I’m in a Planned Parenthood health center. Men are in the waiting room, as well as women and infants. Primary care, including dermatology, urology, and pediatric care, are offered to all comers. But that is not all. In one adjacent building, there is a cooking class and an adjacent café where the teen (and some adult) budding cooks sell their culinary creations to the public. In another building, teens are learning to cut and style hair; next door teens are measuring customers for made-to-order clothes; and in yet another space, teens are rehearsing a play about responsible decision making and warning against illegal abortion. Nearby are the classrooms of a primary school for the orphan children of the neighborhood. A steam bath in another building has a steady stream of customers from the community.
This is Planned Parenthood? Or have I wandered into some alternative universe?
I’m in Fes, Morocco at the Complexe Lalla Fatima Zagra Laazizia, run by Moroccan Family Planning Association, or, more properly, the Association Marocaine de Planification Familiale (AMPF). AMPF is the Member Association of the International Planned Parenthood Federation in Morocco. Founded in 1971, AMPF saw that providing sexual and reproductive health care had to be done in the context of empowerment of women and of disadvantaged young persons, male and female. Family planning had to be part of life planning and life opportunity and needed community support so as to be seen as integral to the futures of girls and boys, women and men. AMPF decided it had to be embedded in the community to succeed. No isolation for them. No services only below the waist.
No women only. In this it has succeeded.
The nation of Morocco is among the most liberal in the Arab world and is developing rapidly. According to the United Nations, the population is approximately 35 million people, and the birth rate is 2.6. The birthrate in the Arab world is 3.5. According to the World Bank, maternal and infant mortality are declining rapidly in Morocco and the Arab World, with maternal mortality in Morocco at 121 (down from 317 in 1990), versus 156 in the Arab World (down from 289 in 1990). Thus, Morocco had had above average maternal mortality in 1990 and now is lower than average. The under-5 mortality is 28 (down from 239 in 1990). In the Arab World it was 37 in 2014 versus 249 in 1990.
While the life expectancy at birth is 73 years for men and 75 years for women, the educational and economic disparities run in the other direction. According to the UN, 59% of boys are enrolled in secondary school but only 53% of girls. These rates are slightly less than the Arab World at 64% and 58% respectively. In University, the ratios even out with about one-quarter of both young men and young women enrolled. The greatest disparity is in labor force participation, where only one-quarter of women are participating, whereas three-quarters of men are.
Birth-control is available for free in government health clinics and abortion is widely practiced, but is legal only in cases of danger to the health of the woman and in cases of rape, incest or fetal defect (these latter exceptions were added this year.) The contraceptive prevalence rate is 68%, with the modern contraception rate being 58%. The percentages for the Arab world are 51% and 43% respectively.
The Moroccan Family Planning Association operates 30 sexual and reproductive health centers and, in addition, has seven mobile health units. It offered over 1.7 million reproductive health care services last year.
The MFPA clinic and complex in Fes is located in a disadvantaged neighborhood called Sahrij Gnaoua. The Complexe serves the 70,000 inhabitants, where the birth rate is about five children per woman. The illiteracy rate is 55% for women and 35% for men. There is only one Ministry of Health center for this entire population and one doctor from the private sector.
The Complexe enables women to make choices about their lives, gives young girls and boys opportunities for the future, campaigns against gender-based violence, and creates a social enterprise model and mutual aid partnership between the clinic and all its programs and the entire neighborhood.
The Complexe is a model for how reproductive health care services can be part of an entire fabric of a neighborhood and garner community and nationwide support. They partner with 65 community groups and do sex education programs in the community schools. Women sit in the hammam and discuss sex and ways to prevent intimate partner violence. There is no opposition. No picketing. No harassment. It is one of Morocco’s great success stories. There are lessons to be learned here.