Goal 4 Reduce Child Mortality
 

• Status and Trends
• Immunization in Mongolia
• Challenges
• Enabling Environment
• Priorities for Development Assistance

Mongolia has realized impressive reductions in under-five mortality rates over the decade. Mortality was more than halved between 1990 and 2000 at a rate, which puts Mongolia well on track to achieving the MDG target by 2015. Though there are discrepancies between administrative data and household survey data over the levels of child mortality, the downward trend is apparent in all data sets.

     This decline in child mortality is attributable to a number of factors. There has bee a steep fall in fertility rate as a response to the economic situation. International standards in diagnosing and treating acute respiratory infections and diarrhea have been introduced and breast-feeding has been successfully promoted. In addition, a successful immunization programme has been implemented with consequent reductions in infectious diseases (see Box).

Despite these positive developments, under-five mortality remains a serious concern for particular population groups and regions.

Rural areas are worse affected than urban areas. The Western region fares amongst the worst due to its remoteness, and the severe climatic conditions. Under-five mortality rates are higher in Ger communities due to the lack of electricity, access to clean water, health care and knowledge of appropriate feeding, sanitation and health care practices.

The causes of under-five mortality include factors linked to infant mortality as well as those that affect older children. The main causes of infant mortality are respiratory diseases, diarrhea, asphyxia, low birth weight, short spacing between births and the young age of mothers. Important factors affecting both child and infant mortality are deterioration in, low quality of, and access to health services, especially in rural areas. Poor living conditions, including access to electricity and low levels of parental education, in particular mother's education are also contribution factors. The links between child mortality and education, general and reproductive health, nutrition, housing and water/sanitation are very close.

Immunization in Mongolia

The successful immunization program in Mongolia is a model for developing countries with limited resources. Family doctors, doctors in soums and bags, and nurses organize the child vaccination program. Systematic publicity and awareness-raising campaigns have succeeded in gaining the support of national and local leaders. In 2001, at the initiative of the President of Mongolia, Parliament passed the Law on Immunization. Ten-day long campaigns are organized biannually on a national level. The public participates actively including street children. Rural areas and soums are provided with cooling equipment for vaccines and doctors are provided with reliable transport. Over the last 10 years the number of immunized children has increased steadily and reached over 90% and a range of infectious diseases have been steadily reduced. Thanks to successful implementation EPI program over the 40 years, there has been no case of death due to measles over the last 7 years (since 1993). Polio was eradicated and the country became the polio free country in 2000. Moreover, there was no case of neonatal tetanus over the last 20 years in Mongolia.

Challenges

Sustaining the progress in reducing under- five mortality will entail meeting a number of core challenges:

Infant Care Measures. Neonatal care and essential newborn care programmes implemented nationwide.
Child Health Programs. Integrated childhood health programmes extended to the national level.

Addressing Urban/Rura land Regional/Spatial Disparities. Maintaining the rate of reduction in under-five mortality will entail focusing increased attention on rural areas, Ger districts and particular regions where rates are higher. Major challenges the Government faces is a unequal access to quality health services and inequity in health status between urban and rural areas. Most of the health resources are concentrated in urban towns, particularly in Ulaanbaatar, while rural areas have shortage of medical personal, poor conditions and lack of necessary medical equipment and supplies. Consequently, child mortality rates and incidence of maternal deaths are consistently higher in rural areas than in urban towns, which indicates rural people have not benefited equally from health services improvements.

Improving Parental Education. Given the close association between education and child mortality, it will be critical to introduce educational programmes which address issues of neo-natal care, utilization of available services, feeding practices, nutrition, child health and care.

Promoting Reproductive Health. The linkages between fertility levels, birth spacing, and mother's age and child mortality attest to the importance of an effective implementation of the National Reproductive Health Programme, which promotes reproductive rights based on informed choice.

Addressing Neo-natal and Child Health Care. Establishing conditions for providing quality and accessible health care with emphasis on fetal, infant and child health issues.

Criterion 1990 2000 2015 Under-Five Mortality Rate (Per 1000 Live Births) 87.5a (1995) 42.4a (1998) 29.2c Infant Mortality (per 1000 Live Births) 64.4b (1995) 32.8b - Percentage of Children below age 1 Vaccinated against Measles 85.2d 92.4d - a. Ministry of Health, Health Sector of Mongolia:80 years, 2002 b. NSO, Statistical Yearbook, 2000, 2001 c. MDG Target d. Immunization team reports of the Study Centre of Infection Diseases, 1991-1995, 2000