Women Health Concerns in the Sociocultural Context of Morocco

Dr Mohamed Chtatou

Moroccan women in street protest

            Women in Morocco face difficulties when it comes to expressing their sexuality and choosing family planning methods. Sex is only socially approved for married women, so unmarried women have a hard time accessing contraception. Married women also have trouble with contraception, both due to misinformation and the cultural norms that a wife is responsible for all birth control. Finally, legal abortion as an option is almost completely inaccessible to both married and unmarried women. This sociocultural atmosphere may result in unsafe practices, shame, or unfufillment on the part of Moroccan women.

          On the issue of sexual socialization in Morocco, Dilamy writes:[i]

Sexual socialization aimed at the establishment of hierarchical and distinct sexual identities. In fact, rites of pregnancy, child birth, children games and rites of marriage revealed a discriminatory and unequal treatment of the sexes to pull boys out of femininity and build up their personality as powerful men. The young girl is born a woman and remains as such (horizontal axis), while the boy is destined to be a man, i.e., powerful (vertically ascending axis). The birth of a boy is the occasion for a collective satisfaction, expressed in the most zealous ritual: the most numerous dinghies, the bath of the boy’s mother seven days after delivery is the most ceremonial. In the Moroccan patrimonial parenthood system, the birth of a boy reassures the perpetuation of the lineage (i.e., the perpetuation of the name and identity). “The house which gives birth only to girls is a deserted house”, affirms an Arab dialectical proverb.

Contraception                       

          In 2004 among currently married women, 89.7% of women had used a form of contraception at some point in their lives. 80.3% had used birth control pills, 17% an IUD, 16.9% the withdrawal method, with a surprisingly low 11.4% ever using a male condom. Another popular method was the lactational amenorrhea method (LAM), in which a woman who frequently breastfeeds her child will not menstruate and therefore not get pregnant. 31% of women reported using this method at some point.[ii] Of course, this method can only be used by women who have already had a child.[iii] This illustrates a reproductive and social trend in Morocco: women are expected to have a child soon after getting married. After that, they can space out their family planning as they desire.

Because of the high value put on childbearing in Moroccan culture, a woman who does not have a child soon after getting married may be the subject of rumors or social consequences, as her fertility will be questioned. The numbers also point to a second factor when it comes to birth control: the low number of male condom usage shows that contraception is seen as a woman’s responsibility, not a man’s. If male condoms are not being used because men do not want to use them for sensation reasons, this means that male sexual pleasure is taken for granted as something that cannot be compromised.       

          Perhaps surprising to those who have preconceived notions about Muslim countries, contraception is generally readily available in Morocco and easily accessible. In 1967, the French Law of 1920, which prohibited the advertising, sale, and distribution of contraceptives, was repealed.[iv] Since independence, Morocco has had one of the highest rates of contraceptive prevalence in the region, with policies and programs that promote contraception and family health. Suppliers of contraception in Morocco are almost evenly split between the public (56.4%) and private (42.2%) sectors.[v] Bajos et al. write that

“In the city of Rabat, where contraception is easily accessible for married women at health centres and pharmacies, more than half of women living in a union (53%) use a modern contraceptive method (mostly the pill) and 14% use a natural method.” [vi]

Moroccan rural women: many “heavy” social obligations and fewer rights

The key thing to notice, however, is that birth control is accessible for women living in a union. In Moroccan culture, premarital sex is not allowed. This is especially true for women, who are expected to be virgins until marriage. Because of this, many family planning programs in Morocco are specifically targeted to married women; acknowledging the existence of any extramarital sex is too taboo.[vii] These programs are not tailored to younger people who may be having sex before marriage. So while family planning programs may be effective in reaching women across the country, they are limited to women that are having sexual relationships within acceptable social boundaries.

Sex outside of the realm of marriage

          Women who choose to have sex outside of the realm of marriage face a dilemma. If they become pregnant, they will have proof that they have engaged in unacceptable sexual behavior. This scandal could lead to family and social problems. A woman may be pressured into marrying a man she does not want to or risk being stigmatized for having a child outside of marriage. The logical step for a sexually active woman to take, in this atmosphere stigmatizing extramarital sex, would be taking all steps to prevent pregnancy outside of marriage. This is where things get difficult, however.

An unmarried woman using contraception would make it obvious that she is having a forbidden sexual life. Anxiety around her friends, family, or community finding out that she has been procuring contraceptives may make it nearly impossible for a woman to access these items. The strong cultural ideal against women having a free right to sex regardless of their relationship status creates a situation in which both extramarital pregnancy and methods taken to prevent pregnancy are stigmatized. This leaves a woman with few options. Abstinence is one option, but perhaps not a realistic one for all women. The other option that arises is, necessarily, abortion.

