UNICEF WeShare -

https://weshare.unicef.org/archive/-2AMZIF2N4IFM.html

[EMBARGOED until 7 May 2018] [RELEASE OBTAINED] Mother Delgermurun Tsolomon, 32, holds her with her baby Sugarmaa, 8 days old, outside her ger in the Alag-Erdene area in Mongolia on 1 March 2018.

Sugarmaa Batjargal, girl, 8 days old, Born on 23 February 2018; weight at birth 3.8 kg. Sugarmaa (the name means Friday in Tibetan) from Mongolia was born in a health centre near her family’s ger (a nomadic tent). Thanks to the midwife’s home visits, she doesn’t get sick (it can be difficult to protect children from getting sick in the countryside due to the cold). And thanks to the local health centre, which is equipped with a ‘mother waiting house’, her mother could stay close to her family. Her father brought her mother local food – mutton soup – as she waited to give birth. Her mother, Delgermurun Tsolomon, 32, is married for the last 11 years to Batjargal Purevjii, 33. She lives in a township in Alag-Erdene, Mongolia, and has 5 children.

Delgermurun Tsolomon says:
“I was so happy and glad after she was born. As soon as I saw her, I knew she looked like me. I didn’t know her sex before birth, but I’m so happy to have three girls now. I dream that they will become well-educated and knowledgeable people, and that they will complete their education. I hope my second daughter, who is sturdy and muscular, will become a wrestler.
Our lunar new year was on 16 February. On the night of the second day of the new year, I started feeling some pain, so I called the soum [county] hospital to come, and they came and brought me to the health centre where I stayed for one week. The hospital gave me some food and my family brought me some as well – mutton soup. After giving birth, I always have mutton soup. My husband had to stay with the children at home. He also takes care of the animals. When I needed food, he drove to the hospital. Two months into my pregnancy, I started going for regular check-ups, about 6 to 7 times. I went to the soum [district] health centre by car. It took about one hour to drive 20 km. Health workers and a midwife also came to visit me twice at my home. The regular visits prevented me and my children from becoming sick – it is easier to get sick in the countryside. It can get very cold, and children can easily run outdoors and catch a cold. I also learned to take vitamins, and try to use more vegetables in my cooking, like turnips and carrots.”

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.
“It is very useful – the mothers who attend our training feel healthier and more supported,” said Erdenetsetseg Sharkhuu, a midwife trained by UNICEF, who trains about 80 mothers per month.

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 2016, the number of lactating and pregnant mothers taking micronutrients has increased by about 50 per cent, from 60 per cent in 2014, when UNICEF started to distribute the pills, to 90 per cent in 2016. In 2014, 13 women nearly died from blood loss, as opposed to just eight in 2017.

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. Erdenetsetseg Sharkhuu, the midwife, delivers about 60 to 70 babies per month. About two to three of them are kept warm by the mattresses. “Before, when it was cold, the mothers were shivering – their skin turned cyanic blue, and we noticed signs of hypothermia in both the mother and her newborn,” Erdenetsetseg said. “Now, because the temperatures are higher, the mothers are feeling much more comfortable and they can properly deliver their babies. We were also worried about the newborns – it was very cold and they developed hypothermia. Their feet and hands felt cold, and they had runny noses, so they could not breastfeed properly. They started coughing and developed ear infections.” Because of improved heating and other essential newborn care practices, the number of babies treated in the intensive care unit declined from 230 in 2015 (when data collection started at the facility) to 139 in 2017.

Before 2014, when UNICEF trained health workers in health facilities across Mongolia, newborns were separated from their mothers after 30 minutes without having been sufficiently breastfed. They were not kept warm. Vaccines and eye ointments should only be administered two hours after the birth, when the baby is more relaxed. Erdenetsetseg Sharkhuu has given early essential newborn care (EENC) to about 700 babies out of 10,000 born at the facility since 2014. “Before EENC, we used to place babies on mothers’ abdomen, not their chest, without properly drying and wiping the baby. That led to hypothermia in some babies. They also never used to put hats on the babies, but now we know that hats are essential because newborns lose a lot of heat otherwise.” “Every mother feels so happy when we put her baby on her chest. Mothers seem to be loving their child even more. It helps them to bond more quickly and develop a closer relationship. Some mothers already start talking to their baby in the delivery bed.” Because of EENC, the number of babies treated in the intensive care unit went down from 230 in 2015 (one year after UNICEF started training midwives in performing EENC) to 139 in 2017.

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.

Cost examples in the country:
Cost to train a mother of how to prepare for delivery: 1 USD
Cost to train a mother to take care of their baby at home: 1 USD
Cost of micronutrients per mother: 5.6 USD (including freight cost to give during pregnancy and lactation for the first 6 months)
Cost for a thermometer: 1.5 USD
Cost for an inflatable heating mattresses (to keep the baby warm): USD 1,750 (including freight cost to the country)
Cost to train a mid-wife on early essential newborn care (EENC) - 2 days training: 115 USD (including transport (for remote health worker), lunch and accommodation and trainers cost).

View more with similar tones

2018

COUNTRIES:

Mongolia

Unique identifier:

UN0188829

Source name:

Ilvy Njiokiktjien VII Photo

Document Date:

March 01, 2018

Download document information

Download