10 May 2018

#EveryChildALIVE: Sugar-Ochir from Tosontsengel soum, Khuvsgul province, Mongolia

5-day-old Sugar-Ochir from Khuvsgul province, Mongolia. © UNICEF/UN0188808 
Sugar-Ochir from Mongolia was born via C-section. His mother is a herder. Her previous babies were born in a very cold and dark room. Thanks to the heated health centre and the micronutrients she took, she delivered Sugar-Ochir feeling warm, and did not feel tired during the pregnancy (iron deficiency can make women feel exhausted and depleted). She said the pills changed her and her baby’s life. His mother, Namjilmaa Naransuren, 38, and the father, Lkagvadorji Dashdavaa are herders, and they live in Tosontsengel soum (subprovince), some 60 km away from the province centre, Murun. The family has 3 boys (aged 18 and 16, and the newborn baby).

Namjilmaa Naransuren says:
“This pregnancy was surprisingly easy for me, compared to my previous two. They were very complicated: I had high blood pressure and was on my own during the pregnancy. When I gave birth in 2000 to my first child, the room was very dark – there was only candlelight – and it was cold. It was very cold, and I was only given a blanket. I felt that the baby was shivering, too. Now, at the health centre, it was so warm – it made a huge difference. I had a C-section because of my age and complications I had previously. So, I was advised to go to the hospital. There, they discovered my baby’s head was facing the wrong way. After the procedure, I was so happy when the baby was put on my chest – I started crying immediately. With my previous two, my babies were separated from me right away. I was constantly worried about them. How were they doing? How were they feeling? I didn’t know. Also, it was very difficult to get my breastmilk flowing back then, but this one latched on quickly. This delivery was so nice – I am ready to give birth many times again! I was so happy because this was a late pregnancy, but I delivered him healthily without complications. During the previous pregnancies, I hardly received any training – how to take care of my baby, how to recognize complications, how to breastfeed, and how to support my own well-being. I was herding in very remote areas and I was on my own during the pregnancy. For example, I felt very tired all the time, even though I was young. But now, for him, I took micronutrient supplements. They changed my life and the life of the boy – I got a healthy baby. Now I don’t feel tired. Now, I could do my house work and other tasks while pregnant. In short, the monthly training was very supportive for me.”

Mother Namjilmaa N. holding her son Sugar-Ochir at a local hospital in Khuvsgul province. © UNICEF/UN0188809
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.

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.

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