Nurturing care
Every child deserves the best possible start in life
- English
- Македонски
- Shqip
The earliest years of life are the most critical.
From pregnancy through early childhood, a child’s brain develops faster than at any other time. These early experiences shape health, learning, and well-being for life.
In North Macedonia, many children are surviving, but not all are thriving.
The challenge
North Macedonia has made important progress in improving child survival and health outcomes.
But new and complex risks are emerging, and too many children are still not receiving the support they need in the earliest and most critical years of life.
The foundations for healthy development are not equally strong for all children. Those born into vulnerable families - including children living in poverty, Roma children, children with disabilities and those facing multiple disadvantages - are less likely to benefit from early support services. Children with developmental delays or disabilities are often identified too late, reducing opportunities for early intervention and support during the years when it can have the greatest impact.
Critical gaps remain in basic health and nutrition. Immunization coverage is still not high enough to fully protect children, with only 84.7% of children receiving the second dose of measles vaccine (MMR2) and 85.8% receiving the third dose of DTP vaccine, leaving some infants at risk of preventable diseases.
Environmental pressures are increasing. Air pollution poses a significant threat to children’s health, contributing to respiratory illness and premature mortality. However, only 59.7% of children are fully immunized against pneumococcal disease. Widespread tobacco use further exacerbates these risks: 47% of adults smoke, increasing children’s exposure to second-hand smoke at home and in public spaces. As a major indoor pollutant, tobacco smoke heightens the risk of respiratory infections, asthma, and long-term health complications, compounding the effects of ambient air pollution.
At the same time, nutrition challenges are evolving. Around 30% of children are living with overweight or obesity, while exclusive breastfeeding rates remain low at just 28%, affecting healthy growth and development from the very start.
Access to services remains unequal. Around 20,000 children lack health insurance, and children from vulnerable groups - particularly Roma children - face additional barriers due to administrative challenges such as missing identity documents.
These challenges are compounded by gaps in early support systems. Services are often fragmented, and families may not receive consistent, integrated guidance on health, nutrition, early learning, responsive caregiving and positive parenting. Many parents and caregivers, particularly those facing adversity, lack access to the information and support they need to promote their children's healthy development and wellbeing
Critically, there is still no fully established system to consistently monitor children’s development in the early years. Without early identification, risks and delays can remain unnoticed, missing the opportunity to act when it matters most.
The result is that too many children start life at a disadvantage, and those early gaps can grow over time.
The solution
Giving every child the best start in life means shifting from reacting to problems to preventing them early and supporting families from the very beginning.
UNICEF works with partners to strengthen systems that provide early, integrated support to children and their caregivers, with a focus on reaching the most vulnerable first - including children with disabilities, children at risk of developmental delays, Roma children, and children living in poverty.
A key part of this approach is expanding the role of home visiting nurses. By reaching families directly - especially those with vulnerable newborns - these services provide trusted, practical support where it matters most: in the home.
This support goes beyond basic health care. Families receive guidance on child development, nutrition, mental health, responsive caregiving, positive parenting, and protection from environmental risks such as pollution. Home visiting services help parents build the confidence and skills needed to support their children's learning, development and emotional wellbeing from the earliest days of life.
At the same time, efforts focus on introducing universal developmental monitoring for children aged 0–6, ensuring that every child’s development is tracked and that delays are identified early when interventions are most effective. Early identification enables children and families to access timely support and services, improving opportunities for inclusion, learning and wellbeing.
Integration is central to this work. Health, nutrition, early childhood development and social services are strengthened to work together, providing coordinated, holistic support tailored to the needs of each child and family.
By investing early and acting early, systems can prevent long-term challenges, reduce inequalities and support every child to reach their full potential.
A healthy start for a stronger future
When children receive the right support in their earliest years, the impact lasts a lifetime.
They are healthier. They learn better. They are more likely to thrive in school, in their communities, and in life.
By strengthening nurturing care and early childhood support systems, North Macedonia can ensure that: every child is given the best possible start, every parent and caregiver has they support they need to provide nurturing care, and no child is left behind.
Because the first years matter the most and every child deserves to start strong.