Maternal and Child Health Handbook promotes antenatal care visits

April 08, 2015

Every year, 300,000 pregnant women and 2,600,000 newborn babies are estimated to die worldwide, and more than 99% of these deaths occur in developing countries. Effective interventions to reduce maternal and neonatal mortality are critically needed, and an ongoing challenge for researchers and health professionals is finding the best way to deliver these interventions in resource-limited settings such as Mongolia. Antenatal visits can provide the first opportunity to deliver these interventions. Now, a new study has shown that Japan's flagship intervention, the Maternal and Child Health Handbook, helped to increase antenatal care visits, identify complications earlier in pregnancy and reduce passive smoking in Mongolia.

The study is available online on 9th April in the journal PLOS ONE. Dr Rintaro Mori, Director of Health Policy at the National Center for Child Health and Development (NCCHD) in Japan, led an international collaborative team of researchers from the NCCHD, the Ministry of Health in Mongolia and other institutes in Japan to conduct a cluster-randomized controlled trial of the Maternal and Child Health Handbook in Bulgan, Mongolia.

The Handbook was first implemented in Japan in 1947 and has since developed into an effective tool to enhance client-provider communication about health, raise health awareness, identify complications earlier in pregnancy, and promote antenatal care visits. Other countries have also adopted the Handbook in recent years. This cluster-randomised trial of the translated Handbook was conducted between 2009 and 2010 to assess its effectiveness in promoting antenatal care attendance in Bulgan, Mongolia.

Pregnant women were recruited from 18 randomly allocated districts in Bulgan. The Handbook was implemented immediately for women at their first antenatal visit in the intervention group, and nine months later in the control group. In Mongolia, the national standard for antenatal care is a minimum of 6 visits. In this study, 82% of women in the intervention group attended antenatal clinics 6 times or more compared to 71% of women in the control group. Of the women who received the Handbook, 89% of women attended the standard number of antenatal care visits or more. Socioeconomic status affected the frequency of clinic attendance: women of higher socioeconomic status visited antenatal clinics more often. Pregnancy complications were 2.5 times more likely to be detected among women using the Handbook, and half of family members stopped smoking at home, thereby reducing the harm of passive smoking for expectant mothers.

D. Atarmaa, Deputy Minister at Ministry of Health and Sports commented "The Maternal and Child Health Handbook is well known among health professionals and parents of Mongolia as a "Pink" book, and is being used to monitor health of pregnant women and children. Initially the handbook was used in Bulgan aimag but now is being used one of the essential documents in the primary health settings in Mongolia. The handbook has a significant contribution to improve maternal and child health by increasing involvement of parents, raising health awareness and enhancing communication between health providers and pregnant women."

Based upon the results of this trial, the Maternal and Child Health Handbook was implemented as a national policy in Mongolia. The Handbook's role in enhancing long-term information sharing via increased antenatal clinic attendance can make a valuable contribution to maintaining Millennium Development Goals 4 and 5 in developing countries.
Mori R, Yonemoto N, Noma H, Ochirbat T, Barber E, Soyolgerel G, Nakamura Y, Lkhagvasuren O (2015) The Maternal and Child Health (MCH) Handbook in Mongolia: A Cluster-Randomized, Controlled Trial. PLOS ONE 10(4): e0119772. doi:10.1371/journal.pone.0119772

Contact details:

For comment or interview, please contact: Rintaro Mori: Tel: +81 (3) 3416 0181, email:

Press officer: Daisuke Yoshida: Tel: +81 (3) 3416 0181, email:

National Center for Child Health and Development

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