10 May 2018

#EveryChildALIVE: Ochir from Murun, Khuvsgul province, Mongolia

2-day-old Ochir from Khuvsgul province, Mongolia. © UNICEF/UN0188803
Ochir, boy, weight 3.8 kg; 2 days old; born on 26 February 2018. Baby Ochir from Mongolia was born healthy. Thanks to the training his mother received, he was breastfed and kept warm after his birth with a blanket around his feet and a hat on his head (all babies in Mongolia must wear hats and are wrapped in a special way when outside). His mother, Zolzaya Baasanjav, 18, is a student. His father is Tserentogtokh and he is 18 years old. Both live in Murun City. Ochir is their first child.

Zolzaya Baasanjav says:
“I had oedema in my feet and legs. Sometimes I had high blood pressure. My mother and my family advised me to go to a health centre. I had to come in early to prevent complications.
I felt very happy after he was born, and I wanted to kiss him. He was very warm and hot to the touch. I just wanted to look at him and couldn’t stop staring at him. Every Friday, they had a training for mothers. We learned how to take care of the baby and how to prepare for delivery. My favourite lesson was how to correctly hold the baby during breastfeeding. I knew how important it was because I learned about colostrum, and so I wanted to support the baby to initiate breastfeeding. After he was put on my chest, after the shock of giving birth, I remembered my training. It wasn’t so comfortable the first time I fed him, but now it is going well. I am confident he is feeding. The training was very helpful. During the training, I learned that newborns should always be kept warm. I first put a warm towel on his feet, then I put a hat on his head, and then I wrap him. I have a favourite blanket which I keep at home – it’s yellow, and looks very special.”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.

Mother Zolzaya and 2-day-old Ochir at a local hospital. © UNICEF/UN0188805
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.

2-day-old Ochir from Khuvsgul province, Mongolia. © UNICEF/UN0188806
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. (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.