Chaimae Moujahid

Background: Maternal health in at-risk communities is a significant public health issue, especially in areas characterized by socio-economic and healthcare inequalities. This study aims to uncover the multiple factors that influence maternal well-being in Morocco, providing insights for targeted interventions and policy development. Methods: An interpretive grounded theory approach was employed, combining in-depth interviews, observations and constant comparative data analysis. Participants ( n = 69, aged 17–49) were recruited from six provinces across five main regions, representing diverse socio-economic backgrounds, cultural contexts, and healthcare systems. Results: The analysis identified four main categories explaining the interactions and interrelations of factors shaping maternal and reproductive health. First, childbirth and postpartum maternal healthcare experiences reveal contrasting realities between home and hospital births, marked by fear, neglect, obstetric violence, and the critical role of family support. Second, cultural practices and beliefs strongly shape perceptions of pregnancy, delivery, and postpartum care, sometimes providing protection and other times reinforcing harmful traditions. Third, maternal health dynamics in the societal context highlight systemic barriers to healthcare access, the weight of sociocultural expectations, and the compounded burden of rural living. Finally, women’s reproductive autonomy and family size underscore limited decision-making power, ambivalence toward contraceptive use, son preference, and contraceptive misinformation. Together, these categories illustrate the complexity of relationships between socioeconomic status, access to healthcare services, education, cultural beliefs, and social support networks, which emerge as important determinants of maternal and reproductive health outcomes in Morocco. Conclusions: By amplifying their voices and perspectives, this research advocates for holistic, equitable, and empowering approaches to maternal healthcare. The findings underscore the need for interventions tailored to local contexts, based on a thorough understanding of the determinants of maternal health.

Les femmes jouent un rôle central dans la planification familiale, mais leur capacité à exercer un contrôle sur leur fertilité est souvent influencée par des facteurs sociaux et relationnels. Cette étude explore les connaissances, attitudes et pratiques des femmes à l’égard de la planification familiale et des méthodes contraceptives actuellement disponibles, parmi la population des femmes mariées en âge de procréer vivant dans les zones rurales au Maroc. Nous avons mené des entretiens approfondis en face à face avec 49 femmes marocaines mariées dans une maternité rurale pendant leur période post-partum. À l’aide de questions ouvertes, nous avons examiné leurs pratiques contraceptives, leur autonomie décisionnelle et les influences sociales qui déterminent leurs choix en matière de procréation. La plupart des participantes a déclaré utiliser des contraceptifs oraux, bien que nombre d’entre elles ait connu au moins une grossesse non désirée en raison d’une mauvaise utilisation des contraceptifs. Les femmes ont exprimé leur préférence pour des familles moins nombreuses afin d’assurer leur stabilité financière et une meilleure qualité de vie. Cependant, elles se heurtent souvent à la résistance de leur mari et de leur famille élargie lorsqu’elles tentent d’utiliser un moyen de contraception ou de limiter la taille de leur famille. Les idées fausses concernant les dispositifs intra-utérins (DIU) étaient très répandues, de nombreuses femmes exigeant le consentement de leur conjoint en raison de préoccupations liées à la santé sexuelle. Nos résultats soulignent le rôle important des facteurs sociaux et relationnels dans les choix des femmes en matière de procréation. Il est essentiel de s’attaquer aux idées fausses et d’améliorer l’accès à l’éducation en matière de santé génésique. L’implication des maris dans les séances de conseil peut renforcer les efforts de planification familiale et soutenir l’autonomie des femmes dans les décisions relatives à la fécondité.

To understand the mechanism of health inequities and their influence on maternal health, the Commission on Social Determinants of Health (CSDH) provides a framework to identify structural and intermediate causes of health inequity. This review maps and describes the current socioeconomic determinants of maternal health in Morocco according to the CSDH framework. A scoping study was carried out from six databases (Springer, Web of Science, Pubmed, Science Direct, Jstor, and Cochrane library) based on quantitative and qualitative research done since 1990. Structural factors such as women's employment and economic status, education level, culture, and gender equity were influenced by intermediary factors such as place of residence, age at marriage, maternal age at childbirth, and parity (either alone or in conjunction with other variables). Together these factors worked to influence maternal health service usage or affected maternal health outcomes. Power dynamics were identified in a variety of social situations that impacted access to health care for women across socioeconomic categories. Studies reveal how social determinants impact maternal health in Morocco. Addressing these determinants is required for sustainably improving maternal and infant health in Morocco.

The cultural context influences women’s antenatal care and postpartum knowledge. This study aims to determine the traditional practices related to maternal health in Morocco. We conducted in-depth qualitative interviews with 37 women from three different Moroccan regions on the first postpartum day. We used thematic content to analyze data, and an a priori coding framework was created utilizing the pertinent literature. Beliefs regarding pregnancy and postpartum positively affect maternal health, such as family support, prolonged rest for health recovery, and specific dietary precautions according to the mode of delivery of the new mother. However, some practices may negatively affect maternal health, such as cold postpartum treatment through traditional medicine and not seeking prenatal care after the first pregnancy experience. Such practices include painting newborns with henna, using kohl and oil to hasten the umbilical cord’s descent, and producing solutions based on chicken throat to cure respiratory ailments in newborns that might harm their health.