On the issue of contraception, Ida Sophie Winter writes in World Policy: [viii]

« Education on contraception targets married people, though, and this represents a larger taboo in Moroccan society: here, premarital sexual intercourse is illegal and heavily stigmatized, according to France’s 2006 Emergency Contraception in Africa survey. While society considers premarital sex necessary to prove male virility and adulthood, 90 percent of women surveyed considered premarital virginity a “social duty.” Most men refused to marry a non-virgin, one likening women’s premarital sexual behavior to prostitution. »

          Between 2003 and 2004 the total fertility rate in Morocco was 2.5. The fertility rate was 3.0 among rural mothers and 2.1 among urban mothers. It also differed with educational level, as women with lower education levels had slightly higher fertility rates.[ix] Generally, two or three children is the reproductive norm. Because the desired number of children is only two or three, contraceptive methods are necessary for married couples. There is a common belief in Morocco, however, that hormonal methods can negatively affect a woman’s fertility. Some women may take them only sporadically or not at all, and depend on less reliable “natural methods” instead. For this reason, there are many unexpected, unplanned, or unwanted pregnancies.


Moroccan women and the issues of dating, marriage and sexuality

Abortion

The option of abortion is not readily accessible in Morocco. It is legal only in instances where pregnancy or birth would threaten a woman’s life or health, and completely illegal for unmarried women. It is not allowed in instances of rape, though there have been moves to change this.[x]

Leila Hassini writes that in Morocco, abortions may be

“induced using indigenous methods, including a range of herbs, medications or alcohol ingested orally or inserted rectally or vaginally, commonly the herbs hantita…and chloroquine. Health professionals…say that the prostaglandin misoprostol, is also increasingly being used.” [xi]

This refers, of course, to illegal abortions. Because abortion may be necessary for certain women’s situations, there is a cultural body of knowledge on how to induce miscarriages or where to go to have an abortion performed, despite the illegality of this. This are often dangerous. In the period 1995 to 2000, almost 700,000 abortions took place in Morocco. There were over 1,000 deaths from unsafe abortions.[xii] Thirteen percent of maternal deaths are a result of abortions.[xiii] National and international groups have tried to spread education to reduce the number of deaths from abortion.

Child-rearing in rural Morocco

In 2012, the Dutch group “Women on Waves” made international news by anchoring a boat in international waters near Tangiers. This group provides abortion information and service to women living in countries where it is heavily restricted. The Moroccan government blocked the ship from docking in a Moroccan port, reinforcing the country’s strict stance on abortion.[xiv] Women on Waves has published information on a miscarriage-inducing drug available in Moroccan pharmacies that is cheap and accessible.[xv] This is available without prescription, but many Moroccan women might not know this opportunity exists. Unfortunately, even this method can be unsafe and cause heavy bleeding.

While official statistics on abortion are not available for Morocco several estimates are available that give some indication of the extent of the issue. Beamish and Abderrazik (2003) put the figure between 130,000–150,000 illegal abortions each year, including among young women.[xvi] A study by the National Institution of Solidarity with Women in Danger (INSAF) estimates that over 800 illegal abortions are performed daily in Morocco in 2010 (Ministère de la Santé 2011).

Family planning

          In Morocco, women’s options for family planning are limited. Moroccan culture values and expects virginity until marriage, specifically in women. Because of this, women having extramarital sex must be secretive. They will not be able to divulge their relationships to family or the general community. They may seek unsafe abortions to prevent being pregnant outside of marriage, and they face greater difficulties in getting birth control because it is not promoted for unmarried women. Married women are allowed to use family planning methods, but this is only socially acceptable after a child has been produced. They may also face challenges in controlling their fertility as they may hold incorrect information about the safety of hormonal methods and/or have a husband who is unwilling to use male condoms.

Final word

On top of the difficulties facing women who want access to contraception, abortion is illegal in most cases, causing women to turn to unsafe methods. Therefore, Moroccan women’s sexuality is heavily regulated by the limitations of reproductive choice. In the continuing fight for women’s rights in Morocco,[xvii] the right to sexuality must be considered.

