some of its most backward districts like Kalahandi, Balangir, Koraput (KBK). Some of the challenges include geographical inaccessibility, poor quality of care, female illiteracy, and huge tribal population. However, central and state sponsored initiatives are contributing significantly in improving this situation. Initiatives of policy makers need to be supplemented with need based research and critical analysis of district level data. Here, academic institutes through active collaborations can assume leadership role. Besides focusing on achieving the targets for institutional deliveries, there is need to improve the quality of care particularly in hard to reach areas.