While the use of modern contraception in Macedonia remains relatively low, the number of newborns continues to decline. Data indicate that, alongside the methods couples use to prevent pregnancy, the demographic landscape is increasingly influenced by the postponement of parenthood, emigration, and a shrinking youth population.
According to UNICEF’s latest national MICS survey (2018–2019), only 14 percent of women aged 15 to 49 who are married or in a union in Macedonia use a modern method of contraception—either themselves or through their partner.
The most common method is ‘coitus interruptus’, or “the pullout method”, relied upon by 43.9 percent of couples.
A total of 59.9 percent used some form of contraception, yet the breakdown reveals a significant reliance on traditional methods. Condoms were used by 10 percent, IUDs by 1.4 percent, and oral contraceptives by 1.1 percent, while 40.1 percent used no method whatsoever.
Despite the relatively low use of modern contraception, Macedonia is simultaneously experiencing a sharp decline in the number of births. In 2025, 15,850 children were born, compared to 16,061 in 2024 and 16,737 in 2023. That same year, 20,287 people died, resulting in a negative natural population growth of 4,437.
Data on abortions also do not indicate an increase that would explain the decline in the number of births. The Institute of Public Health recorded 4,983 abortions in 2013, 3,784 in 2019, 3,168 in 2021, 2,602 in 2022, 2,207 in 2023, and 2,151 in 2024.
Among women under the age of 20, the number of abortions dropped from 237 in 2013 to 51 in 2024.
Therefore, the demographic picture cannot be explained solely by the use of contraception. The birth rate is also influenced by the shrinking youth population, the trend of starting families later in life, smaller family sizes, and emigration.