Progress of family planning in Mongolia

Analysis of current access to reproductive health care resources and impact of lack of accessibility to rural populations especially. Original can be found here.

Family planning services are available in Mongolia, but recent research reveals room for improvement, especially for rural access, prevention of maternal deaths and domestic violence. The UNFPA, Marie Stopes International and several other NGOs are working with the government to provide better access to reproductive health resources.

On June 18, 2018, Naomi Kitahara from UNFPA released a statement applauding improvements to contraceptive access in Arkhangai Province. However, she expressed worry that in 2017, only 15 doses of injectable contraception were available to a soum of 5,000. This covers annual needs of only four to six women.

“How will poor women, marginalized women and isolated women be able to access contraception when they cannot afford them? How do we ensure that no one is left behind from these essential services?” asked Kitahara. “We have estimated that across the country, there is a severe shortage of contraceptives at the moment, and only a portion of the contraceptive needs seems to have been secured so far.”

This pattern has sustained for a while. According to the Ministry of Health and UNFPA in 2016, “The Situation Analysis of Family Planning reveals that despite impressive progress in improving maternal and child health services in Mongolia, […] across all three levels of the health delivery system, family planning is not widely and openly promoted or advocated, and access to quality services is not adequate. The challenges in relation to family planning are further exacerbated by the inadequacy of public funding to finance contraceptives.”

Contraceptives can be bought at pharmacies, markets, hotels, online vendors, family health centers, Soum Health Centers, province health centers, district health centers, specialized centers, hospitals, and regional diagnostic and treatment centers. However, pharmacies have frequently experienced stock-outs, and reportedly there has been a lack of contraceptives available at youth-friendly clinics.

Mongolian women use contraceptives, but at a much lower rate compared to the median of East Asian women. In a 2015 report, the UN found that only 58 percent of Mongolian women married/ in a relationship and of reproductive age used protection, compared to 82 percent of East Asian women as a whole. Furthermore, 14 percent of Mongolian women reportedly had unmet family planning needs.

Marie Stopes International is an NGO providing safe contraception and abortion services in over 37 countries. Their Mongolia branch, MSIM, launched in 1997, operating from Ulaanbaatar and providing almost 2,000 clients a month with access to contraceptives, specifically condoms of the brands “Trust” and “Mungulug”. Additionally, according to their website, “The team are working with the Mongolian government and partner clinics to train doctors and nurses in administering medical abortion and fitting IUDs and implants.”

In rural areas, MSIM is also advocating for an increased, consistent supply of condoms, using existing social marketing techniques and increasing channels for sale.

They are specifically targeting at-risk areas such as bars, night clubs, hotels, entertainment venues and border crossings.

“Border crossings are particularly important because high rates of sex work occur there,” said Baigalmaa Shagdar, finance director at MSIM.

“MSIM also conducts advocacy activities among key stakeholders, local government and owners of entertainment facilities to ensure their support, involvement and collaboration.”

Historically, family planning has been neglected by the government. Prior to the 1990s, virtually no program existed. Instead, the government practiced a pronatalist policy. According to Pandey RN in a 1997 analysis of family planning policy trends, “the government emphasized improving the quality of life by encouraging women not to bear children when they are too young or too old (over 30) and to space their births.” Importation of contraceptives was heavily restricted and only a limited quantity of IUDs was available.

Though following these years the government initiated family planning programs in both urban and rural areas, even in urban environments stigma still remains regarding the purchase of contraceptives, especially for females.

“If you walk into a supermarket as a woman and buy a box of condoms, people might look at you weird or judge you,” said one 24-year-old woman who currently lives in Zaisan. She requested her name be kept anonymous.

Not only does family planning reduce unplanned pregnancies, unsafe abortions and high-risk pregnancies, but it is important in reducing domestic violence.

UNFPA and the National Statistics Office released “Breaking the Silence for Equality”, the first study report on gender-based violence in Mongolia.

“It revealed some shockingly high rates of violence against women in Mongolia. It also clearly showed the linkage between violence against women and girls and its negative consequences on women’s reproductive systems. In many cases, such violence even led to maternal deaths,” said Kitahara. She advocated considering the issue of reproductive health within the context of domestic violence. Access to safe, quality reproductive care can help victims of violence with unplanned pregnancies.

Marie Stopes International hopes to mitigate this issue with future initiatives. “We plan to… expand access to contraceptives, increase availability and awareness of safe abortion choices and provide the trainings to teachers and youth about reproductive health and family planning,” said Baigalmaa.

Kitahara approved of such measures.

“In UNFPA’s recent study on social budget analysis, it was estimated that for every 1,000 MNT we invest in the supply of modern contraceptives, we save 3,200 MNT of the cost of pregnancy-related care and services,” she said. She congratulated the Ministry of Health for allocating 350 million MNT for contraceptives in 2018.

Both UNFPA and Marie Stopes International hope to continue their consultation with the government to fully meet family planning needs, efficiently allocating resources, investing in contraceptives and ensuring quality care for victims of domestic violence.

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