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

^*Zahra Attalla Kareem Almiah
Basrah Health Directorate, Basrah Teaching Hospital, Basrah Health Directorate, Ministry Of Health,, Basrah, Iraq
Sarah Ali Abd Alkreem Alattar
Basrah Health Directorate, Basrah Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq
Baidaa Ayad Abdul Rahman Alyaseen
Basrah Health Directorate, Basrah Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq

^*Corresponding Author:

Zahra Attalla Kareem Almiah
Basrah Health Directorate, Basrah Teaching Hospital, Basrah Health Directorate, Ministry Of Health,, Basrah, Iraq

Published on: 2025-06-27

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.

Keywords

Postpartum depression, Rural health, Urban-rural disparities, Maternal mental health

Introduction

PPD represents one of the most prevalent mental health disorders among new mothers, affecting emotional well-being, maternal-infant bonding, and overall family health [1]. It is increasingly recognized as a global public health challenge with varied presentations across different sociocultural and geographic contexts [2].

The postpartum period introduces significant physiological and psychosocial transitions, often amplifying vulnerability to depressive disorders, especially in the presence of stressors like lack of support, economic hardship, or obstetric complications [3].

Urbanization has long been associated with an increased burden of mental illness, including PPD, due to higher exposure to social isolation, unemployment, housing insecurity, and reduced familial support networks [4]. Studies show that women residing in urban environments may exhibit a higher prevalence of depressive symptoms post-birth compared to rural counterparts, although findings vary across regions and populations [5].

Conversely, rural populations often face unique vulnerabilities such as limited access to healthcare, transportation barriers, and stigmatization of mental health conditions, which can also elevate the risk of PPD [6]. These disparities necessitate a nuanced understanding of how geographic location intersects with sociocultural and health system factors to influence maternal mental health outcomes [7].

Further complexity arises from evidence showing that the risk factors for PPD vary not just by geography, but also by maternal age, parity, socioeconomic status, and prior mental health history [8]. For instance, young urban mothers may be disproportionately affected by social stressors such as preterm birth, single motherhood, and postpartum complications [3].

Meanwhile, rural women may encounter heightened risks due to unwanted pregnancies, poor social support, and financial instability, all of which are well-established contributors to postpartum mental distress [9].

Despite growing attention, there remains a notable gap in comparative studies that dissect the influence of urban versus rural residency on the onset and severity of PPD using standardized methodologies across diverse populations [10]. Without such data, tailored prevention and intervention strategies remain underdeveloped.

This study aims to compare the prevalence and risk factors of PPD between urban and rural populations, identifying locationspecific vulnerabilities to inform targeted mental health interventions and enhance maternal care policies at the community and healthcare system levels.