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This article presents results of research undertaken to identify factors that affect the vulnerability of rural Mongolian herders to climate change. Findings suggest that models of market development instituted since 1990 have failed to recognize and support key elements of the pastoralist adaptive strategy. A retreating state presence has led to the collapse of regulatory regimes needed to safeguard critical common resources. This in turn has produced considerable social differentiation in the countryside, a breakdown in cooperative institutions, and conflicts over water and pasture. In a context of climate change, these changes seriously threaten the sustainability of the rural economy, leading to livelihood insecurity, growing rural poverty, and increasing rates of migration to shantytowns surrounding the capital city of Ulaanbaatar. The newly vulnerable poor are at higher risk for poor health and malnutrition.

Beginning in 1990, Mongolia, a former client state of what was then the Soviet Union, undertook liberal economic reforms. These came as a great shock to Mongolia and Mongolians, and resulted in food shortages, reports of famine, widespread unemployment, and a collapse of public health and health care. Although economic conditions have stabilized in recent years, unemployment and poverty are still at disturbingly high levels. One important consequence of the transition has been the transformation of the rural, primarily pastoral, economy. With de-collectivization, herding households have been thrown into a highly insecure subsistence mode of production, and, as a consequence, have become vulnerable to local fluctuations in rainfall and availability and quality of forage, and many now lack access to traded staples and essential commodities. Household food insecurity, malnutrition, and migration of impoverished households to provincial centers and the capital of Ulaanbaatar are one result. Reductions to investments in the health sector have also eroded the quality of services in rural areas, and restricted access to those services still functioning. Evidence suggests that women are particularly vulnerable to these political-ecological changes, and that this vulnerability is manifested in increasing rates of poor reproductive health and maternal mortality. Drawing on case-study ethnographic and epidemiological data, this article explores the links between neoliberal economic reform and maternal mortality in Mongolia.