Janani Express

A few days ago, Asha went into labour. Veiled to preserve her modesty, she boards the Janani (Hindi for mother) Express, a free ambulance service which takes her to the district hospital for a birth supervised by experts.
Photograph: Nick Cunard/DFID

It's women like Rekha Rawat who are encouraging Asha and other expectant mothers in rural areas to opt for births at health centres using the Janani Express - a fleet of no-frills 900cc vehicles more commonly used as taxis across India. That way, if there are any problems during the delivery, they are able to get emergency obstetric care in time to save their lives.
Photograph: Nick Cunard/DFID

As an ASHA (Accredited Social Health Activist), Rekha advises people from her own community on immunisation, breastfeeding, nutrition and sanitation. One-fifth of the world's maternal deaths and child deaths occur in India. In Madhya Pradesh 17 women die every day in child birth, in India a woman dies every 7 minutes in childbirth.
Photograph: Nick Cunard/DFID

As the Janani Express speeds Asha towards Shivpuri District Hospital 27km away, it has to dodge overladen buses and livestock in the middle of the road. This is the first time Asha has used this service. She had her previous child at home.
Photograph: Nick Cunard/DFID

Asha is helped into the hospital by her mother-in-law Mathura and one of Rekha's colleagues. The Health Department of Madhya Pradesh provides the Janani Express with support from National Rural Health Mission and the UK's Department for International Development (DFID).
Photograph: Nick Cunard/DFID

Outside, the men await news of the women being cared for in the hospital. Thanks to initiatives such as the Safe Motherhood scheme - part-funded by DFID - the number of safe births in health facilities in India has increased by 30% in only 2 years.
Photograph: Nick Cunard/DFID

Inside the maternity ward, Dr Veena Kundra is Shivpuri District Hospital's only gynaecologist. Since 2004 the number of institutional births in health facilities in Madhya Pradesh has doubled over the past four years. Safe delivery and newborn care is reducing the number of women and children who die as a result of child birth - and infant deaths have reduced by 14% since 2004.
Photograph: Nick Cunard/DFID

In Shivpuri, almost one-third of all women delivering in a hospital are using the Janani Express to get there. Since it began in September 2008, the service's call centre has taken more than 10,000 calls across the district.
Photograph: Nick Cunard/DFID

Mothers no longer worry about the cost of giving birth in hospital. The Janani Express and the medical care are free, and mothers receive remuneration of Rs 1400 under the National Rural Health Mission which covers lost days' work and expenses for mothers and their husbands.
Photograph: Nick Cunard/DFID

The Janani Express has helped reduce infant mortality because if there is a problem, newborn babies can get immediate medical attention. Mothers also get support to breastfeed early and know that their children need immunisation and other health services.
Photograph: Nick Cunard/DFID

Cradling her healthy, newborn baby girl, 27 year old Asha Jatav from Madhya Pradesh in India has arrived home after a safe delivery in hospital. But it’s only recently that women like her have been able to get to health centres to give birth. Pictured with mother in law Mathura and Asha's other daughter.
Photograph: Nick Cunard/DFID