Improving access and utilization of sexual and reproductive health services by migrant women in Morocco: A qualitative study

##plugins.themes.academic_pro.article.sidebar##

Published Mar 30, 2025
https://doi.org/10.62438/tunismed.v103i4.5507
Download
pdf
Vol. 103 No. 4 (2025): Tunis Med Apr 2025

##plugins.themes.academic_pro.article.main##

Chaima Amaghdour
Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health (UM6SS), 20250, Casablanca. Public health and health management, Mohammed VI Center for Research and Innovation (CM6RI), 6024, Rabat, Morocco.
Carine Munezero
Public health and health management, Mohammed VI Center for Research and Innovation (CM6RI), 6024, Rabat, Morocco.
Radouane Belouali
Public health and health management, Mohammed VI Center for Research and Innovation (CM6RI), 6024, Rabat, Morocco.
Kenza Hassouni
Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health (UM6SS), 20250, Casablanca. Public health and health management, Mohammed VI Center for Research and Innovation (CM6RI), 6024, Rabat, Morocco.

Abstract

Introduction-Aim: Over the past decade, Morocco has become a major migratory corridor in the Mediterranean, hosting an increasing number of migrants, particularly from Sub-Saharan Africa. This study aims to identify the barriers and facilitators to accessing sexual and reproductive health (SRH) services for migrants in Morocco, while exploring the socio-cultural, economic, administrative, and linguistic factors that influence access.


Methods: We employed qualitative methods through focus group discussions (FGDs) with migrant women (n = 24) and men (n = 24). A total of 48 participants, residing in Morocco for at least three months, were selected, all of whom had experience with public healthcare facilities for SRH services. The study was conducted in July 2024 in two regions (Rabat and Casablanca).


Results: The majority of the 48 participants were young adults aged 18 to 34 (61%), mainly from Côte d'Ivoire (60%). Although all spoke French, only 6% had medical coverage, and 23% had a source of income. The main obstacles identified were lack of information, stigmatization, language and cultural barriers, as well as administrative and economic difficulties. Facilitators included a quality welcome, support from associations and NGOs, confidence in Moroccan health services, support from health professionals, and free access to certain services.


Conclusion: The results highlight significant difficulties migrants face in accessing healthcare in Morocco. Efforts are needed to enhance inclusion, reduce discrimination, and simplify administrative procedures to improve access to healthcare for migrants.

Keywords:

migrants, migrant health, access to health, health services accessibility, sexual and reproductive health, Morocco

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Author Biographies

Chaima Amaghdour, Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health (UM6SS), 20250, Casablanca. Public health and health management, Mohammed VI Center for Research and Innovation (CM6RI), 6024, Rabat, Morocco.

PhD in Public Health.

Carine Munezero, Public health and health management, Mohammed VI Center for Research and Innovation (CM6RI), 6024, Rabat, Morocco.

Pharmacist

Radouane Belouali, Public health and health management, Mohammed VI Center for Research and Innovation (CM6RI), 6024, Rabat, Morocco.

Teacher/Researcher

Director of the Mohammed VI International School of Public Health,

Director of the continuing education centre at UM6SS.

 

Kenza Hassouni, Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health (UM6SS), 20250, Casablanca. Public health and health management, Mohammed VI Center for Research and Innovation (CM6RI), 6024, Rabat, Morocco.

