Prevalence and risk factors of obstetric complications in urban and rural settings

Background: Obstetric complications remain a leading cause of maternal morbidity and mortality globally, particularly in low- and middle-income countries. In Iraq, systemic challenges and regional disparities have hindered equitable access to maternal care, especially in rural areas. This study aimed to compare the prevalence and risk factors of obstetric complications between urban and rural settings in Basrah, a southern province of Iraq. Methods: A comparative cohort study was conducted in 2024, enrolling 120 women (60 urban, 60 rural) who delivered at either Basrah Maternity and Child Hospital or primary healthcare centers in Al-Mudaina and Shatt Al-Arab. Data were collected through structured interviews and medical record reviews. Obstetric complications-including preeclampsia, postpartum hemorrhage, and obstructed labor-were analyzed using chi-square tests and logistic regression to identify significant predictors. Results: Obstetric complications were significantly more prevalent in rural settings (41.7%) than urban ones (21.7%). Rural participants exhibited lower educational attainment, higher unemployment, and greater prevalence of consanguineous marriage and chronic illness. Logistic regression identified key risk factors for complications: fewer than four antenatal care visits (OR = 3.4, p = 0.001), rural residence (OR = 2.6, p = 0.027), chronic illness (OR = 2.5, p = 0.018), and low maternal education (OR = 2.3, p = 0.020). Conclusion: The study highlights substantial urban-rural disparities in maternal health outcomes in Basrah, driven by socioeconomic disadvantage, limited antenatal care access, and health system weaknesses. To reduce preventable obstetric complications, targeted interventions in rural areas-including service expansion, community education, and maternal risk screening-are urgently needed to support Iraq’s ongoing maternal health reform efforts.