Abortion and Family Planning in

UNCLAS CASABLANCA 000169 SIPDIS STATE FOR NEA/MAG, DRL/NESCA, AND G/IWI E.O. 12958: N/A TAGS: PHUM KWMN PGOV MO SUBJECT: Abortion and Family Planning in Morocco REF: 08 Casablanca 222 ¶1. SUMMARY: Despite significant advances to women's legal rights by the passage in 2003 of a new family code (Reftel),pregnant unmarried women in Morocco still face intense social alienation and economic hardships. Contraception is widely available and heavily subsidized by the government of Morocco (GOM),but abortion remains illegal except in cases endangering a woman's life. Because of stringent limits on abortion and the shame associated with unwed pregnancies, women frequently turn to risky and illegal abortions. For the moment, neither women's advocacy groups nor the body politic is willing to discuss liberalization of abortion laws or the condition of single mothers. This report, prepared by Consulate intern, examines reproductive healthcare in Morocco, the dangers of illegal abortions, and challenges faced by unwed mothers. END SUMMARY. -------------- Family Planning, Contraception and Healthcare -------------- ¶2. Contraceptives are widely available and heavily subsidized with GOM funded Centers for Family Planning present throughout the country. According to a 2007 UNCIEF study, contraceptive use has increased drastically within the last decade, with a nearly 63 percent prevalence rate in 2007. However, while the Democratic Association of Women in Morocco (ADFM) found in a recent survey that 98.6 percent of Moroccan women have a basic understanding of contraceptive use, they noted that contraception promotion campaigns rarely target men. The onus is often put on women to guard against pregnancy with birth control pills, IUD devices, and spermicide being the preferred methods of protection. Dr. Zoubida Ellorhaoui, a gynecologist in Casablanca, recalled an incident in which boxes of free condoms in front of pharmacies were destroyed in protest of a governmental push to increase their use amongst the general population. Because of men's antipathy towards condoms this cultural view on contraception, women are not adequately protected from sexually transmitted infections. In addition, the ADFM also reported that many women regard abortion as a birth control option despite its clandestine and illegal nature. ¶3. Although contraceptives are widely available in urban areas many of the rural areas have limited or no access to healthcare, despite GOM efforts to provide mobile health clinics to many rural areas. A 2000 GOM study showed that over 33 percent of the rural population must spend more than one hour to reach the nearest health facility. Morocco has some of the highest maternal mortality rates in North Africa, and these figures reflect the country's many social inequities. According to a 2004 UNDP study, the maternal mortality rate, deaths of women related to childbirth, was twice as high in rural areas as urban ones. The same study also found that in rural areas only 48 percent of women received pre-natal care, and 60 percent did not have a doctor present at birth. -------------- Stigma of Single Motherhood -------------- ¶4. While Moroccan policies acknowledge the importance of family planning and contraception, sex outside of marriage is both culturally forbidden and illegal; though the prohibition is rarely enforced. Women face numerous obstacles both judicial and social to establishing the paternity of a child born out of wedlock and hence the ability to sue for child support. Even in cases where the father is known to the mother, the hospital will only record the father's name if the father acknowledges paternity. Aicha Channa, president of Solidarite Feminine, a non-governmental organization that works with single mothers, explained that a child with no father listed on the birth certificate will face a lifetime of discrimination and hardship as the child moves through the bureaucracy of the state. In addition, unwed mothers and their illegitimate children are often ostracized by their families and communities, leaving them with even fewer economic options. Many single mothers turn to prostitution or begging to support themselves and their children. ¶5. Groups such as Solidarite Feminine have estimated that the majority of the single mothers that have benefited from their services are former child domestics, or "petite-bonnes". Petite-bonnes are young girls, usually from poor, rural areas, who are trafficked by intermediaries to work in the houses of wealthy urban families. They are paid very little, and the money they do receive typically goes directly to their families. Once they reach adolescence, they are often dismissed with no economic resources and are particularly vulnerable to sexual exploitation. These young women have few options should they become pregnant outside of marriage. -------------- Abandonment or Abortion -------------- ¶6. Because of social and financial burdens, child abandonment has been a significant problem in Morocco. In the past, single mothers were pressured by hospitals and relatives to give the child to the government orphanage. While Channa stresses that this attitude has changed significantly in the last decade, putting a child up for adoption abandonment still remains prevalent, particularly in large cities. Abortion is another option that many women turn to in lieu of facing the harsh social consequences of pregnancy outside of marriage. ¶7. Abortions are legal in Morocco only to safeguard the health of the mother. The practical measures to garner permission for a legal abortion, however, are especially difficult. In addition to written consent by the spouse, the region's chief medical officer must approve all pending abortions. These stringent procedures mean that legal abortions are rarely approved beforehand. However, according to Dr. Ellourhaoui, doctors routinely perform clandestine abortions which cost between 400 and 700 US dollars on average, but can cost as much as 2000 dollars. In some cases the doctors justify the abortion to a hospital by falsely claiming an emergency intervention was necessary. In other instances the operation is performed in private clinics and is not reported. According to Professor Chafik Chraibi, head of the maternity ward at the Central University Hospital in Rabat and president of Moroccan Association for the Fight against Clandestine Abortion (AMLAC),the price of an abortion would drop to 150 or 200 USD if it were legalized. ¶8. Dr. Chraibi estimates that nearly six hundred clandestine abortions are performed daily in Morocco. However, only 250 of these procedures are performed by doctors. While the Moroccan Association for Family Planning (AMPF) has confirmed these figures, both organizations acknowledge that it is impossible to determine the precise number of abortions taking place outside of hospitals and consider 600 a conservative estimate. Data collected by the AMPF in Agadir and Fez determined that of the 473 women interviewed, 35 percent had undergone at least one abortion. However, statistics on this topic are often hard to corroborate, and this particular survey only represented a small sampling of women. ¶9. Although it is hard to say how many illegal abortions are performed by unqualified practitioners, it is widely known that many women choose to undergo clandestine abortions outside of hospitals. Women often turn to herbalists or unlicensed doctors for abortion remedies that range from herbal concoctions to the physical penetration of the fetus with, often unsanitary, household items. According to a recent WHO study, nearly 13 percent of the maternal mortality rate is a direct result of clandestine abortions. The lack of hospital accessibility has especially exacerbated the dangers of clandestine abortions in rural areas, leaving women who are unwilling or unable to travel with fewer options. ¶10. COMMENT: The GOM has taken a relatively liberal approach to family planning, particularly with the subsidized distribution of contraception, but has failed to target men in their awareness raising campaigns. Women are expected to bear the responsibility of protection against pregnancy, and are expected to accept the consequences alone should she fail to protect herself. Additionally, the government has done very little to safeguard single mothers against social stigmatization or economic burden. Because of conservative social pressures and a lack of general awareness on the topic, many women turn to clandestine abortion as a method of birth control. However, the illegality of the procedure has led to high costs for safe abortions and a complete lack of regulation for the majority of abortions performed. Reforms of abortion laws and the overall improvement of reproductive healthcare are not popular topics for debate in Morocco's political sphere. The most vocal proponents of the liberalization of abortion have been private organizations, such as AMLAC. Even women's organizations such as Solidarite Feminine and others are reluctant to raise the issue admitting that it is controversial and low on their list of priorities.