Context

Demographic characteristics

Morocco has experienced major demographic and socioeconomic changes in recent decades, as shown in the table. The population grew by nearly 50% in 30 years, from 24.8 million in 1990 to 36.9 million in 2020.¹ Fertility rates declined from an average of 4.0 children per woman in 1990 to 2.4 in 2020, with projections suggesting a further decrease to 2.05 in 2023.^2,3 Life expectancy rose by about 10 years, from 64.7 years in 1990 to 74 years in 2020, and under-five mortality declined from 80.8 deaths per 1,000 live births in 1990 to 18.6 in 2020.^4,5 These changes have reshaped the age structure of Moroccan society. Children under 15 now constitute a smaller share of the population, while the proportion of adults of working age has increased (Figure 27).

Education rates are high for both men and women, with the completion rate of lower secondary school rising from 33.7% to 72.3% of the population from 2000 to 2022.⁶ Higher education rates also continue to rise, with women notably making up slightly more than half of university graduates in Morocco in 2021.⁷ This same year, the proportion of Moroccans with higher education was 6% for women and 14% for men.⁸

Urbanization steadily increased from 53% in 2000 to 64% in 2020, due primarily to migration from rural areas.⁹ In 2023, Morocco’s largest urban areas included Casablanca, Fes, Tangier, Sale, and Marrakesh.¹⁰ Rabat is the capital city of Morocco.

Morocco’s 2011 constitution defines Islam as the religion of the state, while guaranteeing its citizens the right to religious plurality and practice.¹¹ The vast majority of the state is Sunni Muslim, representing more than 99% of the population in 2020.¹¹ Shia Muslims, Christians, Jews, and Bahá’ís combined constitute less than 1% of the population.¹¹ National languages in Morocco are Moroccan Arabic and Amazigh. Though not an official language, French is used widely in government and business, and is spoken by about a third of the population.¹²

Table: Demographic characteristics of Morocco, 1990–2020

Note: All indicators are from the World Bank, except where noted.

Household infrastructure

Economic progress has translated to improved infrastructure at the household level, as seen in Figure 28. Nearly all households in Morocco have access to an improved water source, improved sanitation facility, electricity, and a mobile phone as of 2018.¹³

Increased road infrastructure and vehicle ownership are other broad societal shifts that impact women’s access to health care. Improvements in road infrastructure have impacted access to health care facilities in Morocco by connecting rural areas and decreasing travel time. The Moroccan government has made substantial investments in the length of the road network, expanding from 10,348 km in 1956 at independence, to 29,310 km in 1990, and further to 45,240 km in 2021.¹⁴ An increased number of motorized vehicles has also increased access to health services for women.¹⁵

Women’s empowerment

Revision of the family code (Moudawana) in 2004

Morocco has improved gender equality through additional legal reforms and policies that recognize and ensure women’s human rights. One marquee policy change supporting gender equality was the revision of the family code, known as the “Moudawana,” in 2004.¹⁶ Policy action was spurred by civil society, with campaigns led by the Women’s Action Union (l’Union de l’Action Féminine). The 2004 revisions established principles of equality between men and women, and stipulated equal eligibility to enter into a marriage contract, take joint responsibility for the family, and equal rights and duties for both spouses.¹⁶ Overall, it granted women greater rights in marriage, divorce, self-guardianship, and child custody, as well as making sexual harassment punishable by law. Additionally, the 2004 reform raised the legal age of marriage from 15 to 18 for both boys and girls—a significant step toward preventing child marriage and protecting the rights of girls.¹⁶

As marriage patterns are linked to fertility, delaying age at first marriage can contribute to decreases in adolescent fertility rates.¹⁷ Data from household surveys show that the percentage of women in Morocco first married at 15 declined dramatically, from 19.7% in 1987 to 1.7% in 2018.^18,19,20 Over the same time period, fertility for 15-19 year old women in Morocco decreased from 46 births per 1000 women-years to 19.4 births per 1000 women-years in 2018. This fertility decline is also likely linked to other factors such as increased family planning usage, higher levels of women’s education, and socio-economic shifts in Morocco – which all accompanied the codification of gender equality measures in the Moudawana revision.

Policy shifts supporting gender equality

Additional laws in the decades following the revision of the Moudawana elevated and supported women’s rights, encouraging more women to enter the labor force and continue education. The constitution was revised in 2011, expanding the scope of social protection, individual freedoms, and gender equality.²¹ In the constitution, Article 31 required the mobilization of all available means to facilitate equal access to health care for the entire population, Article 34 stipulated that the public authorities should draw up and implement policies for vulnerable persons and poor populations, and Article 154 specified that public services must be organized on the basis of equal access and equitable coverage for all.

