Obstetric care: Supply and demand care in three valleys of the western High Atlas region of Morocco (Anougal, Azgour and Imnane)

Abstract

This article analyses the data of an exhaustive retrospective survey of maternal morbidity among 656 women from 3 valleys of the Western High Atlas mountains of Morocco who gave birth within the previous 5 years and from the obstetric register of the hospital providing obstetric care in the study area. This analysis reveals a very large gap between the prevalence of symptoms of maternal morbidity recorded in the High Atlas valleys we studied and those measured on a regional and national scale. Only a minority of women have either prenatal or postnatal care, and delivery in a medically monitored environment is uncommon. Although morbidity during pregnancy should lead women to give birth in such a setting, only one third of the women with morbidity during pregnancy gave birth in a medical facility. This situation increases the risk of complications and morbidity during pregnancy, delivery and the postpartum period. This inadequate utilisation of preventive and curative healthcare appears to be related not only to sociocultural representations and socio-economic conditions but also to inadequate provision of obstetric care by the health-care system for complications and the poor quality of pre- and postnatal consultations. The proportion of serious complications of pregnancy or delivery complications requiring emergency obstetric care admitted to the hospital does not exceed 4.5%, while the acceptable level is 15%. Among these cases, nearly half were subsequently referred to Marrakech, to a second-level referral centre.