Strengthening midwifery practices in Morocco: a gender perspective: Suzanne Kerouac, Fatima Temmar and Bilkis Vissandjee, from the University of Montreal, Quebec, Canada, explore current issues for Moroccan midwives.

Author:Kerouac, Suzanne
 
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Morocco's midwives are called upon to meet a growing demand for care of mothers and newborns in birthing homes, in maternity hospitals and in landlocked rural centres. In a context that remains greatly influenced by biomedical perspectives, midwives offer services that are largely 'invisible'. This notable lack of professional recognition for midwifery in Morocco is a reflection of the widespread inequalities associated with gender and social status. Which social constructs and gender relations support the professional development of Morocco's midwives? What development opportunities would be congruent with Moroccan midwives' personal values and societal expectations? In examining a profession whose services are increasingly in demand in Morocco, this article attempts to address these questions.

It also offers a renewed vision of a midwifery model of care inspired by current gender-sensitive undergraduate training of nurses and midwives in Morocco, an initiative funded by the United Nations Fund for Population Aid (UNFPA). Challenges associated with implementation of standard midwifery practice include an adequate disciplinary link with the biomedical community and recognition as a valid, autonomous and necessary profession in Morocco.

The practice of midwifery in Morocco

The continued existence of midwifery in Morocco bears witness to its long history. Care in pregnancy and delivery has always been the business of women: the traditional birth attendants known as kablas were, and still are, respected and appreciated by the community. They are recognised for their role as confidantes and experts on women's bodies and infant care. The very nature of this care--centred on women, provided by women--inadvertently reinforces prevailing gender constructs in Moroccan society.

Historically, male doctors have seldom provided obstetrical care in Morocco. In the 1960s, the task of 'monitoring pregnancy and delivering infants' was still the responsibility of 'female practitioners' ranging from auxiliaries to nurses acting under medical aegis. However, in response to a population explosion and thus an increase in pregnancy rates, male health care professionals, including physicians trained in fields other than midwifery, began to become involved in pre-, peri- and postnatal care. They did so primarily from a biomedical perspective.

Despite the emerging need for midwives in the community, only one official midwife training programme at the graduate level was instituted, in 1965, at the 'Ecole des Cadres' in Rabat. Geographic restrictions, stringent selection criteria and social constraints made this training inaccessible to most women. Inadequately sensitised to social conditions and the responsibilities that women face in this society, the graduate programme for midwives...

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