Uuriintsolmon from Murun, Khuvsgul province, Mongolia
Uuriintsolmon from Mongolia was born healthy and, unlike her older sister, remained in good health after her birth. Thanks to the home-care training received with the support of UNICEF, her mother did not make the same mistakes: Her sister had jaundice as a baby – her mother thought she was going to die. She also had a rash and small cuts on her arm because her mother did not bathe her frequently, and she suffered from constant colds because the house was not ventilated. Thanks to the nutrition training, Uuriintsolmon's milk is healthier (Mongolians believe meat, bread and cookies stimulate breastmilk production, while vegetables are better.) Her mother, Bayarmaa Erdenejargal,30, and her father, Nyambat 26, live in Murun city.
"With my second baby, I entered antenatal care much earlier. That was helpful. I learned how to recognize the signs of jaundice, how to bathe her, how to refresh the air in her room, how to keep her warm, and how to feed her"
Bayarmaa Erdenejargal says:
“I didn’t always know how to take care of my first baby – she had jaundice, skin infections, a runny nose, and felt cold. At one point, I feared she might die. I was very worried about her. With my second baby, I entered antenatal care much earlier. That was helpful. I learned how to recognize the signs of jaundice, how to bathe her, how to refresh the air in her room, how to keep her warm, and how to feed her. I didn’t bathe my first daughter enough, so she had a few wounds on her arms that got infected. That never happened to my second daughter because I frequently bathed her thanks to the UNICEF training.
I also learned that, every two hours, the window should be opened for five minutes to clean the air of the home. Before the training, I thought that closed windows kept a baby warm. But they only gave her frequent colds. When the air is clean, a baby has no stuffy nose. I also learned how to correctly wrap the baby and keep her head [the fontanelle] warm – that’s why I always put on a hat. I didn’t always do that for my first baby. Finally, I learned how to feed my baby. During the training, for example, I learned what kind of foods I should eat to produce good breastmilk. Mongolians used to think that we should eat a lot of wheat – bread and cookies – to enhance breastmilk production. Thanks to the training, I understand a lot of soup and vegetables are better. I now use enriched flour, minced carrots and eggs. Thanks to the UNICEF training, my second baby is much healthier. I didn’t worry so much about her because I knew what was normal and what was abnormal, so I understood the situation. I feel confident now. I wish for my daughter to have a healthy life.”
In Mongolia, newborn mortality rates have decreased from 10.2 deaths per 1,000 live births in 2014 to 8.7 deaths per 1,000 live births in 2017. In Khövsgöl, Mongolia’s northernmost province, newborn mortality rates have decreased significantly, from 15.4 deaths in 2014 per 1,000 live births to 13 deaths per 1,000 live births in 2017. Despite these advances, challenges remain: malnutrition, long travel distances to maternal health clinics, and insufficient government support to buy essentials (such as medication, micronutrients, newborn hats, masks, staff trainings and education materials) continue to imperil lives.
Birth is a natural process. In recent decades, however, too many rules have started to interfere with the natural way of giving birth. After years of study, experts identified four key life-saving interventions to support a newborn’s survival. First, nurses should wipe and dry the baby right after birth by wrapping the wet baby in two pieces of cloth. (If it remains wet, the baby will cool off. The drying and wiping motions will also support the first few breaths of the newborn.) Second, skin-to-skin contact between the mother and the baby is vital to keep the baby warm. Other benefits, such as the transfer of bacteria that stimulate growth, also occur. Third, the umbilical cord should only be cut after its pulsation movements stop, and all its blood is transferred to the baby. Fourth, breastfeeding should be initiated in the delivery room, right after birth. This should last at least two hours.
When a baby is born, its body temperature is higher than that of adults, about 37.5 °C. This ensures a newborn remains warm and healthy after the shock of birth. In Mongolia, where winter temperatures can drop to -30 °C, temperatures in some delivery rooms were as low as 11°C, causing newborns to die from problems caused by hypothermia. In 2010, the government, spurred by UNICEF, mandated that all delivery rooms be heated to 25 °C, to ensure babies remain warm. Thermometers were installed to ensure compliance and monitoring. In addition, UNICEF provided inflatable mattresses that can be heated.
Mothers are encouraged to take micronutrient pills to combat iron deficiency anaemia. When a mother is anaemic, she might feel tired during pregnancy and will be very vulnerable if she loses a lot of blood during the delivery. Her children will also feel tired and not perform well at school later.
When a baby is born, its body temperature is higher than that of adults, about 37.5 °C. This ensures a newborn remains warm and healthy after the shock of birth. In Mongolia, where winter temperatures can drop to -30 °C, temperatures in some delivery rooms were as low as 11°C, causing newborns to die from problems caused by hypothermia.
Since 2014, UNICEF has provided two types of trainings to mothers: One to prepare women for delivery, and one to teach them how to take care of their babies at home.
First, one of the most important parts of preparing women for delivery is teaching them about breastfeeding, which is initiated immediately after birth. Mothers learn about the benefits of colostrum – the breastmilk that is produced in the first two days after giving birth. It comes in very small quantities – droplets – and is packed with essential nutrients. If a mother doesn’t know she will only produce very little milk in the beginning, she might start feeding her baby with powdered milk to prevent it from going hungry. Second, expectant mothers learn how to keep their baby warm at home, bathe it, take care of its skin and umbilicus, and spot signs of jaundice and other dangerous infections. Nutrition, during pregnancy and lactation, is another important element of home-care training. While a traditional Mongolian diet includes lots of meat and cookies, it is healthier to eat vegetables and soups. Training include recipes and cooking classes to improve mothers’ intake of vitamins.
Since 2014, UNICEF has been working with public health officials to develop solutions to address these challenges. Thanks to the solutions put in place by UNICEF – most notably the training of medical personnel in Early Essential Newborn Care in 2014 – newborn mortality rates have decreased.
The number of babies who needed intensive care declined from 230 in 2015 to 139 in 2017 on an average of 2,000 births per year.
The number of babies who needed intensive care declined from 230 in 2015 to 139 in 2017 on an average of 2,000 births per year. (In 2007, the government recommended that at-risk herder women be transferred to ‘maternity waiting houses’ at provincial health facilities to avoid complications. This policy also significantly reduced newborn deaths. UNICEF provided furniture, cooking appliances and newborn care materials to the maternity waiting houses.) UNICEF is advocating with the Government of Mongolia to pass a national law that would allocate a budget for essential package of maternal and child health care across the country. There is currently no fixed budget for essential health care package.