Prevalence and associated factors of postpartum anemia among women in Southeastern Iran: a cross-sectional study

Postpartum anemia is a significant public health concern, particularly in low- and middle-income settings. In Iran, prevalence rates are higher in socioeconomically disadvantaged regions such as Iranshahr in Southeastern Iran, where nutritional deficiencies may further increase vulnerability. This study aimed to estimate the prevalence of postpartum anemia and identify its associated factors in this underserved population. In this cross-sectional study conducted from July to December 2023, 500 postpartum women were recruited from five comprehensive health service centers in Iranshahr, Iran, using proportional cluster sampling with systematic random sampling within each cluster. Socio-demographic, obstetric, and antenatal laboratory data were extracted from participants’ medical records using a structured data extraction form. Postpartum hemoglobin was measured at the six-week postnatal visit using complete blood count (CBC). Postpartum anemia was defined as hemoglobin < 12 g/dL and classified as mild (11–11.9 g/dL), moderate (8–10.9 g/dL), and severe (< 8 g/dL). Anemia during pregnancy was defined as hemoglobin < 11 g/dL. Bivariate associations were assessed using chi-square and Fisher’s exact tests, and independent predictors were identified using multivariable binary logistic regression. The prevalence of postpartum anemia was 37.2% (95% CI: 33.0–41.4%), comprising 25.6% mild and 11.6% moderate cases; no severe anemia was identified. In multivariable logistic regression, anemia during pregnancy was the strongest independent predictor (AOR = 5.73; 95% CI: 3.81–8.61; p < 0.001), followed by postpartum hemorrhage (AOR = 2.41; 95% CI: 1.07–5.41; p = 0.033). Age, occupation, body mass index, economic status, educational level, and iron supplementation were not independently associated with postpartum anemia. Postpartum anemia is common in this population, primarily predicted by anemia during pregnancy and postpartum hemorrhage. Routine hemoglobin screening from early pregnancy, education on correct iron supplement use, and regular postpartum monitoring are essential to reduce its burden in resource-limited settings.