Self-harm among adolescents is a growing public health concern, particularly in low- and middle-income countries. This study assessed maternal awareness of self-harm prevalence and associated risk factors among high school children in rural and urban Bangladesh.

A descriptive cross-sectional study was conducted from July to October 2024 in 16 purposively selected schools (eight rural, eight urban) across three divisions of Bangladesh. A total of 480 randomly selected mothers of children in grades six–ten were interviewed using pre-tested, semi-structured questionnaires. Descriptive statistics summarized demographics and regression identified self-harm risk factors.

The awareness about children's self-harm was higher among urban mother's (30 %) compared to rural mother's (23.3 %). More urban mothers were concern of self-harm among high school going children as a significant issue (85.8 % vs. 35.8 %, p < 0.0001) and were more likely to seek additional information and resources (98.3 % vs. 75 %, p = 0.0002) to get a solution. Cutting and hitting were the common methods of self-harm in both settings, while starvation was more prevalent in urban areas (30.6 % vs. 10.7 %). Emotional distress, academic pressures, and social media were key triggers for urban adolescents, while rural children faced more family-related stressors. Urban parents were more inclined to seek professional help (22.2 % vs. 3.6 %, p < 0.05), while rural parents preferred community counseling.

Significant rural-urban disparities exist among mother's awareness on self-harm and associated risk factors. Interventions to control emotional distress, academic pressure, and family related stressors are essential to address self-harm among adolescents in Bangladesh.