Inequities in maternal healthcare access in the Marrakech-Safi region, Morocco: a cross-sectional study

INTRODUCTION: Gender norms may shape maternal healthcare utilization, yet evidence from Morocco remains limited. This study examined the association between gender norms, measured using the Moroccan Arabic Gender Equitable Men scale (MA-GEM), and maternal healthcare utilization (antenatal care, facility-based delivery, and postnatal care) in the Marrakech-Safi region. METHODS: We conducted a cross-sectional survey among 632 adults aged ≥ 18 years using mixed online and in-person convenience recruitment. MA-GEM was administered to both women and men to assess general gender-norm attitudes and household power relations, while maternal healthcare outcomes were assessed separately using direct service-utilization questions. Analyses of maternal healthcare outcomes were restricted to pregnancy-exposed respondents (n = 207). Chi-square tests and multivariable logistic regression were used to examine associations between MA-GEM categories, sociodemographic factors, and maternal healthcare utilization. Sex-stratified models were conducted as sensitivity analyses. RESULTS: Our findings reveal that participants adhering to inequitable gender norms were significantly less likely to use antenatal care (AOR = 0.169, 95% CI [0.061-0.469], p = 0.001) and facility-based delivery (AOR = 0.034, 95% CI [0.007-0.169], p < 0.001). Rural residence (AOR = 0.071, 95% CI [0.014-0.367], p = 0.002) and lack of paid employment (AOR = 0.101, 95% CI [0.027-0.380], p = 0.001) were also associated with lower facility-based delivery. No statistically significant adjusted associations were observed for postnatal care. CONCLUSION: MA-GEM-measured gender norms were associated with antenatal care utilization and facility-based delivery in Marrakech-Safi. Findings support integrated interventions addressing both sociocultural norms and structural barriers to improve maternal healthcare utilization.