First Foundations Program

Problem statement

The first few years of a child’s life offer a unique window of time, with the brain rapidly processing and establishing the architecture upon which all future learning, behavior, and health is built. The nurturing care all children need in their first 1000 days should provide for a safe and secure environment, early learning, responsive caregiving, health and nutrition. Despite the evidence, this stage in the life cycle receives limited attention in politics and public policies. Very few state-funded initiatives are designed to tackle inequalities experienced by the most vulnerable children.

One of the specific challenges derailing early childhood development in disadvantaged communities in Bulgaria is poor nutrition. Maternal/child under-nutrition has been found to contribute to reduced school attendance and economic potential. This is an issue that disproportionately impacts the Roma, with 42% malnourished compared to 6% for the general population. Roma in Bulgaria are particularly at risk of anemia –with 61.2% of infants aged 6-11 months with anemia.

Another factor that adversely impacts child development outcomes is the high rate of teenage pregnancies. Women who get pregnant in their early teen years face risks–including anemia, a higher rate of infant mortality, high blood pressure/pregnancy induced hypertension, low birth weight and premature birth. Having a child at such a young age also puts financial strains on families and often results in the mother dropping out of school. Ten percent of all live births in Bulgaria are teen pregnancies (compared to 1% for the EU). This is an issue that disproportionately impacts the Roma.

An infant’s health and later development is also put at risk by limited access to prenatal care. While mothers are entitled under Bulgarian law to at least one prenatal check, even if uninsured, this is way below the minimum of eight prenatal care visits recommended by the WHO.

Children living in financial hardship in Bulgaria (about one-third of all children) also face limited access to prescription drugs. Very often poor families cannot afford the high cost of drugs for their infants, which results in increased hospitalisations and development of chronic conditions.

The most vulnerable group of young children are those of undocumented parents. About 10% of Roma live in shacks and due to the restrictive address registration policies, most of them do not have valid IDs. At the same time, the social housing policy does not provide support for these families, and the need for safe and secure home is seriously compromised for hundreds of infants and pregnant women along with access to basic health and social services.

What we do

For the period 2020-2023, one of the key goals of the First Foundations Program is to integrate the nurse home visiting service (NFP) targeting teenage first-time low-income moms and their infants in the system of state-funded services. We have been testing and adapting this evidence-based service for more than five years and we have great confidence it significantly improves both maternal and child health and development outcomes as well as the economic independence of the families.

We have also developed a scholarship program for Roma women who aspire to become nurses and midwives. On one hand, this will address one of the greatest challenges to scaling up of the NFP – shortage of nurses. On the other hand, it will increase the chances of a traditionally inactive group on the labour market for employment. The program also has the potential to create a community of role models who could bolster the development of women and young girls.

Another key focus of the FF Program is advocacy. We aim for systemic changes that address the major inequalities experienced by vulnerable children. We work with a coalition of NGOs to introduce a national cross-sectoral early childhood development program and in our partnership within the We Care network, we prioritize improving access to prenatal health, nutrition support, prescription drugs, low-threshold social services, and legal status for families of young children.