11 p.m., springtime, somewhere between Ifrane and Fes. In a hospital that has already closed for the night, a potbellied man in his fifties and two young women negotiate the price for an illegal procedure: 2,500 Moroccan dirhams for two injections and a pill. Hugging one woman, the man leads her into a back room and tells her to pull down her pants and underwear. O., graduate of University X, asks herself if this is a nightmare. She takes off her clothes and freezes in place as the man, whom she describes as “not really a doctor” but rather a hospital manager, begins touching her stomach. This is the first time O. has exposed herself in front of a man of this age, and she begins to shake. Asking her to spread her legs, the man uses a cone-shaped tool to push a pill inside of O.’s vagina. She feels like fainting, and sees stars. After two minutes, she can stand again. The man injects her with an unidentified fluid, twice, and O. and her friend travel back to their town. Due to severe cramps, O. is sure that this time, finally, the procedure will work.
This is the second time O. has avoided seeking an abortion from a doctor. Following suggestions from friends, she has already tried pills, ostensibly from France, which she estimates cost 1,000 dirhams. After discovering that her second attempt has failed as well, O. takes time off work to visit a doctor in Meknes, who charges 400 dirhams for an ultrasound, inserts his finger in her anus and storms out of his clinic when she asks to bring her friend into the operating room. Finally, a friend refers O. to a clinic in Rabat, where, for 2,300 dirhams, she feels respected, is treated well, and, finally, ends her pregnancy.
Despite undergoing sham abortions by two people without medical licenses and suffering significant financial and mental costs, as well as unwanted sexual penetration, O. suffered no severe physical consequences and was finally able to find a safe medical facility.
In her attempts to find an illegal abortion, however, O. is hardly alone. In Morocco, contraception was legalized in the 1960s, and rates of use are among the highest in North Africa. Free condoms are available in public hospitals to everyone, emergency contraception can be found in pharmacies and abortions are legal if pregnancy threatens a mother’s life and/or general health (this law, by the way, is currently up for debate in the Moroccan parliament. Read about it here). Education regarding contraception is targeted at married people, though, and this situation represents a larger stigma in Moroccan society: in this country, premarital sexual intercourse is illegal and heavily stigmatized socially, according to one analysis of the French National Institute for Demographic Studies (INED)’s 2006-2007 Emergency Contraception in Africa survey.
While premarital sexual activity is often accepted and even considered necessary for males in order to prove virility and enter adulthood, 90 percent of women in the ECAF study considered virginity before marriage as a “social duty.” Most men in the survey refused the idea of marrying a non-virgin: one likened female sexual behavior before marriage to prostitution.
Despite stigma, sexual relationships are prevalent among unmarried people: according to a 2006 L’Economiste study, which involved 776 young Moroccans, 86 percent of men and 34 percent of women between the ages of 16 and 29 reported sexual relations before marriage (these relations did not necessarily include penetration).
Premarital sexual relations may be influenced by a number of factors. The fear of losing potential husbands by refusing sex before marriage is strong among women, according to the ECAF study, and many couples headed for marriage feel sexual activity is necessary to better know their partner. Attitudes toward sexual expression became more liberal among women with high levels of education, and some female ECAF participants chose to initiate intercourse as a way of rebelling against social taboos and double standards.
While women who are discovered to have engaged in these relationships are often stigmatized, their situation can worsen drastically should they become pregnant, regardless of education level: consequences range from shunning to rejection by families and communities, and abuse.
Perhaps because of these consequences, levels of illegal abortion are significant. In an analysis of the ECAF survey, one third of women in Rabat aged 18 to 35 had had abortions, while one sixth had used emergency contraception, an often cheaper method to avoid pregnancy. Fifty-three percent of married women used different modern contraceptive methods, such as the birth control pill. Between 130,000 and 150,000 illegal abortions are completed each year in Morocco, according to a 2003 USAID study. The rate for North Africa in 2003 as a whole, for comparison, was estimated at 23 illegal abortions per 1,000 women, according to the World Health Organization.
In a country where contraception is readily available, why do studies indicate so many illegal abortions? According to the ECAF survey, unprotected consensual intercourse was prevalent among married and unmarried women due to requests from male partners (author interviews with Moroccan students from University X indicated that females also encourage male partners not to use condoms) and lack of planning regarding penetration. The USAID study also pointed to Morocco’s rising age at marriage, rising periods of premarital sexual activity and inadequate education on contraceptive services as reasons for “high rates” of unplanned pregnancy.
Interviews with students at University X, as well as various studies, indicate ignorance regarding sex as a huge influence on unprotected/uninformed sexual behavior. In the ECAF survey, women reported taking “breaks” from the pill, during which some reported becoming pregnant, as well as other hormonal contraceptive methods like injections, as women believed these methods negatively affected their future fertility. The survey also found that unmarried women often began having sexual intercourse without contraception, as the issue was only briefly discussed in schools and not at all in their families (note: between 30 and 50 percent of pregnancies worldwide are unplanned, even when contraception is readily available, according to the WHO).
Lack of contraceptive knowledge also affects youth. Though awareness of contraception was, according to USAID, high among urban-dwelling adolescents (in 2003, around 85 percent of Casablanca youth between 13 and 19 years of age were aware of one or more contraceptive methods), general education levels played a large role: while awareness was greatest among highly educated youth, more than a third of illiterate youth were completely unaware of any family planning methods. Regardless of location or education level, the study indicated that youth were “starved for more information about sexual and reproductive health.”
Next Week: More members of University X speak about their experiences with sexual education and culture.
Note: Obviously, I am an outsider to Moroccan culture. If you would like to challenge or discuss anything written here, I welcome your thoughts below.
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