Socio-demographic Disparities, Risk Factors, and Prevalence of Postpartum Depression Among Urban and Rural Women in Basrah, Iraq

Abstract

Background: Postpartum depression (PPD) is a major public health issue affecting maternal well-being and family dynamics globally. Geographic disparities in mental health outcomes are increasingly recognized, yet comparative data from regions such as southern Iraq remain scarce.

Objective: To compare the prevalence and risk factors of PPD among urban and rural women in Basrah, Iraq, to inform targeted mental health interventions.

Methods: This comparative cross-sectional study recruited 270 postpartum women (135 urban, 135 rural) between October 2023 and October 2024 from healthcare facilities across Basrah. Participants were 4 - 12 weeks postpartum, aged ≥18 years, and free from pre-existing psychiatric diagnoses. The Edinburgh Postnatal Depression Scale (EPDS) was administered to assess depressive symptoms, with a score ≥13 indicating probable clinical depression. Additional data on demographics, obstetric history, and psychosocial factors were collected via structured interviews.

Results: PPD prevalence was significantly higher among rural women (31.9%) compared to urban women (22.2%). Severe depression (EPDS ≥15) was nearly twice as common in rural areas (18.5% vs 10.4%). Rural participants reported higher rates of unplanned pregnancy (37.8% vs 21.5%, p = 0.008), low social support (42.6% vs 28.9%, p = 0.041), and lack of postnatal care (29.6% vs 14.1%, p = 0.016). In multivariate analysis, no postnatal care (OR = 2.59; 95% CI: 1.40–4.78), unplanned pregnancy (OR = 2.14; 95% CI: 1.23–3.72), and low social support (OR = 1.75; 95% CI: 1.02–3.01) were independently associated with elevated PPD risk in rural settings.

Conclusion: Rural women in Basrah face a disproportionate burden of PPD, driven by modifiable risk factors such as lack of postnatal care and psychosocial support. These findings underscore the need for routine mental health screening, enhanced postnatal services, and culturally sensitive interventions to address maternal mental health disparities across geographic contexts in Iraq.