In partnership with the National Alliance for Maternal Health and Human Rights (NAMHHR), CHSJ undertook an ethnographic study to understand maternal health practices of tribals in Odisha. Over the past 10 years, several efforts have been made by the Government of India to address maternal health and reduce maternal and infant mortality. While the proportion of institutional deliveries has increased in Odisha from 2006 to 2012, this increase has not been uniform. In the southern part of the state which has a large tribal population, indicators are lower than they are for the rest of the state. In this region, a large proportion of births still occur in the home and are out of the purview of maternal health schemes. In this background, we undertook a study in Rayagada district of Odisha to understand the maternal health practices of tribal women who deliver in the home. In contrast to the rest of Odisha, in Rayagada, 38% of deliveries still take place in the home. Through in-depth interviews with recently delivered and pregnant women from the Kondh tribe, this study explores the maternal health practices of women who deliver in the home, the meanings attached to them, and the range of traditional health providers that they consult. The study also explores women’s experiences with the formal health system, the barriers of distance, language and customs, the alienating environment in the hospital, large out of pocket expenses and women’s anxieties related to the same. The single minded focus on institutionalizing deliveries seems misdirected in such a situation where a complex web of barriers, makes access to health care facilities so difficult. The study emphasizes the need for trust-building measures between the community and health system, efforts to cater to the specific cultural needs of tribal women (birthing position, diet, birth companion), efforts to preserve parts of traditional practices especially nutrition and so on.