You can follow Professor Mohamed CHTATOU on Twitter : @Ayurinu

End Notes :


[i]  http://dialmy.over-blog.com/2014/01/sex-education-in-morocco.html

[ii] “Morocco 2003-04 : Results from the Population and Family Health Survey” Studies in Family Planning, Vol. 37, No. 1 (Mar., 2006), pp. 66-70

[iii] https://gynopedia.org/Morocco

In Morocco, you can purchase birth control without a prescription. You can also access emergency contraception (the morning after pill), and ellaOne (which is currently considered the most effective EC) is available. There are no travel restrictions related to HIV or STD status, and you can get free anonymous HIV tests at certain facilities, which we list on this page. There is currently no HPV vaccination program. There also appears to be no PrEP in Morocco yet. You can find pads and tampons in Morocco, and there are some small-scale menstrual cup vendors. Abortion is legal under certain circumstances, and in recent years, these circumstances have been expanded. However, legal abortions are still not the norm and many women still seek out underground and unsafe abortions each year.

[iv]  “Childbearing in Five Arab Countries” Studies in Family Planning, Vol. 32, No. 1 (Mar., 2001), pp. 17-24

[v] “Morocco 2003-04 : Results from the Population and Family Health Survey” Studies in Family Planning, Vol. 37, No. 1 (Mar., 2006), pp. 66-70

[vi]  Bajos et. Al “Normative Tensions and Women’s Contraceptive Attitudes and Practices in Four African Countries” Population-F, 68 (1), 2013, 15-36

[vii]  Bajos et. Al “Normative Tensions and Women’s Contraceptive Attitudes and Practices in Four African Countries” Population-F, 68 (1), 2013, 15-36

[viii]  https://worldpolicy.org/2015/07/27/the-moroccan-stigma-around-sexual-health/

[ix]  “Morocco 2003-04 : Results from the Population and Family Health Survey” Studies in Family Planning, Vol. 37, No. 1 (Mar., 2006), pp. 66-70

[x]  Cf. https://arrow.org.my/wp-content/uploads/2016/08/Interlinkages-Between-Religion-and-SRHR_National-Report__Morocco.pdf

The legislation on abortion in Morocco:

Articles 449-458 of the Penal Code The articles of the Criminal Code (Ministry of Justice and Freedoms 2014) provide for imprisonment for anyone who engages in the practice of abortion or even advertising on abortion.41 Below are the penal code articles about abortion in Morocco:

Article 449: provides for a prison sentence of one to five years for anyone who procures or attempts to procure the miscarriage. If death is caused, the penalty is imprisonment from ten to twenty years.

Article 450: provides for 20 to 30 years in prison for those providing or engaged in the practice of abortion. Article 451: provides for the same penalties for health professionals and traditional health providers that recommended, encouraged or practised the means to procure the miscarriage.

Article 455: provides for the same punishment for any advertisements on abortion, regardless of its nature. Only

Article 453 is the exception: abortion is not punished when it constitutes a necessary measure to safeguard the health of the mother. A physician or surgeon, with the authorization of the spouse, openly practices it. If the practitioner believes that the life of the mother is in danger, that authorization is not required. However, he must give notice to the chief doctor of the prefecture or province. Source: Kingdom of Morocco Ministry of Justice and Freedom’s office of legislation, penal code, consolidated version dated 20 March 2014. Chapter VII (articles 449-504) section 1 on abortion

[xi]  Leila Hessini “Abortion and Islam : Policies and Practice in the Middle East and North Africa” Reproductive Health Matters, Vol. 15, No. 29

[xii]  Leila Hessini “Abortion and Islam : Policies and Practice in the Middle East and North Africa” Reproductive Health Matters, Vol. 15, No. 29

[xiii]  “New Prime Minister Surprises Moroccans With Support for Abortion” New York Times http://www.nytimes.com/2012/01/12/world/africa/new-prime-minister-surprises-moroccans-with-support-for-abortion.html?_r=0

[xiv]  “Morocco moves to block Dutch ‘abortion ship’” Al Jazeera http://www.aljazeera.com/news/africa/2012/10/201210415467467715.html

[xv] http://www.womenonwaves.org/en/page/3447/how-to-do-a-medical-abortion-in-morocco

[xvi]   http://unpan1. un.org/intradoc/groups/public/documents/CAFRAD/ UNPAN014702.pdf.

[xvii]

Revisiting Family Code Reform in Morocco – Analysis

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https://arabstates.unfpa.org/sites/default/files/pub-pdf/Sexual.pdf

https://arrow.org.my/wp-content/uploads/2016/08/Interlinkages-Between-Religion-and-SRHR_National-Report__Morocco.pdf

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