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Background and Aims: The family size plays an important role in fulfilling the primary needs of each family member and providing a quality life for them. This research studies the association of family size with various socioeconomic and demographic factors and the lifetime fertility patterns of previous decades., Methods: This cross-sectional study was conducted at the Maternity Teaching Hospital in Erbil, Kurdistan Region of Iraq (KRI). The data was collected from December 11, 2023, to April 15, 2024, after the ethics committee of the Kurdistan Higher Council for Medical Specialties approved the proposal. A convenience sample of 400 women aged 45-74 years who had completed their families were directly interviewed. The data was analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States)., Results: The prevalence of large family size (seven members and above) was 78.5%. The lifetime fertility rate of the women was 6.78 live births per woman. Large family size is significantly (p < 0.001) associated with age <18 years at marriage, short birth spacing interval, and unplanned pregnancies. The majority (91.7%) of the participants were grand multipara. The Cesarean section (CS) rate was 7.3%, 60.2% of the births were delivered at home, and 46.6% of the live births were delivered with a preceding birth interval of less than two years. The majority (82.2%) of the pregnancies were unplanned., Conclusions: Large family size is highly prevalent among women who have completed their families in Erbil. Many demographic and socioeconomic factors are associated with large family sizes, such as rural residency, age <18 years at marriage, low socioeconomic status (SES), short birth spacing interval, and unplanned pregnancies. For a more desired family size, it is recommended that young females be empowered by encouraging their education and providing occupation opportunities. In addition to that, prohibiting early marriage and providing/strengthening premarital programs focusing on the importance of family planning including birth spacing and utilizing contraceptive methods properly play a great role., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Kurdistan Higher Council of Medical Specialties Ethics Committee issued approval 1974 on 28.11.2023. According to the authority given to us in the decree of the Ministry of Higher Education and Scientific Research No. 4573 dated April 8, 2010, and referring to the minutes of meeting No. 9 on November 26, 2023, on the sidelines of the Ethics Committee of Medical Research, we decided to approve the change of title and research protocol of trainee Halbeen Abdulrazzaq Adil, in community medicine specialty, referring to our administrative order number 885 on April 13, 2022, from the research title "Pattern of Pregnancies and Their Outcomes in a Group of Married Women Aged More Than 45 Years, in Erbil" to the research title "Family Size and Past Obstetric History of Married Women Aged 45 Years and Older in Erbil.". Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Adil et al.)

Background and Objectives: Improving maternal health is one of the World Health Organization's (WHO) key priorities, grounded in a human rights approach and linked to efforts on universal health coverage. This study aimed to assess maternal health experiences among refugees and displaced women in Iraq during the COVID-19 pandemic., Methods: A cross-sectional study was done on 1321 women of reproductive age living in four camps supervised by the Barzani Foundation Charity in the Kurdistan Region of Iraq from June to August 2021. Researchers developed a questionnaire, and the data was collected by four staff members working in the camps through direct interviews with women. The World Health Organization Brief (WHOQOL-BREF), generalized anxiety disorder seven-item (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scales were used to measure quality of life (QoL), anxiety, and depression. The frequency, percentage, percentile, and the Chi-square test were used for data analysis., Results:  The women's mean age (SD) was 31.9 (±7.7) years. Around two-thirds of women attended the camp's healthcare facilities, and 16.4% attended the private facilities. Women mentioned the following as barriers to seeking health services: COVID-19 (387/29.3%), transportation (351/26.6%), lack of someone watching children (300/22.7%), and language (242/18.3%). The rate of high-level QoL among currently pregnant women (8/8.7%) was significantly (p = 0.002) less than the rate among nonpregnant women (297/24.2%). More than half (734/55.6%) of the women had mild depression, 247/18.7% had major depression, and 50/3.8% had severe major depression. Regarding anxiety, 580/43.9% had minimal anxiety, 467/35.4% had mild anxiety, 173/13.1% had moderate anxiety, and only 101/7.6% had severe anxiety., Conclusions: Refugees and internal displaced women in Iraq have barriers to seeking maternal healthcare. They suffer from low QoL, depression, and anxiety. Factors affecting the quality and accessibility of maternal healthcare in the camps should be studied. Health policymakers have to consider its improvement., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of College of Health Sciences, Hawler Medical University issued approval Sc.E.C.4. The Scientific and Ethics Committee of the College of Health Sciences, Hawler Medical University approved the study proposal. Informed verbal consent was obtained from the study sample, and participants were free to withdraw from the study during data collection. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mirkhan Ahmed et al.)