Background <p>Zambia has made significant progress in reducing maternal and neonatal mortality as seen in the preliminary report of the 2024 Zambia Demographic and Health Survey. However, there is need for concerted efforts to attain the Sustainable Development Goals on maternal and neonatal health. Knowledge of obstetric danger signs is key to improving health seeking behaviour. This study aimed to investigate the factors associated with knowledge of obstetric danger signs.</p> Methods <p>This was a health facility-based cross sectional study conducted from 1 May to 31 July 2023. A structured questionnaire was administered using face-to-face interviews to 562 participants recruited using systematic random sampling. Data was analysed in Stata version 17.</p> Results <p>A total of 562 pregnant women participated in the study, with 197 (35%) demonstrating adequate knowledge of obstetric danger signs. In this study, factors associated with adequate knowledge of danger signs included a history of stillbirth (AOR: 3.44; 95% CI, 1.76–6.71), previous delivery at a health centre/post (AOR: 2.76; 95% CI, 1.55–4.92), the use of a taxi/bus to reach a health facility (AOR: 3.44; 95% CI, 1.65–7.16) and uncertainty about travel time to a health facility (AOR: 8.06; 95% CI, 4.06–16.03). Similarly, being Catholic was associated with higher odds of adequate knowledge of danger signs (AOR: 4.10; 95% CI, 2.41–6.98).</p> Conclusion <p>This study revealed that a significant proportion of participants (65%) had inadequate knowledge of obstetric danger signs. These findings highlight the need to strengthen health education on danger signs during antenatal care. Collaboration with religious leaders is key for dissemination of health education during religious gatherings. Lastly, improving access to health facilities and transport will enhance knowledge of danger signs of pregnancy.</p>