Emergency Contraception: When Prevention Collides with Taboos

Emergency contraception has, in recent years, begun to make inroads into the Moroccan pharmaceutical market, but access to it remains regulated, cautious, and well below what is practiced in several Arab and African countries.

While in some of these countries its use is strictly limited to the hospital setting, in others—such as Senegal, Benin, Mozambique, and South Africa—legislation has authorized its over-the-counter sale in pharmacies.

In Morocco, its marketing remains controlled and relies essentially on the supply of a single industrial operator: Sothema, which handles its production and distribution. “Legalized in Morocco in 2008, emergency contraception has a low penetration rate. Our product accounts for about 2.6% of the contraceptives market share.

Its actual use remains marginal compared with other methods, even though emergency contraceptive pills such as ulipristal acetate are registered and marketed in Morocco with a marketing authorization as a medicine,” the laboratory’s officials explain.

According to Chakib Chraibi, a gynecologist and president of the Moroccan Association to Combat Clandestine Abortion (Amlac), “contrary to a widely held belief, these pills are not abortifacient. They act mainly by delaying or preventing ovulation and do not end an already established pregnancy.

This confusion nonetheless fuels strong reluctance, particularly for religious reasons, as abortion is prohibited under the Maliki rite.” And the staunch advocate of the legalization of abortion adds: “It is a pill taken for rescue purposes following an unplanned or unprotected sexual encounter, rape, incest, or simply when one forgets for a day or two.”

This confusion is holding back the liberalization of the emergency pill, even though it is a recognized public-health tool. There are two types of emergency pill: the morning-after pill and the day-after-the-next pill.

The first can be used within 3 days after intercourse, whereas the second is used within 5 days. The effectiveness rate, if used as indicated, is 99 to 100%.

“Not being 100% abortive, the emergency pill only stops, therefore, immediate ovulation. But if ovulation occurred the day before or on the day of intercourse, then it may not be effective,” Dr. Chraibi is keen to уточify. His association runs, twice a year, an awareness campaign on the use of this pill which, he stresses, “is not haram, contrary to preconceived notions that are widespread in certain social groups.”

Between religious caution and public-health challenges

A visit to several pharmacies in the city reveals that many young unmarried women resort to emergency contraception for lack of being able to access regular contraception.

“Fear of parents, social pressure, and the fear of being found out often prevent them from consulting freely for a prescription for conventional contraception,” explains a pharmacist who was interviewed.

This situation highlights a deficit in sex education and communication. This leads, according to the president of Amlac, “some young women, in order to get around the obstacles, to invoke other medical indications to justify taking a hormonal pill.” They then speak of regulating the hormonal cycle, treating menstrual pain, managing hormonal disorders, or treating acne.

Sold respectively at 65 and 145 dirhams, the morning-after and day-after-the-next pills must be taken occasionally. There are certainly, for the moment, no scientific studies on side effects, but doctors recommend three to four doses per year.

That is, once per quarter. Because in the event of repeated use, potential risks may appear, particularly hormonal or cardiovascular ones. The morning-after pill therefore remains an emergency solution and not a regular method of contraception.

This is the main message that Amlac seeks to convey through its awareness campaigns, both to users and to the health authorities who, for now, the association’s president notes, are wary of this product.

The authorities’ wariness is explained by the precedent of two medicines, initially intended for the management of postpartum hemorrhages, introduced onto the Moroccan market and whose abortifacient effect diverted their use and sparked very strong demand.

Faced with this drift, the Ministry of Health eventually banned their sale in pharmacies, reserving them henceforth for exclusively hospital use. This precedent, dating back to the early 2000s, still seems to weigh on decisions relating to emergency contraception.

350,000 clandestine abortions per year!

But that is not the only reason, because in Morocco the debate around emergency contraception is often muddied by its conflation with abortion. This confusion is holding back the liberalization of the morning-after pill even though it is a public-health tool.

Its use makes it possible, it should be recalled, to prevent unwanted pregnancies and, by extension, to reduce recourse to clandestine abortions, the consequences of which can be fatal for women. Moreover, its use also helps prevent child abandonment.

According to the INSAF association, there are nearly 350,000 clandestine abortions per year. The association’s statistics also report 80 to 100 babies born out of wedlock every day! It should also be noted that 25 children among them are abandoned.

For Solidarité Féminine, these figures will rise significantly in the coming years if emergency contraception is not properly regulated and “especially if the abortion law is not enacted.” From a legal standpoint, Morocco is moving forward very slowly.

Abortion is currently authorized only in limited cases: serious fetal malformations or danger to the mother. The draft law provides for extending it to cases of rape, incest, or serious illnesses.

However, adoption of this text remains closely linked to reform of the Penal Code. The country has nevertheless recorded, from the perspective of associations, notable progress.

“Single mothers are no longer prosecuted criminally and can register and give their name to a child born out of wedlock. An important development, but insufficient as long as access to prevention remains limited,” Dr. Chraibi believes.

In this context, the question of the morning-after pill clearly goes beyond the simple pharmaceutical framework—and thus beyond its liberalization on the market—and instead points to a broader debate on reproductive health, women’s autonomy, and a balance between religious norms, social realities, and public-health imperatives.

The emergency IUD: a little-known alternative…

Less well known than the morning-after pill, the emergency IUD is nonetheless the most effective method of emergency contraception.

Inserted within five days following unprotected intercourse, this copper device can prevent pregnancy with a reliability rate above 99%, while not causing an abortion. Copper acts directly in the uterus and makes the environment hostile to sperm, reducing their mobility.

Once inserted, this IUD can serve as an emergency measure or as a regular method of contraception for several years, notably 5 to 10 years.

This device must be prescribed by a doctor. As for side effects, it can cause cramps or irregular bleeding during the first weeks.

In Morocco, the price of this IUD remains affordable and ranges between 30 and 50 dirhams depending on the model. To this is added the cost of insertion by the gynecologist, which can run to around 1,000 dirhams. On the practitioners’ side, it is specified that demand is very low, because women are not aware of the device for lack of communication.