Por Renan Filho · 2026-11-06
**Lead**
A midwife in a rural Mongolian province delivers a baby by lamplight, miles from the nearest hospital with a functioning operating theatre. In the capital, Ulaanbaatar, a young mother bleeds out on a gurney because the blood bank ran short of her type. These are not isolated tragedies: Mongolia’s maternal mortality ratio – roughly 45 deaths per 100,000 live births – is nearly seven times higher than the United Kingdom’s and has barely budged in a decade, despite rapid economic growth and billions of dollars in mining revenue. For Britain, where maternity care is already creaking under budget constraints and a shrinking workforce, Mongolia’s struggle is a distant but instructive case study in how economic policy, infrastructure spending and workforce planning must align to make childbirth safe.
**Contexto**
Mongolia presents a stark paradox. The country’s GDP per capita has more than doubled over the past fifteen years, fuelled largely by coal and copper exports to China. Yet improved national wealth has not translated into uniformly better health outcomes for mothers and newborns. According to figures from the World Health Organization and the United Nations Population Fund, Mongolia’s maternal mortality rate has plateaued at around 45 per 100,000 live births since 2015, whereas neighbouring Kazakhstan and China have recorded steady declines. A major 2022 report by the Mongolian Ministry of Health, supported by the Asian Development Bank, identified three structural bottlenecks: a critical shortage of skilled birth attendants in rural areas, chronic underfunding of emergency obstetric care, and a fragmented referral system that leaves women in labour travelling hundreds of kilometres in search of a caesarean section.
The economic dimension is impossible to ignore. Mongolia spends roughly 4% of its GDP on health, well below the global average of 6% and far behind the OECD benchmark of 9%. The government’s Health Sector Development Programme, launched in 2023 with a budget of around $150 million, aimed to equip every soum (district) health centre with basic emergency obstetric facilities and to train an additional 500 midwives by 2026. Yet implementation has been slowed by bureaucratic inertia and the diversion of funds towards prestige infrastructure projects in Ulaanbaatar. The result is that while the capital now boasts three modern maternal hospitals equipped with neonatal intensive care units, provinces such as Khövsgöl and Bayan-Ölgii still rely on a single doctor to cover a territory the size of England.
For the United Kingdom, this pattern resonates uncomfortably. The Royal College of Obstetricians and Gynaecologists (RCOG) has repeatedly warned that UK maternity units are operating with staffing levels below safe thresholds, particularly in rural areas of Wales, Scotland and the South West of England. A 2025 report by the National Audit Office noted that England alone faces a shortage of roughly 2,500 midwives, and that the closure of smaller delivery units has forced women to travel longer distances for care. While UK maternal mortality stands at just 6 per 100,000 – a figure that ranks among the lowest in the world – the trend is not uniformly positive. Late maternal deaths, those occurring up to a year after childbirth, have risen, and the gap between outcomes for white women and women from ethnic minority backgrounds remains stubbornly wide. Mongolia’s experience suggests that economic growth alone does not automatically fix these fractures; deliberate, sustained investment in the maternity workforce and transport infrastructure is required.
**Analise**
What does Mongolia’s struggle tell Britain about the economics of safer childbirth? First, that maternal health spending offers an exceptionally high return on investment. Every pound spent on skilled birth attendance and emergency obstetric care reduces downstream costs in neonatal intensive care, disability support and lost economic productivity. A 2023 study published in The Lancet Global Health calculated that every maternal death prevented in low‑ and middle‑income countries saves the equivalent of two years of per‑capita GDP in lost future earnings. For middle‑income nations like Mongolia – and even for high‑income countries facing austerity – this argues against cutting maternity budgets precisely when the health system is most strained.
Second, the link between geography and outcome is becoming an economic issue in its own right. As the UK continues to centralise maternity services in larger hospitals – a trend driven by clinical safety arguments and cost savings – the cost to rural families rises: higher transport expenses, more time off work for partners, and added childcare for other children. The Office for National Statistics has documented that women in the most deprived areas of England are nearly five times more likely to die in childbirth than those in the wealthiest areas. Mongolia, where the urban‑rural divide is even starker, shows that failing to address these regional disparities entrenches inequality and undermines the labour market participation of women – a key driver of long‑term economic growth.
Finally, Mongolia’s reliance on extractive industries poses a cautionary tale for any country whose health budget is tied to commodity cycles. When copper and coal prices slump, as they did in 2020 and again in early 2025, health spending is among the first areas to be squeezed. Britain, with its diversified economy, is less exposed to such volatility, but the principle remains: childbearing women deserve a health budget that is resilient, predictable and protected from short‑term fiscal manoeuvring.
**Fontes**
World Health Organization, trends in maternal mortality 2000–2023. UNFPA Mongolia country programme evaluation (2024). Asian Development Bank, Mongolia health sector assessment (2022). Royal College of Obstetricians and Gynaecologists, workforce report (2025). National Audit Office, maternity services in England (2025). The Lancet Global Health, economic impact of maternal mortality (2023). Office for National Statistics, maternal mortality by deprivation decile (2024).