A mother with hearing and speech impairments told us that when she went to a maternity hospital to give birth, there was no sign language interpreter available. Despite being able to deliver naturally, she was taken directly for a Caesarean section without being consulted, under the pretext of preventing potential risks. Because of communication difficulties, doctors and nurses were unable to accurately assess her condition.

“The truth is that doctors and medical staff find it inconvenient to communicate with mothers with disabilities. It is no secret that, as a result of decisions made unilaterally by medical professionals, mothers often give birth in fear and anxiety, without understanding what is happening during labour or why they are undergoing surgery. The facilities and equipment in maternity hospitals remain inaccessible, particularly for mothers who use wheelchairs or have physical disabilities affecting their mobility. Examination tables and delivery beds are not adapted to the needs of people with disabilities. Mothers with back or hip conditions are required to give birth in standard positions, even though this can cause severe pain and potentially lead to injuries. We often discuss these issues among ourselves, but nothing seems to change,” said the woman.  

She then continued, “Society widely assumes that women with disabilities should not be sexually active or have children in the first place. In particular, doctors and other medical professionals, despite having taken an oath to care for patients, can be even more dismissive and discriminatory than ordinary people. Psychological abuse is common, with remarks such as, ‘You can barely take care of yourself, and now you’ve gotten pregnant’, or, ‘Will you be able to care for and support your child?’ The situation is even worse for women with intellectual disabilities or those who have difficulty expressing themselves. They are often provided with inadequate examinations and services, or medical decisions are imposed on them without allowing their family members to be present. Such practices seriously violate their rights.”

It was further provided that “Having a disability does not mean a person is incapable of making independent decisions. It depends on the nature of the disability. This is a deeply misguided attitude that has become entrenched in society”. 

65% SUFFER PHYSICAL AND PSYCHOLOGICAL ABUSE

Access to reproductive healthcare for girls and women with disabilities, particularly their right to receive appropriate care during childbirth, remains inadequate in Mongolia and continues to be a major concern.

Monitoring activities, research and reports by the National Human Rights Commission of Mongolia (NHRCM) and civil society organisations have repeatedly exposed the challenges faced by mothers with disabilities. In other words, shortcomings in maternity hospital services, the attitudes and conduct of medical staff, and the failure to provide patients with adequate information have been documented in numerous human rights studies. Although recommendations and guidelines have been issued and deadlines set for addressing violations, obstetric violence against mothers with disabilities, including cases of forced surgical intervention, continues unabated.

A study published by NHRCM four years ago, titled Sexual and Reproductive Health and Rights of Women with Disabilities, provides a detailed account of the difficulties they encounter when seeking medical care. According to the study, 65 percent of the women with disabilities who had given birth and participated in the survey had experienced some form of physical or psychological abuse at maternity hospitals. Of the remaining respondents, 12.5 percent rated the attitudes and conduct of medical staff as poor, while 4.8 percent said they had received no advice about childbirth. Another seven percent reported that no suitable beds or equipment were available for them, and 4.8 percent said they had been unable to use the toilets.

As a result, the women said they were afraid of having to return to a hospital. From the beginning of pregnancy and throughout prenatal care, childbirth and the period after delivery, when they must care for their babies, women with disabilities are forced to navigate a storm of inaccessible facilities, communication barriers, neglect and discrimination.

CHILDREN ARE ALSO DENIED MEDICAL CHECK-UPS  

Becoming a mother is one of the most delicate, precious and responsible moments in a person’s life. Pregnant women therefore need professional care, a safe environment, doctors who understand their pain, respect for their choices, and compassion and support. For women with disabilities, accessible facilities, equipment, information, services and support tailored to their specific needs are equally essential. This is not about receiving special privileges, but about having equal access to healthcare.

Yet mothers with disabilities continue to be denied their rights, and the difficulties and barriers they face in accessing reproductive healthcare remain unresolved, according to the Report on the Human Rights and Freedoms Situation in Mongolia, presented by NHRCM in April.

