The use of antenatal services in health centres of Fès, Morocco.

Morocco has reported important achievements in coverage for mother and child healthcare services. Nevertheless, client-use and quality of antenatal care (ANC) services need to be improved. The aim was to identify factors related to the use of ANC services through a cross-sectional survey among women attending an urban maternity hospital in Fès. We describe quality of ANC services assessed in six health centres through pre-established national checklists. Of 240 women interviewed in postnatal wards, 23% had not undertaken any ANC consultation during their last pregnancy. The main characteristics of women not using ANC services were being multiparous (OR: 2.7; CI: 1.5 - 4, 8) and having no formal schooling (OR: 3.7; CI: 2.2 - 6.4). These women stated three main reasons: (1) did not find it necessary (46.9%); (2) health centre too far away (14%); (3) dissatisfied about the quality of care (12%). Evaluation of the quality of care showed a shortage of personnel and basic supplies and malfunctions were identified at various levels. In the region of Fès, there is a need to strengthen ANC and overall maternal health activities through community mobilisation and information and education. We recommend that the WHO ANC protocol (less ANC visits with emphasis on quality) be pilot tested in Morocco.