On February 16, 2017, the national dissemination  meeting of the Maternal Mortality Review was held at the National Center for

 Maternal and Child Health (NCMCH). UNFPA Country Representative Naomi Kitahara  gave the opening speech, which precluded the launch of the official report  entitled “Why Mothers Died”. This is the fourth review of the  case series and covers the period from 2012-2015.

In her speech, Ms. Kitahara reiterated UNFPA’s global mandate to  reduce maternal mortality, especially the critical importance of gathering quality  data.  Specifically, quality data gleaned  from the “Confidential Enquiry for Maternal Deaths,” an internationally-recognized  methodology for assessing maternal mortality.

“The Confidential Enquiry is, by design, an approach aiming at  improving the health system and the quality of health care by collecting data,  identifying shortfalls in health service provision, and suggesting  recommendations,” she said. “It forms a basis for key policy and  technical-level decisions needed to avert maternal deaths.”

Findings of the review highlighted a decrease in maternal  mortality cases from 151 to 118. The direct and indirect causes were registered  as 52.5 % and 46.3% respectively in the current study, which showed no  significant difference from the past review (54.3 & 44.4%). The main,  direct causes of maternal mortality were identified as Septic condition  (24.2%), Hemorrhage (17.7%) and Preeclampsia (17.7%).

On this basis, the report provided the following key  recommendations: 1) the need for urgent in-depth review of sepsis cases as well as changing the prevailing antibiotics administration regimen to strengthen the  current obstetric infection management protocols to meet the international  guidelines and standards; 2) improving the skills  of the health care service providers and the quality of antenatal care,  with particular attention to critical  elements of antenatal care such as quality rapid testing, a functional referral  system, and outreach programs with health education and counseling services.  It was emphasized that these should all be  made available at no cost to poorer segments of the population.

As Mongolia now looks towards the global targets set by the  Sustainable Development Goals in 2030, specifically in achieving good health  and wellbeing for all, these recommendations have become even more crucial if  it hopes to replicate its past successes. “It was a proud achievement for  Mongolia to be one of only 9 countries in the world in 2015 which met the  maternal mortality reduction target of the Millennium Development Goals,” says  Ms. Kitahara, “However, the recent increase of the maternal mortality ratio by almost two-fold indicates the fragility of Mongolia’s health system and its  vulnerability to external shocks, including economic difficulties which the  country faces today. In addition, the effect of violence against women and  girls, and especially violence by intimate partner, should not be forgotten, as  it is contributing to maternal deaths, and this has to be explored more deeply  in the future studies."

Further, the review provides solid data, which could serve as the  basis for policy and programme development and implementation. “Globally,  we know strong family planning programmes, strengthened emergency obstetric  and newborn care (EMONC), and enhanced skilled birth attendance are key to  reduce maternal mortality. Mongolia has done well in ensuring skilled birth  attendance, but needs to continuously improve the quality of emergency  obstetric and newborn care and recalibrate its approach to family planning,”  Ms. Kitahara says.

She goes on to emphasize the rationale behind policy and programme  environment with a strong family planning agenda at its core goes far beyond  ensuring the health of individuals, but addresses a universal principle. “Family  planning is a human right, and modern contraceptives must be available for  women in need to avoid any unwanted pregnancies. Health care providers should  have good counselling skills in family planning, and strong political will is  essential to secure sufficient state funding for contraceptives.”

She concluded her speech with continued confidence in the  Mongolian government’s ability to overcome the present challenges in the realm  of maternal mortality.” It is my firm belief that through the leadership of the  Ministry of Health and NCMCH, backed by a deliberate, concerted allocation of  the right levels of financial and human resources, a replication of past  success in the reduction of maternal mortality is more than achievable in  Mongolia.”

With UNFPA’s commitment to be a partner to the Government of  Mongolia in this endeavour, assurances were given to fulfill UNFPA’s mandate:  to deliver a world every pregnancy is wanted, and every child birth is safe.  “Mothers do not need to die, giving birth,” declared  Ms. Kitahara.

And the more when there is known about maternal mortality in  Mongolia through such undertakings as this report, taken seriously by government through supportive policies and programmes.

A. Esguerra, Dr. Shinetugs B.,  Dr. Tsednmaa B.