title: Trends in health facility deliveries and caesarean sections by wealth quintile in Morocco between 1987 and 2012.
abstract: OBJECTIVE
  To examine trends in the utilisation of facility-based delivery care and caesareans in Morocco between 1987 and 2012, particularly among the poor, and to assess whether uptake increased at the time of introduction of policies or programmes aimed at improving access to intrapartum care.
  
  
  METHODS
  Using data from nationally representative household surveys and routine statistics, our analysis focused on whether women delivered within a facility, and whether the delivery was by caesarean; analyses were stratified by relative wealth quintile and public/private sector where possible. A segmented Poisson regression model was used to assess whether trends changed at key events.
  
  
  RESULTS
  Uptake of facility-based deliveries and caesareans in Morocco has risen considerably over the past two decades, particularly among the poor. The rate of increase in facility deliveries was much faster in the poorest quintile (annual increase RR: 1.09; 95% CI: 1.07-1.11) than the richest quintile (annual increase RR: 1.01; 95% CI: 1.02-1.02). A similar pattern was observed for caesareans (annual increase among poorest RR: 1.13; 95% CI: 1.07-1.19 vs. annual increase among richest RR: 1.08; 95% CI: 1.06-1.10). We found no significant acceleration in trend coinciding with any of the events investigated.
  
  
  CONCLUSIONS
  Morocco's success in improving uptake of facility deliveries and caesareans is likely to be the result of the synergistic effects of comprehensive demand and supply-side strategies, including a major investment in human resources and free delivery care. Equity still needs to be improved; however, the overall trend is positive.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Cresswell
authors.affiliation: Ecole Nationale de Santé Publique, Rabat, Morocco.
authors.forename: Bouchra
authors.initials: B
authors.lastname: Assarag
authors.affiliation: Ecole Nationale de Santé Publique, Rabat, Morocco.
authors.forename: Fatima-Zahra
authors.initials: FZ
authors.lastname: Meski
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Veronique
authors.initials: V
authors.lastname: Filippi
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
keywords: assistance à l'accouchement qualifiée; caesarean section; cesárea; césarienne; equidad; equity; exemption de frais d'utilisation; exenciones de uso; maternal health; maternal health services; matronas cualificadas; salud materna; santé maternelle; services de santé maternelle; servicios de salud materna; skilled birth attendance; user fee exemption; équité