The report’s chapter on “The Implementation of the Right to Health Protection and Access to Healthcare Services” noted that inspections conducted by the sector’s supervisory authority at 1,109 healthcare facilities between 2023 and 2025 had revealed inadequate quality and accessibility of healthcare for women with disabilities during pregnancy, childbirth and the postnatal period. The NHRCM confirmed, through the Ministry of Health’s official letter No. 3/1185 of 2026, that the rights of mothers and children with disabilities were not being upheld and that medical care standards were not being met.

For example, 23 percent of primary healthcare facilities, which are supposed to provide initial medical care, had failed to maintain registries and records of women of reproductive age with disabilities, give them special attention, or provide family planning services.

Meanwhile, 11 percent had failed to comply with standards requiring expectant mothers living in remote areas to be accommodated in maternity waiting homes or transported to hospitals before their due dates. Another 23 percent had failed to provide early pregnancy screening, refer women to specialist care in a timely manner, or give them adequate attention.

Although newborns should receive at least six home visits during their first two months, with medical assessments conducted at each visit, 46 percent of healthcare facilities had failed to fulfil this obligation. Furthermore, 53 percent had not conducted monthly examinations, screenings and follow-up visits for infants aged two to 12 months, nor had they implemented the standard requiring annual monitoring and assessments.

These findings demonstrate that a proper system has yet to be established to register and monitor expectant mothers with disabilities from the beginning of pregnancy, plan the necessary healthcare services, assess risks and refer them to appropriate levels of medical care, the report stated.

The research also included the testimony of a woman who was turned away when she visited her local hospital for prenatal care. She was warned that the doctor would not be held responsible if complications arose, a remark that amounted to a threat. When a pregnancy is considered high-risk, the patient should be referred to a higher-level healthcare facility. Instead, the doctor made a decision based on personal opinion and refused to provide care outright, leaving the woman with little choice but to file a complaint.

Pre-emptively concluding that a woman with a disability is unfit to become pregnant or give birth is an unacceptable clinical error. Such a determination must be based on thorough professional examinations and diagnostic tests, followed by the necessary monitoring and care. Disability itself must never be grounds for refusing medical assistance, as international clinical guidelines also emphasise.

ENVIRONMENTS THAT ALLOW WOMEN TO MAKE INFORMED CHOICES

An incident involving a woman with a visual impairment highlights another problem with prenatal care. When she attended a childbirth preparation class alongside other expectant mothers, the doctor taught the exercises by demonstrating the movements and explaining them visually. This approach was inaccessible to her and left her feeling humiliated.

Although she could hear instructions such as “Raise your arms like this” and “Stretch your legs in that direction”, she could not see the movements and was therefore unable to imitate and practise them, she said.

All women preparing to give birth at that maternity hospital had been included in the class, but the information had not been delivered in a format accessible to everyone. She emphasised that this had effectively placed her at a disadvantage and exposed her to discrimination. Moreover, maternity hospitals in Mongolia have yet to introduce Braille signage and other Braille-based accessibility measures.

Women with hearing impairments also face restrictions on their ability to communicate their pain during labour, answer doctors' questions, receive information about their own and their babies’ conditions, and make decisions about procedures and treatment.

Although staff at the First Maternity Hospital reportedly sent a few nurses and care assistants for sign language interpreter training in 2022, no maternity hospital in Mongolia currently has an official sign language interpreter. Without addressing such basic communication barriers, discussing improvements to other aspects of accessibility seems premature.

Mongolia has approximately 108,000 people with disabilities. Women account for 45 percent of this population, and more than 38,000 of them are of reproductive age. Yet violations against these women during childbirth persist. To speed up labour, medical staff sometimes cut their perineums without justification or consent, perform Caesarean sections without permission, hit or slap them, verbally abuse them and discriminate against them.

Pressuring women to undergo Caesarean sections because of their physical disabilities, or failing to provide them with adequate advice and information, is inconsistent with the principle of person-centred healthcare.

The World Health Organization (WHO) particularly recommends that when patients have difficulty expressing themselves, healthcare providers should choose appropriate communication methods and tools from among the available options.

It is worth noting that the WHO’s recommendations on a positive childbirth experience call on countries to ensure that all women receive care in an environment that protects their dignity, privacy, confidentiality and safety, free from mistreatment and violence, and where they are able to make informed choices.

To be continued.