ULAANBAATAR, MONGOLIA — On a March evening in 2021, the TV news shared a warning from the Ministry of Health: “It is recommended for pregnant women not to get vaccinated against COVID-19.”
A 32-year-old woman, watching the broadcast just moments after rejoicing at the two clear lines on her home pregnancy test, began to panic.
Оyunkhand Bayartsog had gotten her first shot, as required by her employer, before realizing she was pregnant — or that there could be any conflict between the two, both of which had been planned for months. The first doctor she called advised her to have an abortion; she called five more, hoping for a different response, but none could assure her that all would be well.
“As there have not been any newborns globally since the coronavirus vaccination started, it has not been studied yet,” she recalls of their warnings. “This is new, so no one can guarantee that a healthy infant would be born.”
For the first four months of Mongolia’s COVID-19 vaccination campaign, the Ministry of Health included pregnant women among groups that should not be vaccinated. Even when the warnings were lifted on May 27, 2021, based on international research confirming the vaccine’s safety, public fears persisted — leading to a plummeting birth rate and spike in maternal deaths.
“People mostly trust negative information spread through friends and social media,” says Dr. Munkhtsetseg Davaatseren, dean of the Obstetrics and Gynecology Faculty at the Mongolian National University of Medical Sciences and member of the Ministry of Health’s clinical advisory team on coronavirus care. “When hearing what professionals and doctors have to say, they usually take condescending or defensive attitudes. This happens not only in Mongolia but also globally.”
As COVID-19 vaccinations became available around the world, public health officials offered contradictory advice for pregnant women. By mid-2021, 47 countries, including Mongolia’s northern neighbor, Russia, advised against the vaccine; 22 countries, including the United States, explicitly recommended vaccinations for them; and the rest, including Mongolia’s other neighbor, China, remained neutral.
By March 2022, only 16 countries still recommended that pregnant women avoid vaccination, while 104 countries recommended vaccinations, according to the COVID-19 Maternal Immunization Tracker, a tool developed by the Berman Institute of Bioethics & Center for Immunization Research at Johns Hopkins University.
Mongolia’s plummeting birth rate is a setback for a country that has spent two decades working to improve this metric.
In 2005, the country’s birth rate had fallen to 1.95, the lowest in its recorded history, due to factors including poverty, health challenges and regional conflicts, according to the National Statistics Office of Mongolia. Concerned about the long-term impacts of a declining birth rate on the country’s labor force, economic growth and social welfare system, the government instituted pro-birth policies, including special awards for mothers with four or more children, and cash allowances of 3,000 Mongolian togrogs ($1) per child that year. The per-child payment grew to 20,000 togrogs ($7) in 2012, then was raised to 100,000 togrogs ($34.50) in April 2020 in response to the pandemic.
Despite these efforts, the birth rate fell to a 14-year low in 2021. According to the Center for Health Development, the number of abortions also decreased, indicating that families were delaying rather than terminating pregnancies.
At the same time, the maternal mortality rate was also three times higher in 2021 compared to 2020, with close to 70% of maternal deaths stemming from COVID-19 complications. The medical community has connected this spike to the country’s low vaccination rate among pregnant women and the misconception that the virus was no more dangerous than a common cold, Munkhtsetseg says.
URANCHIMEG TSOGKHUU, GPJ MONGOLIA
Weighing the risks of vaccination versus contracting COVID-19 while pregnant caused high anxiety for women like Oyuntugs Ider.
“Because I heard about several mothers dying of COVID-19 before, I cried out of fear when I first came in close contact with the virus,” the 33-year-old says.
Her decision felt easier after the local hospital in Umnugovi province, which has led the country with a 91.6% vaccination rate, reached out to answer her questions and urge her to get vaccinated.
Another woman who faced a tough decision is 26-year-old Saruul Tserendorj, who discovered she was pregnant in December 2021 after having received three vaccine doses — including one a few weeks earlier. She opted to end her pregnancy in January, even though the Ministry of Health had stopped warning pregnant women against vaccinations eight months earlier.
“I was afraid that it might lead to giving birth to a deformed infant,” she says. “Many people were commenting on my Facebook that I might give birth to a baby with a cleft lip or a cleft palate, so I discussed with my husband and decided to go through abortion.”
URANCHIMEG TSOGKHUU, GPJ MONGOLIA
They already have one toddler, born during the first year of the pandemic, and still plan to have more children — after the pandemic is over.
“My husband calmed me down by saying that as we are young people, we will have a healthy baby in peaceful times without anything to worry about in the future,” Saruul says.
This sentiment gives government officials hope that last year was a temporary setback in their two-decade effort to encourage childbearing.
Oyunkhand decided against abortion after one doctor — out of the seven she ultimately consulted — advised her that among the unknown side effects of vaccination on a fetus, one outcome could be stronger immunity for the baby.
“This gave me hope to give birth to my child,” she says, adding that she also received her second shot while pregnant.
After contracting a mild case of the disease during her third trimester, she welcomed a healthy baby girl in November 2021. But before they could leave the hospital to join her husband and two older children at home, she says, she had to recover — not only physically but also from the mental and emotional stress she had endured.
She says, “I just wanted to calm down and take a deep breath.”