ArticleBMJ public health2026
Barriers to sexual and reproductive health access among migrant women: a cross-sectional study in five regions in Morocco.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Morocco, a transit and destination country, has implemented policies granting free primary care and community outreach to improve sexual and reproductive health (SRH) services for migrant women. Despite this, studies suggest that SRH services remain underutilised. This study assessed barriers to SRH services and migrant-supported strategies to improve access. Methods: We conducted a cross-sectional study in July 2024 in five Moroccan regions with high migrant concentrations. Migrant women of reproductive age were recruited via respondent-driven sampling with local non-governmental organizations (NGOs). A structured questionnaire assessed sociodemographic characteristics, migration profile, SRH barriers and preferred strategies. Bivariate and multivariable logistic regression identified sociodemographic predictors of experiencing barriers. Results: Overall, 1213 migrant women participated (mean age 29.5, SD 7.7). 80.2% were from Sub-Saharan Africa and 14.0% reported experiencing barriers to SRH services. Undocumented migrants had significantly higher odds of reporting barriers than documented migrants (adjusted OR: 2.21; 95% CI 1.05 to 5.24). Among those reporting barriers (N=170), the most prevalent were absence of health insurance (89.4%), cost of consultations (88.2%), lack of information about services (82.4%) and transport difficulties (68.8%). Cultural and provider-related barriers were rarely reported. Affordability-related interventions were most strongly endorsed: free SRH services (mean 4.56), health insurance coverage (4.55) and free medicines and contraceptives (4.53). Conclusions: Barriers to SRH access are driven predominantly by structural factors, including financial hardship, administrative constraints, and information gaps, rather than individual or cultural factors, reflecting a the persistence of the policy-practice gap. Addressing this requires financial protection for undocumented migrants, action on upstream access barriers, and innovative financing leveraging Morocco's ongoing health reforms. This should be paired with migrant-sensitive, co-designed communication to empower migrant women and support service navigation.
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