Reproductive and Sexual Health
This domain covers care outside pregnancy that still sits inside a midwife's scope: sexually transmitted infections, cervical screening, abortion care, violence response and adolescent services.
STIs and HIV
Manage syndromic presentations - discharge, genital ulcer - with national first-line regimens, offer HIV testing with consent, and give post-exposure prophylaxis within 72 hours after sexual assault or occupational exposure: tenofovir, lamivudine and dolutegravir for 28 days.
Cervical cancer prevention
Cervical cancer is a leading cause of cancer death among Mongolian women. Primary prevention is HPV vaccination of adolescent girls; secondary prevention is screening - HPV testing where available, otherwise cytology or visual inspection with acetic acid - with treatment of pre-cancer by thermal ablation or excision. Vaccination never replaces screening.
Abortion and post-abortion care
Abortion is legal in Mongolia and must be provided at a licensed facility with counselling and consent; later termination requires defined medical or social grounds. Post-abortion care includes contraception counselling before discharge, because the interval to the next pregnancy is often short.
Violence and adolescents
Ask about violence privately, document injuries objectively, offer emergency contraception and STI prophylaxis, and know the referral pathway under the domestic violence law. Adolescents need confidential, non-judgemental services.
Worked example
A 24-year-old presents 60 hours after unprotected intercourse. Reasoning: levonorgestrel is licensed to 72 hours but is less effective late; ulipristal acetate works to 120 hours; a copper IUD is the most effective option and can be placed up to five days after estimated ovulation. Offer STI testing, HIV risk assessment and an ongoing method.
Traps
Believing emergency contraception causes abortion; using it as a routine method; missing the 72-hour prophylaxis window; breaching confidentiality.