Assessment of Social Determinants of Maternal Health in Morocco Using Interpretive Grounded Theory.

Abstract

BackgroundMaternal health in at-risk communities is a significant public health issue, especially in areas characterized by socio-economic and healthcare inequalities. This study aims to uncover the multiple factors that influence maternal well-being in Morocco, providing insights for targeted interventions and policy development.MethodsAn interpretive grounded theory approach was employed, combining in-depth interviews, observations and constant comparative data analysis. Participants (n = 69, aged 17-49) were recruited from six provinces across five main regions, representing diverse socio-economic backgrounds, cultural contexts, and healthcare systems.ResultsThe analysis identified four main categories explaining the interactions and interrelations of factors shaping maternal and reproductive health. First, childbirth and postpartum maternal healthcare experiences reveal contrasting realities between home and hospital births, marked by fear, neglect, obstetric violence, and the critical role of family support. Second, cultural practices and beliefs strongly shape perceptions of pregnancy, delivery, and postpartum care, sometimes providing protection and other times reinforcing harmful traditions. Third, maternal health dynamics in the societal context highlight systemic barriers to healthcare access, the weight of sociocultural expectations, and the compounded burden of rural living. Finally, women's reproductive autonomy and family size underscore limited decision-making power, ambivalence toward contraceptive use, son preference, and contraceptive misinformation. Together, these categories illustrate the complexity of relationships between socioeconomic status, access to healthcare services, education, cultural beliefs, and social support networks, which emerge as important determinants of maternal and reproductive health outcomes in Morocco.ConclusionsBy amplifying their voices and perspectives, this research advocates for holistic, equitable, and empowering approaches to maternal healthcare. The findings underscore the need for interventions tailored to local contexts, based on a thorough understanding of the determinants of maternal health.