Qualified professor of social sciences and health

References

  1. The world bank. World Bank. 2023 [cité 27 mai 2024]. Global Migration in the 21st Century: Navigating the Impact of Climate Change, Conflict, and Demographic Shifts. Disponible sur: https://www.worldbank.org/en/news/feature/2023/12/11/global-migration-in-the-21st-century-navigating-the-impact-of-climate-change-conflict-and-demographic-shifts
  2. World health organisation. Refugee and migrant health [Internet]. 2024 [cité 27 mai 2024]. Disponible sur: https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health
  3. United Nations High Commissioner for Refugees (UNHCR). UNHCR. 2023 [cité 27 mai 2024]. Refugee Data Finder. Disponible sur: https://www.unhcr.org/external/component/header
  4. Haut-Commissariat au. Plan du Royaume du Maroc. Site institutionnel du Haut-Commissariat au Plan du Royaume du Maroc. 2021 [cité 21 août 2024]. Enquête nationale sur la migration internationale. Disponible sur: https://www.hcp.ma/Enquete-nationale-sur-la-migration-internationale_a3237.html
  5. International Organization for Migration (IOM). Interactive World Migration Report 2022 [Internet]. 2022 [cité 21 août 2024]. Disponible sur: https://www.iom.int/wmr/interactive
  6. IOM. Determinants of migrant vulnerability | EMM2 [Internet]. 2019 [cité 27 mai 2024]. Disponible sur: https://emm.iom.int/handbooks/migrants-vulnerable-violence-exploitation-and-abuse/determinants-migrant-vulnerability
  7. WHO. Refugee and migrant health 2022 [Internet]. 2022 [cité 27 mai 2024]. Disponible sur: https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health
  8. Hasan-ul-Bari SM, Ahmed T. Ensuring sexual and reproductive health and rights of Rohingya women and girls. The Lancet [Internet]. 8 déc 2018 [cité 27 mai 2024];392(10163):2439‑40. Disponible sur: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32764-8/fulltext
  9. Zong Z, Sun X, Mao J, Shu X, Hearst N. Contraception and abortion among migrant women in Changzhou, China. Eur J Contracept Reprod Health Care Off J Eur Soc Contracept. févr 2021;26(1):36‑41.
  10. Heaman M, Bayrampour H, Kingston D, Blondel B, Gissler M, Roth C, et al. Migrant women’s utilization of prenatal care: a systematic review. Matern Child Health J. juill 2013;17(5):816‑36.
  11. Khin YP, Nawa N, Fujiwara T, Surkan PJ. Access to contraceptive services among Myanmar women living in Japan: A qualitative study. Contraception. nov 2021;104(5):538‑46.
  12. Ministère De La Santé Et De La Protection Sociale. Stratégie Nationale D’immigration Et D’asile. 2018 [Internet]. [cité 22 août 2024]. Disponible sur: https://marocainsdumonde.gov.ma/wp-content/uploads/2019/01/Politique-Nationale-dimmigration-et-dAsile-_-Rapport-2018.pdf
  13. Ministère de la Santé. et de la Protection Sociale. Plan Stratégique National Santé et Immigration 2021–2025. 2021 [Internet]. [cité 23 août 2024]. Disponible sur: https://picum.org/wp-content/uploads/2024/01/PICUM-Strategic-plan-FR.pdf
  14. International Organization for Migration [Internet]. [cité 23 août 2024]. Journée internationale des migrants 2023. Disponible sur: https://www.iom.int/fr/journee-internationale-des-migrants-2023
  15. El Berri,H. Journée Mondiale de la santé Couverture sanitaire des Migrants au Maroc. 2018. [https://www.sante.gov.ma/Documents/2018/04/PROGRAM-JMS.pdf](https://www.sante.gov.ma/Documents/2018/04/PROGRAM-JMS.pdf).
  16. Acevedo-Garcia D, Sanchez-Vaznaugh EV, Viruell-Fuentes EA, Almeida J. Integrating social epidemiology into immigrant health research: a cross-national framework. Soc Sci Med 1982. déc 2012;75(12):2060‑8.
  17. Gagnon AJ, Zimbeck M, Zeitlin J, ROAM Collaboration, Alexander S, Blondel B, et al. Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med 1982. sept 2009;69(6):934‑46.
