Fighting to breathe in Mongolia

As air pollution gets worse, maternal health suffers

As air pollution gets worse, maternal health suffers
Altanchimeg, 34, holds her 3-month-old daughter, who was born prematurely, at their home in Ulaanbaatar on Sept. 30, 2015.

It’s September, the morning after the first snowfall of the season, and Otgontuuya already knows that winter will be brutal. She sits on a pink plastic chair in her living room, takes off her thick jacket and breast-feeds her crying toddler. She has just gotten home, having walked across the uneven dirt roads overlooking the city, where the white ground is slowly turning a slushy gray. Even when the weather is nice, sharp turns and steep inclines often make it impossible for off-road vehicles to reach her neighborhood.

Otgontuuya is 28, and like most Mongolians, goes by only her first name. She is married, a stay-at-home mother who spends her free time sewing traditional tunic-like clothes for her kids. “I live for my children,” she says, rocking her 1-year-old daughter in her lap.

Along with freezing temperatures, winter brings memories of the child that never came. Six years ago, Otgontuuya was informed during a routine checkup that her baby had stopped growing. She miscarried at 12 weeks.

The culprit, doctors told her, was air pollution.

Her story isn’t unique; she has heard many accounts of expectant mothers who have suffered miscarriages because of Ulaanbaatar’s devastating air quality.

“It’s been here for many, many years,” Otgontuuya says, “but the problem is that no one really cares.”

Otgontuuya, 28, inside her home in Songinokhairkhan district with her son, left. Children play outside their yurt in Khaan-Uul district. Khaan-Uul is near a coal plant, shown below. (Click to enlarge images)

Ulaanbaatar is the coldest capital in the world, and about 60 percent of its 1.5 million residents live in combinations of brick housing and traditional felt gers, or yurts, in informal settlements on the outskirts of the city. The sprawling, haphazard ger districts lack sanitation, sewage systems, electricity and central heating. Instead, residents use iron stoves and burn plastic, rubber, trash and cheap coal. Smoke covers the city in a dense, impenetrable fog. During winter, which lasts from November to February, the city is so blanketed by fog that it looks like 17th century England.

The pollution dates back to 2000, when a mining boom made Mongolia one of the world’s fastest-growing economies. When harsh winters known as dzuds killed off entire herds of livestock, rural nomads began migrating to Ulaanbaatar in search of health care, education and economic opportunities. Settlers took gers and traditional stoves, bought plots of land and set up their homes, and as their density increased, so did air pollution. By 2010, the capital had more than 800,000 new residents, and the World Health Organization ranked it the second-most-polluted city in the world, just after Ahvaz in Iran. Two years later, a World Bank Study found that toxin levels in Ulaanbaatar’s ger districts were 10 times higher than permitted under Mongolia’s air quality standards.

Pollution from coal is known to cause health issues such as asthma, pneumonia, heart disease, lung cancer and even premature death. A 2011 study by researchers at Simon Fraser University in Burnaby, Canada, showed that 1 in 10 deaths in Ulaanbaatar is connected to air pollution. Now focus is shifting to the links between air pollution and women’s maternal health. A 2014 report by the Saban Research Institute of the Children’s Hospital of Los Angeles found “alarmingly strong statistical correlations between seasonal ambient air pollutants” and pregnancy loss in Mongolia. The study, which looked at data collected from 10,000 women, established a connection between seasonal patterns and miscarriages: The number of spontaneous abortions jumped from 23 per 1,000 live births in May to 73 per 1,000 live births in December, when temperatures have been known to drop to –40 degrees Fahrenheit.

Inside the Bayan Beger health center in the Songino-Khairkhan district, Sept. 28, 2015. (Click to enlarge images)

Though the impact of pollution on pregnancies has not been studied in depth, these findings confirmed the beliefs of Delgerzul Lodoisamba, a professor of environmental health at the Health Science University of Mongolia. She says she has observed that miscarriages are more common from November to January, when toxin levels in the air are higher. “It seems like if you get pregnant within those three months, it’s not possible to carry to full term,” she says. “Our government encourages women to have more babies, but they don’t pay attention to how and if the children come out healthy.”

At the moment, the influx of migrants, along with their gers and stoves, is not stopping. And there is little infrastructure in place to help women in ger districts get the care they need during pregnancy.

