Fighting against maternal and neonatal mortality

Boosting the profession and skills of midwives in Mongolia

Through my work, I want to make families happy by providing a safe and healthy birth to mothers and children. That's why I love my job and what gives me pride and strength to work.

Lkhagvasuren. D, midwife of the maternity referral hospital in the Arkhangai region

Location of Project National project: Ulaanbaatar and the 21 regions of Mongolia.
Name of Association www.santesud.org
Santé Sud
  www.santesud.org
Project Partners
(financial and operational)
  • The Ministry of Health and Sports
  • The Association of Mongolian Midwives
  • The Health Development Center
  • The Department of Midwifery at the Medical University
  • The National Centre for Mothers and Children (CNME)
  • The Regional Health Directorates (DRS) of the 21 regions of Mongolia
  • The Association of Gynecologists/Obstetricians
  • The Sanofi Espoir Foundation

Program description

There are 888 midwives practicing in 2,500 health establishments in Mongolia.

The "Boosting the profession and skills of midwives in Mongolia" project aims to reduce maternal and infant mortality and diseases at birth.

To achieve this, it is essential to improve the profession, skills and training of midwives in Mongolia. This must comply with the legal and academic standards in place in Mongolia, so that it can be fully covered by the framework law on gynecological and obstetric care.

This process of improving the legal framework of the midwifery profession will be leveraged as a multiple-actor working methodology to achieve results at the highest level and ensure national impact. This project was designed with key organizations attached to this work theme that are all strongly involved in the multiple-actor work group – the central body responsible for managing the project.

The actions planned in this project provide a response to the needs of improving the quality of care for mothers and children. Boosting midwifery is a decisive way to achieve this. The project provides for the establishment of a powerful leverage effect: the Mongolian Ministry of Health will include the benchmarks and proposed amendments produced by the project as part of the legal framework of the midwifery profession (framework law on gynecological and obstetric care). It will duplicate the training module for upskilling working midwives developed at the CNME in all maternity hospitals in Ulaanbaatar and in the 21 regions with the support of the Regional Health Directorates (DRS).

Building on learning is fundamental in this project. The methodology for upskilling midwives is both participatory and structured. All steps will build on learning in order to understand how to move from the initial situation to the project completion situation. This methodology aims to be exemplary so that it can be applied as a model to other projects to improve public policy in Mongolia: it will also be disseminated to other international cooperation players working on similar actions in other countries.

Santé Sud has been involved in the country for 20 years, and has greatly contributed to reducing the rate of maternal and infant mortality. In the region of Arkhangai, epidemiological and statistical data show that neonatal mortality has been reduced by 39%. The "Well-born in Arkhangai" project carried out by Santé Sud with the support of the Sanofi Foundation, and in partnership with the DRS, is a flagship project for the region.

For two decades, significant efforts have been made in Mongolia to reduce maternal and child mortality. The infant mortality rate at birth dropped from 97.2 per 1,000 births in 1990 to 26.4 per 1,000 in 2013. Eighty percent of prenatal deaths occur within seven days of birth and result from monitoring problems, which also cause birth pathologies. The maternal mortality rate during childbirth dropped from 130 to 50.8 per 100,000 live births over the same period. These results were achieved by implementing national programs and international solidarity programs particularly aimed at improving the quality of care in Mongolia.

However, even though these rate reductions are encouraging, they remain high. Mother and child mortality would be preventable if the profession and skills of midwifery were improved and better integrated with those of gynecologists and obstetricians. The maternity homes in Ulaanbaatar perform 8,000 to 16,000 deliveries per year. Faced with the influx of births, gynecologists and obstetricians need stronger support from their midwife colleagues. The challenge is to ensure careful and regular monitoring of mothers before, during and after childbirth.

Project goals

The project is planned over a period of two years (from January 1st 2016 to December 31st 2017)

The overall goal is to help reduce maternal and infant mortality and diseases at birth.

Its specific goal is to boost the skills of midwives in Mongolia.

To achieve this, there will be three deliverables:

  • Result 1:The reference framework for the profession of midwifery will be improved by means of a multiple-actor approach
  • The multiple-actor working group, the key project management unit, operating under the Ministry of Health and Sport, will meet to produce a reference document on the profession and its skills and training, to be validated by the cabinet of the Ministry of Health. Amendments to the legal framework of the profession of midwifery in accordance with Mongolian legal standards will be formulated.

  • Result 2: Midwives gain greater global recognition for their skills and their image
  • The training module dedicated to reinforcing the skills of working midwives will be designed and tested with 40 midwives and gynecologists/obstetricians. The Ministry of Health will organize the reproducibility of this module for the 888 midwives in Mongolia. Staff in the public maternity hospitals in Ulaanbaatar and Mongolia’s 21 regions (i.e. 360 maternity homes in hospitals and health centers) will be sensitized to the role and place of midwives. Awareness will be raised among mothers and their families as to the professional midwifery actions and skills that can assist them in monitoring their pregnancy, childbirth and during the post-delivery phase.

  • Result 3: Mechanisms for consultation and cooperation between public authorities and civil society will be set up.
  • Midwives will benefit from a more robust national association capable of bringing them together in a collective dialogue and interfacing with the government. At the end of the project, the multiple-actor working group will have experimented with a methodology for improving public policies and the effective professional framework for midwives. The results delivered by the project will be widely communicated.