Mongolia: Future Threshold Adolescent Centres Increase Choices and Opportunities for Adolescents

The town of Tsetserleg in Arkhangai aimag is about 400 kms west of Ulaanbaatar

Mongolia, remote and roadless, is wedged between Russia and China in Central Asia. Half of the country consists of the Gobi Desert, shared with China, the rest is short-grass steppe that gives way in the north to forests of larch and birch laced with pristine rivers. It is the last frontier in this part of the planet.

Mongolia is an anomaly in crowded Asia. With 2.5 million people spread out across 1.5 million square kilometers of land – an area roughly the size of western Europe – it is the most sparsely inhabited country in the world. Mongolians are vastly out-numbered by their animals – 30 million camels, sheep, goats, yaks and horses share this primeval landscape with 3 million wild ungulates (mostly Mongolian gazelle).

Driving out of the capital Ulaan Baatar, which harbors close to 40% of the entire population, is like going back in time. Before agriculture began to root people to the earth. Before towns sprang up along caravan tracks. Before empires rose and fell. Before commerce and trade tied distant peoples together. Before the earth began to shrink.

Much of Mongolia's 1.5 million square kilometers consists of short grass steppe.

Some 400 kms west of Ulaan Baatar, the town of Tsetserleg is nestled in a high wooded valley. In June 2003 the first Future Threshold Adolescent Center in Arkhangai Aimag (Province) opened its doors here. The Center is one of eight in the country that delivers adolescent friendly health services and counseling to teenagers and young people. Though this project is part of UNFPA’s regular country programme, the Centers are also one component of a broader inter-agency initiative that aims to:

• Provide better quality reproductive health services for adolescents;
• Introduce comprehensive reproductive health education in secondary schools;
• Set up Student Councils in schools;
• Educate communities, especially parents and local officials, of the need for adolescent friendly health services;
• Train adolescent peer counselors on health issues;
• Design and distribute information and education materials more relevant to the specific concerns of adolescents.

This integrated programme – Improving the Outlook of Adolescent Girls and Boys in Mongolia – involves UNFPA, UNICEF, UNESCO and WHO working together as partners, with overall funding provided by the United Nations Foundation. The two main government counterparts are the Ministry of Health and the Ministry of Science, Technology, Education and Culture.

Tsetserleg was a good choice for the Future Threshold Center, since a full 26% of the entire population of 97,000 consists of adolescents between the ages of 11 and 19. And before this Center was established, there were no reproductive health services or information tailored to the needs of adolescents in the entire aimag.

Routine health check from the Center's medical doctor.

Dr. Dagvasumberel, head of the health department in Arkhangai aimag, was instrumental in getting the Future Threshold Center established in Tsetserleg and in the nearby county of Erdenemandal. “We have high rates of maternal mortality and teen pregnancies, compared with the rest of the country,” he points out emphatically. “We fought for this project because the needs are so great in this province. Now everyone understands the need for adolescent friendly health services.”

The Center has three full time staff: a medical doctor, a counselor and a receptionist. The response from adolescents and the community has been overwhelming. “During our first three months of operation, 500 adolescents, mostly girls, utilized the clinic’s reproductive health services, 86 came in for specialized counseling, and we distributed over 1000 condoms,” points out Dr. Naranchimeg, the Center’s ebullient medical doctor. “I inserted 30 IUDs during this time, and prescribed birth control pills for another 67 young women. Girls as young as 16 come in for pregnancy tests. We have a very busy schedule.”

Narantsatsarralt, left, talks with a fellow Board member at the Center.

Like other Future Threshold Centers, this one has a Teen Board, consisting of 8 adolescents – five girls and three boys. The Board meets once a week to discuss their work plan, including progress on an outreach campaign. They design and distribute their own posters advertising the services of the Center, but their campaign materials also draw attention to major issues such as how to prevent STIs (sexually transmitted infections), HIV/AIDS and unwanted pregnancies.

Narantsatsarralt, a Teen Board member, is a lovely 18 year old, with raven hair and an engaging personality. “This project has changed my life,” she says matter-of-factly. “We all face problems, but I have learned how to be more open, communicate with others and help my peers understand important issues, like gender roles and relationships. I am now popular in school and have many friends.”

She is recognized in school as a source of information on teen concerns – love, dating, puberty, relations with parents and responsible sexual behavior, among others. “I do have a boyfriend, but we haven’t had sex yet. When we do, we will use contraception. I want to be a role model for others in my community,” she continues, “and help improve our lives.”

Bold-Orgil, 14, one of Narantsatsarralt’s fellow Teen Board members, agrees with her views. “I can’t think of anything more important than the work I do here at the Center,” he says. “The sexual health issues we deal with are absolutely vital, they shape our outlook, our lives.”

Thanks to the work of the Center’s doctor and local officials, Arkhangai has included the costs of running this Center (and the one in Erdenemandal) as part of the province’s annual budget. “So now,” says Dr. Naranchimeg, “we have a sustainable initiative that is immensely popular with both adolescents and the entire community. And it is a model for other aimags in the country that want to set up their own adolescent health Centers.”

The Center has become much more than a health clinic. It is used by Teen Board members and others as a place they can come to “hang out”, read their favorite publications, including the highly popular quarterly newspaper, “Love,” and share their problems and concerns. For Narantsatsarralt the Center is a home away from home. “ I feel comfortable here,” she says. “The doctor is a role model for me. Because of this experience I want to go on to the university and become an adolescent doctor. Before becoming involved in this project, I had no such dreams.”

Ends.