  18. Bouirbiten S, Salhi S, Benhsain W. Accès aux soins de santé : freins, défis et exigences d’équité territoriale. Le cas de la Province d’al Haouz, Maroc. Geografares [Internet]. 1 déc 2023 [cité 11 août 2024];(37). Disponible sur: https://journals.openedition.org/geografares/10488
  19. Fidelin C. La lutte contre le sida au Maroc : opportunités et limites pour l’accès aux soins des personnes en migration. L’Année Maghreb [Internet]. 15 juin 2021 [cité 11 août 2024];(25):79‑93. Disponible sur: https://journals.openedition.org/anneemaghreb/7904
  20. Rihem K, Khaled A, Amal M, Tasnim M, Mohamed BD. Access to healthcare for migrants in Tunisia in 2023-2024: Current situation and ethical challenges. Tunis Med [Internet]. 2 mai 2024 [cité 7 janv 2025];102(2). Disponible sur: https://pubmed.ncbi.nlm.nih.gov/38567469/
  21. L’accès aux soins des étudiants internationaux au Maroc [Internet]. [cité 11 août 2024]. Disponible sur: http://wd.fmpm.uca.ma/biblio/theses/annee-htm/FT/2023/these424-23.pdf
  22. Esako Toirambe S, Camara T, Khalis M, Serhier Z, Darkaoui N, Hassouni K, et al. Facteurs prédictifs de la non-complétude vaccinale chez des enfants migrants de moins de 5 ans, Maroc. Santé Publique [Internet]. 2021 [cité 11 août 2024];33(3):435‑43. Disponible sur: https://www.cairn.info/revue-sante-publique-2021-3-page-435.htm
  23. Schmidt NC, Fargnoli V, Epiney M, Irion O. Barriers to reproductive health care for migrant women in Geneva: a qualitative study. Reprod Health [Internet]. 6 mars 2018 [cité 7 janv 2025];15:43. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838955/
  24. La migration forcée au Maroc, résultats de l’enquête nationale de 2021, rapport détaillé. HCP.2021 https://www.wmaker.net/testhcp/file/230791/.
  25. Delescluse A. Interactions et transactions identitaires d’immigrés noirs dans l’espace public et les centres de santé au Maroc. L’Année Maghreb [Internet]. 20 nov 2023 [cité 11 août 2024];(30). Disponible sur: https://journals.openedition.org/anneemaghreb/12638
  26. Jaouadi I. Évaluation de base des vulnérabilités socioéconomiques et | IOM Tunisia [Internet]. 2016 [cité 7 janv 2025]. Disponible sur: https://tunisia.iom.int/fr/resources/evaluation-de-base-des-vulnerabilites-socioeconomiques-et-sanitaires-des-migrants
  27. Babahaji L. The Current State of Migrant Health in Morocco: Pre-and Peri-COVID-19 Pandemic. Indep Study Proj ISP Collect [Internet]. 1 avr 2020; Disponible sur: https://digitalcollections.sit.edu/isp_collection/3353
  28. Haince MC, Mouro YB, Mansour HA, Ksikes D. Les déterminants socioculturels d’accès à la santé des personnes migrantes au Maroc. 2021; Disponible sur: https://www.economia.ma/fr/Travaux-de-recherche/etude-les-d%C3%A9terminants-socioculturels-d%E2%80%99acc%C3%A8s-%C3%A0-la-sant%C3%A9-des-personnes
  29. Situation socioéconomique des réfugiés au Maroc _ Analyse des résultats de l’Enquête de 2022. HCP. 2022. https://www.hcp.ma/Situation-socioeconomique-des-refugies-au-Maroc-Analyse-des-resultats-de-l-Enquete-de-2022_a3884.html.
  30. Acharai L, Khalis M, Bouaddi O, Krisht G, Elomrani S, Yahyane A, et al. Sexual and reproductive health and gender-based violence among female migrants in Morocco: a cross sectional survey. BMC Womens Health [Internet]. 11 avr 2023 [cité 27 mai 2024];23(1):174. Disponible sur: https://doi.org/10.1186/s12905-023-02307-1
  31. Koubri H, Hami H, Coulibaly SK, Soulaymani A, El Kouartey N, Essolbi A. The role of NGOs and associations in health care for migrants in North West Morocco. In: E3S Web of Conferences [Internet]. EDP Sciences; 2021 [cité 7 janv 2025]. p. 02009. Disponible sur: https://www.e3s-conferences.org/articles/e3sconf/abs/2021/95/e3sconf_vigisan_02009/e3sconf_vigisan_02009.html