Tell us about Marie Stopes Mongolia.
Marie Stopes Mongolia uses social marketing, selling condoms and other methods of contraception in order to promote family planning and safe sex practices across Mongolia.
The population of Mongolia is 3 million and we sell over 5 million TRUST condoms a year. In 2015, Marie Stopes Mongolia reached 50% of Mongolia’s total contraceptive users, reaching 70% condom market share.
Is unsafe abortion an issue in Mongolia?
Although abortion is legal in Mongolia, in practice various obstacles prevent small clinics from obtaining accreditation. On one hand, this prevents under-equipped, inexperienced and untrained practitioners from harming clients, but on the other hand, dedicated and highly professional clinics such as our centres have been blocked from accreditation for years, as they are not ‘hospital settings’ (i.e. large centres which operate 24 hours, with an accident & emergency department, blood transfusion facilities etc.) as the law stipulates they must be. Hence, only large government hospitals (and very few large private practices) qualify for this provision and they mostly exist in the more densely populated areas of Mongolia.
The result is that hospitals are under a huge amount of pressure and, due to low capacity, women can expect a long wait in-clinic or on a surgical waiting list. Some of these women feel they cannot wait, especially given gestation limits and unfortunately resort to illegal abortions either by buying abortion pills of unknown origin from black markets, or by going to small unaccredited clinics that perform illegal abortions at a high price.
In 2015 there were several maternal deaths and serious complications due to unsafe and illegal medical abortions, which served to draw government attention to this important issue. We are now working closely with the government, and have developed an excellent training program, which we are delivering across the country to educate providers on how to effectively, safely and legally provide medical termination of pregnancy services.
How have you been addressing the challenge of providing access?
We did not let restrictions on surgical abortion prevent us from providing choice to Mongolian woman. When we were refused abortion accreditation, we turned our focus and attention to offering women a new choice of safe abortion – medical abortion – which would not require them to wait on a surgical list.
We have worked relentlessly over the last 3 years and continue to do so – to train and educate doctors, who were largely ignorant about medical abortion, all across Mongolia about the benefits of this non-surgical option. We train practitioners, dispense the medication to control quality, and help to manage any complications our network of practitioners may face, which helps them confidently deliver excellent care to their patients.
As a result we have increased our reach by 99% compared to last year.
We are also collaborating with the Ministry of Health to tackle the issue of illegal medical abortion pills sold in black markets and premises that are not authorised for sales.
Who are your most important supporters or partners?
We work collaboratively and closely with the Ministry of Health, as they support and understand the Marie Stopes mission, particularly in the areas of family planning and STI education and prevention. The DANIDA (Danish International Development Agency) funding that was granted in 2014 has also played a major role in helping us expand access.
Of the programs, products or services delivered by Marie Stopes in your country, which one are you proudest of, and why?
Although I talked about our new medical abortion initiative, I am also exceptionally proud of our condom social marketing efforts. We have 70% of the total condom market in Mongolia and last year we sold 5 million condoms! The scale of our reach demonstrates our success in changing the attitudes and behaviours of the population when it comes to safe sex. Condoms are much less stigmatised these days and the younger generation is embracing their use.
If you had additional funds to invest in achieving ‘children by choice’ in Mongolia, what would you invest in? What is top of your wish list?
A state-of-art medical centre that offers the full range of modern contraception options and safe abortion choices to all women.
If you could tell just one story about, say, a passionate employee, a courageous patient, a dedicated midwife; whose story would you tell?
Munkhtsetseg Baatarkhuyag. Under Munkhtsetseg’s leadership, medical abortion is now a common safe abortion choice for Mongolian women facing an unwanted pregnancy. She successfully leads advocacy work and engages with major stakeholders to advance safe, non-surgical options for women here, which has contributed to a doubling of uptake of medication terminations. She is continuing to enrol more clinics into our network with her impressive people skills, team leadership and training programme. She is someone who truly walks the path of our mission, ‘children by choice,’ and is a valued Marie Stopes Mongolia team member.
What do you want to accomplish in the next 5 years?
50% reduction in unsafe abortions and a 60% increase in post-abortion family planning.