Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi region of Morocco: a qualitative study.

INTRODUCTION: Improving access to sexual and reproductive health remains a public health challenge, especially for women, whose access is affected by several determinants, such as gender inequality, which is the underlying barrier to all other determinants. Many actions have been carried out, but much remains to be done before all women and girls can exercise their rights. This study aimed to explore how gender norms influence access to sexual and reproductive health services. METHOD: A qualitative study was conducted from November 2021 to July 2022. The inclusion criteria were women and men aged over 18 years old, living in the urban and rural areas of the Marrakech-Safi region in Morocco. A purposive sampling method was used to select participants. Data were obtained through semi-structured interviews and focus groups with selected participants. The data were coded and classified using thematic content analysis. RESULTS: The study highlighted inequitable, restrictive gender norms that lead to stigmatization and affect the sexual and reproductive healthcare-seeking behavior and access of girls and women in the Marrakech-Safi region. These most common gender norms for women include parental refusal, stigmatization, and social exclusion of girls from sexual and reproductive health education services; strong decision-making power of family members over contraceptive use and women's adherence to pregnancy monitoring and access to supervised delivery; and culturally constructed role allocation, assigning a reproductive role to women and making them responsible for the health of new-borns. CONCLUSION: Sexual and reproductive health projects must strive to be gender sensitive. Gender-blind projects are missed opportunities to improve health outcomes and advance gender equality.

A Quantitative Study on the Ethnobotanical Knowledge about Wild Edible Plants among the Population of Messiwa.

Background: The preservation of traditional knowledge of wild edible plants (WEPs) is one of the challenges to the sustainability of natural resources. Therefore, it is crucial to assess the traditional knowledge of WEPs in relation to some socio-demographic and economic factors. Methods: The survey was conducted among the Messiwapopulationthrough a semi-structured questionnaire. The first part of the questionnaire concerns socio-demographic and economic information, while the second part concerns the plants recognized and used by the informant. The recognition frequency (RF), the use frequency (UF), the general consumption frequency(CF), the recent consumption frequency (RCF), and the correlation between these frequencies were evaluated. A comparison of means was also used to compare informant's knowledge according to their socio-demographic and economic status. Results: The three species;Foeniculum vulgare, Ziziphus lotus, and Malva sylvestris were the most recognized (FR = 1) and the most used (FU = 1). The consumption frequency (CF) and the recent consumption frequency (RCF) for Foeniculum vulgare were 1 and 0.9, respectively. Taraxacum getulum, Calendula arvensis and Cyperus rotundus were the least recognized (FR= 0.16; 0.16; 0.48) and least used (FU = 0.3; 0.3; 0.4) species, respectively. The informants who showed a high level of traditional knowledge on WEPs were housewives, with a low level of schooling and at least 45 years old. Conclusion: Despite the decline in traditional knowledge about wild edible plants, some populations preserve this knowledge, especially among the elderly. Therefore, documentation of this knowledge is necessary through ethnobotanical and ethnomedicinal studies.

Determinants of Maternal Health Services Use among Vulnerable Women in a Rural Community in the Moroccan High Atlas.

Several factors affect the use of maternal health care services in developing countries. The aim was to describe the knowledge and attitudes of women in a rural area of the Moroccan High Atlas regarding aspects of maternal health, and to identify the determinants of use of maternal health care services. A cross-sectional study of 87 participants was conducted in a mountainous area near Marrakech utilizing two sampling methods (a door-to-door approach, and a mobile health caravan). Fisher test was used to compare two proportions, and the non-parametric Mann-Whitney test to compare two means (p value was 0.05). Median participants' age was 24 years old [15-60]. Findings indicated that husband's education (p=0.005), woman's age (p=0.011), awareness of warning signs during pregnancy (p=0.01) and use of health center for other purposes other than pregnancy (p=0.007) were important influencing factors for use of prenatal consultation services. Factors that influenced supervised birth outcomes were the age of the woman (p=0.013), her education (p=0.027) and a positive attitude towards monitoring her pregnancy by a health professional (p=0.006). To improve utilization rates for maternal health services, these factors must be considered when designing interventions that aim to improve the quality of these services in the community.

The effect of socio-economic status and area of residence on household food variety in Morocco.

BACKGROUND: In Morocco, few studies have specifically addressed the association between food variety and household socio-economic status and area of residence. AIM: The study's objective was to obtain a qualitative description of food consumption in samples of Moroccan households and to examine the influence of socio-economic factors and area of residence on their food variety. SUBJECTS AND METHODS: A qualitative food frequency questionnaire was administered by adolescent school pupils in their own households between March 2005 and March 2006 in 526 households in the regions of Marrakesh north of the High Atlas range and Ouarzazate to the south. We calculated the Food Variety Index (FVI) based on 183 food items and compared scores for advantaged/disadvantaged and urban/rural households. RESULTS: Mean FVI scores for all individuals and total food groups differ significantly between the area of residence, urban and peri-urban Marrakesh and urban Ouarzazate having the highest scores. The mean total FVI scores, presented according to the household's socio-economic status from highest to lowest, are 123.8 +/- 17.1 for urban Marrakesh, 107.6 +/- 21.6 for urban Ouarzazate, 92.0 +/- 22.4 for rural Skoura, 110.5 +/- 21.5 for peri-urban Marrakesh and 89.9 +/- 10.8 for rural Iguerferouane (F-test = 26.7, p < 0.001). Advantaged households have significantly greater variety than disadvantaged households for all variables only in the two urban samples. In peri-urban Marrakesh and rural Skoura, there are no significant differences between advantaged and disadvantaged households. CONCLUSION: In our Moroccan sample, food variety is distributed according to two patterns: One based on area of residence, urban areas having greater variety than rural areas, and the other on socio-economic factors, with advantaged households having higher FVI values but only in urban areas. The limited availability of certain foods and food preferences by the populations mean that not all households are able to diversify their diets.