When Staying Is Not an Option: How Healthcare Access Drives Migration in Rural Mongolia
- Maral Erdene E
- Jan 24
- 5 min read
Updated: Mar 31
A Mother’s Journey
On a freezing winter morning in Arkhangai Province, Nomin packed a small bag and climbed into a neighbor’s truck. She was seven months pregnant and had no choice but to travel 200 kilometers over unpaved roads to reach the nearest hospital. The trip was risky, but she knew staying home was even more dangerous. Her village clinic lacked an ultrasound machine, and there were no doctors trained in complicated deliveries. If something went wrong, there would be no one to help her.
For thousands of families like Nomin’s, migration is not a matter of ambition or opportunity. It is a matter of survival. In Mongolia’s vast rural provinces, where healthcare is limited and medical specialists are scarce, the decision to leave is often made out of necessity, not choice.
The Hidden Crisis Behind Migration
When people think of migration, they often associate it with economic opportunity—a move to the city for better jobs or education. But in Mongolia, another force is quietly pushing families away from their homes: a lack of basic healthcare.
Mongolia’s healthcare system is heavily centralized, meaning most specialized medical services are concentrated in Ulaanbaatar. In many rural areas, hospitals are underfunded, short-staffed, and unequipped to handle anything beyond routine checkups. Pregnant women often travel hundreds of kilometers for prenatal care, herders with serious injuries struggle to access emergency treatment, and elderly patients with chronic conditions have no local specialists to turn to.
This healthcare gap forces families to make impossible choices: risk staying in a place where medical care is unreliable, or uproot their lives for the hope of better access in the city.
Two Mothers, Two Realities
To understand the impact of healthcare access on migration, I spoke with two mothers: one who left the countryside for Ulaanbaatar, and one who stayed behind. Their experiences reveal the stark gap between urban and rural healthcare and the difficult choices families must make.
Nomin, 27 – Arkhangai Province (Rural Mother Who Stayed)
Nomin sits in the small living room of her home, rocking her newborn daughter in her arms. The wood stove crackles, fighting off the chill of the early morning air. Her pregnancy was not easy, she had to travel over 200 kilometers to reach a hospital for prenatal checkups.
"I worried every day," she admits. "What if something went wrong? What if I went into labor early? There's no one here who can handle a complicated birth."
Despite the risks, Nomin and her husband chose to stay. Her husband is a herder, and their entire livelihood depends on their animals. Moving to the city felt impossible.
"If we left, how would we survive?" she asks. "At least here, we have land. In the city, we would be starting from nothing."
Yet, she doesn’t dismiss the idea entirely. Many of her friends have left, unable to endure the lack of medical care and opportunities for their children.
"Sometimes, I think about it too. But then I wonder—should we really have to leave our home just to feel safe?"
Saranzaya, 30 – Ulaanbaatar (Rural Mother Who Moved to the City)
Saranzaya’s life is different, but not necessarily easier. After a difficult first pregnancy in Zavkhan Province, where she had no access to an obstetrician, she and her husband decided to move to Ulaanbaatar before their second child was born.
"I still remember the fear," she says. "The nearest hospital was hours away, and we had no car. I was lucky nothing went wrong. But I knew I couldn’t go through that again."
Now in the capital, she has access to modern hospitals, specialists, and emergency care, but new struggles have taken their place. Like many migrants, her family ended up in a ger district on the outskirts of Ulaanbaatar, where infrastructure is poor and jobs are scarce.
"We left for safety, but now we have new worries," she explains. "The air pollution is terrible, the schools are overcrowded, and life here is expensive. We survive on my husband’s construction job, but it's not stable. Some months are good, some months are not."
Despite the hardships, she does not regret moving.
"At least here, I know that if my child gets sick, I can take him to a doctor," she says. "That peace of mind is worth everything."
The Choice No Mother Should Have to Make
Both Nomin and Saranzaya made the best decisions they could for their families, but their stories highlight a larger failure: no mother should have to choose between her home and her health.
For families like Nomin’s, staying means risking their well-being. For families like Saranzaya’s, moving brings new struggles. The solution isn’t to force people to leave or to struggle in place. It’s to create a Mongolia where staying in rural areas is a viable, safe option.
Investing in better regional healthcare, economic development, and stronger infrastructure would mean that families don’t have to uproot their lives just to access something as fundamental as medical care.
Until then, thousands more mothers will continue to face the same impossible choice.
More Than Just a Healthcare Problem
Even for those who make the move to Ulaanbaatar, the struggles don’t end. The city’s ger districts, informal settlements on the outskirts, continue to grow as more rural families arrive. These areas lack proper sanitation, reliable public transportation, and ironically good healthcare facilities. Instead of escaping hardship, many migrants trade one set of challenges for another, struggling to find stable jobs, affordable housing, and access to services they expected to improve.
The problem is clear: Mongolia’s migration crisis is not just about people leaving; it is about the conditions that push them away.
What Needs to Change?
If we want to slow the forced migration from rural areas, we need to stop treating it as an individual decision and start addressing the systemic issues behind it. Here’s how:
Build Better Healthcare Infrastructure in Rural Areas – This means funding regional hospitals, expanding maternal care services, and incentivizing medical professionals to work outside the capital. If people can receive adequate medical care where they live, fewer will feel compelled to leave.
Invest in Local Economic Opportunities – Many rural families rely on herding, an industry becoming more unpredictable due to climate change. Developing local industries, modernizing agriculture, and providing alternative job opportunities would help families build sustainable lives in their hometowns.
Expand Mobile and Telemedicine Services – For remote communities, bringing medical care to people rather than forcing them to travel could be life-changing. Mobile health clinics, virtual consultations, and community health programs could help bridge the gap.
A Future Where People Can Choose
Migration should be a choice, not a necessity. People should be able to stay in their communities because they want to. Not because they are forced out by failing infrastructure and lack of support.
Nomin’s journey to the hospital that winter was just one of thousands. Some mothers make it in time. Some don’t. But the real question is: why should they have to make that journey at all?
If Mongolia invests in stronger rural healthcare, sustainable local economies, and long-term solutions, families won’t have to choose between their roots and their survival. They can build their futures where they belong at home.
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