Information on postpartum morbidity in developing countries is limited and, when available, usually describes the type of medical conditions diagnosed at the hospital level [15]. This study is one of the few surveys conducted in Morocco studying SRPPM within the population.
Our results show that 13.1 % of women expressed at least one postpartum problem. The percentage was close to the one recorded in Marrakesh in 2008 which is 10.8 % [16]. However the rate of postpartum haemorrhages (9.91 %) was much higher than the one recorded in 2008 which is 1.5 % [16].
The rates of postpartum haemorrhage are incomparable since the amount of blood loss is difficult to estimate [11]. The rate of fever was 1.5 %, the one recorded in 1999 [11] and 2010 [16] were 3.3 and 2.2 % respectively. Pregnancy-induced hypertension is more common (1.65 %) in comparison with other studies carried out in Marrakesh (0.2 %) [16].
Nevertheless, a limitation of the present study is the wide variation of information reported by women based on socio-cultural and medical context. Hence, it is unclear whether the SRPPM represent the magnitude of the genuine morbidity. Thus, to understand the gap between the reported morbidity and the one defined medically, studies should be conducted to assess the validity of the information reported by women [12].
However, estimates of self-assessed morbidity prevalence are generally more specific than sensitive [15]. Underestimation or overestimation by women tends to be influenced by age, level of education, and specificity of clinical symptoms [15]. In industrialized countries, greater value is given to womens’ self-reports of complaints, and responding to these complaints is considered more important than measuring the incidence of true postpartum morbidity [2].
But in non-industrialized countries such as Morocco, we noted a lack of or in-complete information due to poor documentation about self reported postpartum morbidity [15].
Also, we found that the amount of women in our study population who attend a postnatal clinic is low (30.1 %), and it is also low nationally (22 %) [11, 17]. Our study has brought clear supporting arguments to increase this percentage given the important role of the PNC.
Furthermore, some associations of socio-demographic and health variables with the SRPPM were observed including the woman’s age at the last childbearing, education level, number of pregnancies, failed pregnancies and place of birth.
The age at childbearing over 35 years increases several maternal complications like pregnancy-induced hypertension, dystocia and haemorrhage [18]. In this study, 13.9 % of the participants were found to be 35 and above during their last pregnancy. Retreat from marriage has moved from 17.3 years old in 1960 to 26.6 years old in 2010, can explain partly this finding [19].
Similarly, women who had been pregnant more than three times reported significantly more postpartum complications. This can be attributed to the deeper impact of multiple pregnancies, which causes the exhaustion of the uterine muscle promoting more complications; particularly haemorrhage [18].
Furthermore, the average number of pregnancies (2.17) is lower than the one recorded in 1998 (2.5) [17]. This further shows the continuing decline in fertility in Marrakesh. The use of contraceptive methods is increasing thanks to the national family planning program that provides Moroccan couples a range of free contraceptive methods in public health centres [11].
Illiteracy has been found to be another important determinant strongly associated with the SRPPM. This has been confirmed by other studies conducted in Marrakesh and its regions [16]. In fact, the education level is an important determinant of reproductive and health behaviour [11]. Illiteracy is higher among women than their spouses (p < 0.01). This difference is due to socio-cultural factors related to gender and also to disadvantaged socio-economic conditions that hinder access to more advanced levels even for males. The Moroccan educational system has changed and improved significantly over the past two decades through an explicit commitment to ensure compulsory education for all. However, more progress is still to be achieved for a more balanced distribution of education between Moroccans, including the fight against illiteracy and dropouts [11].
In addition, failed pregnancy during the reproductive life is lower than the one found in 1999 (26 %) [11]. It is associated with SRPPM in subsequent pregnancies which was a result also confirmed [16].
Our study shows that the delivery rate in a health facility (97.6 %) is more frequent than at the national scale (90.7 %). Also women who gave birth in a public hospital reported more postpartum complications than those who gave birth in private clinic. Moroccan public hospitals suffer from a shortage of health workers failing to meet the needs of the population [11].
Finally, adjusting on other significantly associated variables in bivariate analysis, and through the multivariate analysis, only illiteracy and over three pregnancies determine the SRPPM independently.
