Morocco has made great strides on maternal and child health, but newborn mortality remains a challengeSince the 90s and especially during the last decade, Morocco has made significant improvement in terms of maternal and child health (MCH). Continuous efforts during two decades resulted in cutting-down the maternal mortality ratio by 66% and decreasing the ratio from 332 in 1990 to 112 deaths per 1000,000 births in 2010. This improvement is to some extent correlated with a progressive increase in MCH service utilization and free care for pregnancy, childbirth and obstetric complications. In addition, in 2009, the implementation of maternal death surveillance system revealed the leading causes of maternal deaths (i.e. postpartum hemorrhage, preeclampsia, eclampsia and sepsis after birth) and provided guidance on immediate actions to be implemented at health facilities and in the community to prevent similar deaths.
Complications of preterm birth, birth asphyxia and severe infections are the main causes of neonatal mortality, which represents almost 71% of Under-5 mortalitySimilarly, substantial efforts have been made to improve child health and led over the last two decades to a 60% reduction in Under-5 mortality rate (from 76.1 in 1990 to 30.5 deaths per 1000 live births in 2011). However, neonatal mortality has only slightly decreased from 31.4 in 1990 to 21.7 deaths per 1000 live births in 2011. Complications of preterm birth, birth asphyxia and severe infections are the main causes of neonatal mortality, which represents almost 71% of Under-5 mortality. Certainly, the progress in child health status has been made possible through the combination of several programs such as the Expanded Program on Immunization offering free vaccination for 12 antigens (i.e. eleven for child health protection and one to prevent neonatal and maternal tetanus). With over 90% immunization coverage, Morocco is free of polio since 1987, free of diphtheria since 1991 and free of neonatal tetanus since 2002.
Seemingly, due to factors like geographical and socioeconomic backgrounds, the overall progress veils disparities between regions and within regions. Indeed, the decrease in mortality rates has benefited children from the wealthiest families (15.2 for the richest quintile against 37.9 / 1000 live births for the poorest quintile) and women living in urban areas (73 deaths per 100,000 births in urban areas against 148 in rural areas).
The decrease in mortality rates has benefited children from the wealthiest families and women living in urban areasFortunately, these inequities are being taken into account during the implementation of the 2012-2016 National Action Plan to accelerating the reduction of maternal and neonatal mortality. Actually, to narrow the gaps, rural areas and regions with low coverage (antenatal care, skilled birth attendance, etc.) are given high priority when assigning human resources for MCH; upgrading maternity hospitals and birthing centers; implementing the obstetrical Emergency Medical Service, etc.
Nevertheless, the government and the Ministry of Health are placing special emphasis on tackling the social determinants of health and adopting cross-ministerial and multi-sectoral approaches to maximize the opportunities aiming to reduce the burden of maternal and Under-5 mortality especially for the most vulnerable populations.
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