In the Songino-Khairkhan district, a nondescript white building serves as the first stop for nearly 15,000 residents when they want medical attention. Six doctors and four nurses work at this local clinic, and for many women, the only way to reach it is by walking long distances. Because of these obstacles, nurses say that pregnant women often wait until the last minute to be seen by medical professionals.

The majority of new arrivals do not register with local administrations and aren’t informed about clinic procedures, so it’s common for women to experience significant delays in receiving medical care. “Most of the people who have migrated, they settled here without permission,” says Yamsuren, a nurse who works in the clinic. “We just can’t access the pregnant people.” This makes it harder to treat many of the pollution-related problems that the clinic routinely addresses, from premature delivery to respiratory issues to low birth weight. In the ger districts, babies are born with everything from hypoxia, in which the fetus doesn’t receive enough oxygen, to cleft palates and more severe birth defects, such as underdeveloped organs and developmental problems.

Taivanjargal, 37, top, is a pregnant mother of five. She and her husband also care for a child they adopted from her sister. Two of her children play near the ger where the family lives, left. Dari Eh district in Ulaanbaatar, right. (Click to enlarge images)

Taivanjargal, 37, lives with her husband and six children in a ger on top of a steep hill overlooking Ulaanbaatar’s Khan-uul district. She’s pregnant and due to give birth in December. She is increasingly worried about her baby’s health, as doctors have warned her that the newborn might experience severe developmental difficulties. “All the pregnant women here, they always talk about how pollution causes problems, that it causes both their children and them to be sick,” she said. “We can’t see anything outside in the winter because there’s so much smoke. All the children and their clothing smell of smoke, and they often get sick.” She has already experienced some effects of the pollution. One of her boys suffered neurological problems and anemia; he eventually improved after receiving treatment from an international nonprofit group.

In 2013, Ulaanbaatar approved plans to upgrade water, sewage and road infrastructure in the ger districts — which would give residents better housing and access to services. The plan would turn some ger settlements into apartment buildings. This means that residents, through land swap agreements, would get apartments with central heating, running water and sanitation services in exchange for giving up their land. Reaction to this proposal has been divided, since many families live on shared plots of land and there’s concern that the arrangement would leave some residents homeless.

Bolormaa breast-feeds her 8-month-old son inside the ger where they both live with her sister, left. Uyanga, 19, walks outside the ger where she lives with her husband and 2-month-old baby. (Click to enlarge images)

Bolormaa, 29, who lives in a ger district and suffered respiratory problems last winter during her pregnancy, dreams of living in a warm apartment. “The children would be healthy. There would be no pollution, no dirt. I wouldn’t have to worry about running water and the coal,” she says. “As a woman, it would be a very good, clean environment for me.” But her brother owns the land she lives on, and she worries that she might no longer have a home if he accepts the government’s offer to exchange his land for an apartment.

As temperatures rapidly drop and yellow bags of coal pile up along the roads of the ger districts, talk among residents anxiously turns to 2016’s designation as the year of the monkey. According to the Chinese zodiac, a monkey year brings severe and devastating winter weather, so some people are intent on leaving their gers by any means necessary.

Uyanga sits in her new ger with her baby, top. Enkhzul, 37, dresses her infant son, left, and sits with her family in the basement apartment they occupy in a building in the Khan-Uul district. (Click to enlarge images)

After living in gers for many years, two months ago, Enkhzul, a 29-year-old beautician, moved her husband and three children into a cramped, windowless basement apartment. She often hears tenants drunkenly fighting on the ground floor, and the damp environment has given her 2-month-old bouts of diarrhea. Still, she says, the basement is much better than a ger.

“It was difficult because there was smoke everywhere. Here it’s much better because we have central heating,” she says, changing her crying son’s diaper. He’s bundled on a mattress, their one piece of furniture, beneath a poster that reads “Happy childhood.”

Across town, Otgontuuya is in the waiting room of the Blue Skies Day Care Center, the only free day care in the city. She is dropping off her daughter, the child who made everything better again after she lost her first baby.

She dreams of having more children and of giving them a good life. Growing up, she went days on end without food or proper clothing, and she wants to make sure her children avoid that. But she knows the future will bring a different set of problems.

“Yes, of course I am worried about the air pollution,” she says. “But what can I do? I just have to take the risk.”

This article was made possible through a reporting fellowship from the International Reporting Project.

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