Other key policies and laws included:

• Introducing gender-responsive budgeting at the government level (2015)
• Setting up a national institute about women’s images in media (2015)
• Establishing a family and children’s advisory council for public policy (2016)
• Improving employment and working conditions for domestic employees (2017)
• Fighting against discrimination (2017)
• Addressing violence against women via improved monitoring, reporting, and communication (2015, 2018)
• Launching government plans for gender equality (2012–2016 and 2017–2021)

These legal reforms support women’s empowerment in the home, the workplace, and in civil society, which in turn contribute to reducing gender inequality.

Women’s education

Rising female education rates contribute to women’s empowerment broadly, as school provides literacy skills, socialization, economic opportunities, and social mobility. Completion rates of primary education for women in Morocco increased from 52% in 2000 to 100% in 2021, and completion rates of lower secondary education (grades 7–9) for women increased from 29.6% in 2000 to 78% in 2022.²² Morocco has made substantial progress in raising education attendance for women at all levels.²³ From 1999 to 2010, the country underwent several ambitious educational reforms to restructure the education system.^24,25,26

Our team interviewed many stakeholders in Morocco who noted the importance of women’s education and its impact on health and autonomy. One director at the Ministry of Health (Ministère de la Santé) shared the following:

Several education reforms prioritized women’s education throughout early 2000s, such as the National Human Development Initiative (INDH; three phases in 2005, 2011, and 2019) and the National Education Emergency Support Program (2008–2012). Both programs were well funded and had targeted programs to reduce gender gaps.^23,27 The INDH included initiatives such as school construction, safe school transport systems, separate sanitation facilities, dormitories, housing for female teachers, and support for disadvantaged girls to continue their education.²⁸ By 2019, education interventions under the INDH resulted in the establishment of 1,400 boarding schools and the provision of 1,260 school buses, primarily benefiting women in rural areas.²⁹ The National Education Emergency Support Program increased the age of compulsory schooling from 13 to 15.³⁰ It also focused on reducing gender gaps in education via similar types of initiatives.^27,28,29 This program also introduced gender-specific metrics and leaders at the system level and adopted gender equality training for teachers.

Though education rates increased for Morocco broadly, targeted programs were needed to encourage girls in rural areas to attend. Barriers to sending girls to school in rural areas included gender role expectations, early marriage, and costs associated with sending girls to school. In 2008, the Moroccan Ministry of National Education and Higher Council of Education developed a cash transfer program called Tayssir, aimed at increasing the primary school completion rate in rural and high-poverty regions.³¹ The program implemented cash transfers for primary school enrollment and attendance. It was scaled up nationwide to eligible poor regions and targeted all municipalities with a poverty rate above 30%.³² Between 2010 and 2018, up to 800,000 children in 434 municipalities received transfers.²⁹ Annual transfers were equivalent to between 6% (in grades 1 and 2) and 10% (in grades 5 and 6) of the average annual spending per capita.^33,34 The Tayssir program substantially reduced school dropout rates by 41% overall and by 50% for girls, and improved school attendance by 4.5% overall and 7% for girls.^33,34

Other public health challenges

Morocco has prioritized women’s nutrition over several decades, resulting in fewer pregnant women with short stature, anemia, and low body mass index (BMI)—which are all risk factors for various obstetric and neonatal complications.

In recent decades, a declining proportion of women in Morocco have had low BMI, but an increasing percentage of women have had high BMI—a risk factor linked to other health conditions that affect pregnancy. As Morocco faces a growing burden of chronic health conditions, shifts in health policy may be required to address the evolving challenges the epidemiologic transition brings.³⁵

Economic growth and industries

Morocco’s gross domestic product (GDP) per capita in current US dollars grew from US$1,492 in 2000 to US$3,442 in 2022. Over the past two decades, Morocco has implemented pro-growth policies in strategic sectors such as agriculture, mining, energy, and industry. As of 2017, services, mining and manufacturing, and agriculture accounted for approximately 56.5%, 29.5%, and 14% of Morocco’s economy.³⁶ As a service, tourism has grown substantially, with Morocco welcoming 14.5 million tourists in 2023. Revenue from tourism in 2023 was US$9.8 billion, with a 15.8% increase from the previous year.³⁷ Key mining and manufacturing industries in Morocco include automotive parts, phosphate mining and processing, aerospace, food processing, leather goods, textiles, energy, and construction. Morocco has developed significant trade and investment relationships with EU countries, especially Spain and France, its largest import and export partners.³⁶ Agriculture also remains an important component of Morocco’s economy, employing approximately a third of the workforce.³⁸

Morocco’s economic development has helped to mobilize additional domestic resources for health, especially for maternal, newborn, and child health (MNCH). In parallel, incoming development assistance for MNCH has decreased from 2000 to 2019. Figure 29 shows that aid for child and newborn health and reproductive and maternal health have both decreased to below US$2 million by 2018. Aid is a very small component of Morocco’s overall health expenditure, shown in Figure 19.