Perspectives and lived experiences of postpartum women seeking health services from traditional birth attendants (TBAs) in Mayuge District, Eastern Uganda

Abstract

In Uganda, despite ongoing efforts to promote skilled birth attendance, many women in rural communities continue to deliver with Traditional Birth Attendants (TBAs). Understanding the reasons behind this preference and the nature of care provided by TBAs is critical for informing maternal health policy and community-level interventions. To explore the experiences, perceptions, and underlying factors influencing the continued use of TBAs for childbirth among postpartum women in Mayuge District, Eastern Uganda. A descriptive qualitative study was conducted in Mayuge District. In-depth interviews were held with 12 postpartum women who had delivered with TBAs within the past six months. Participants were purposively selected to capture variation in age, parity, and location. Data were collected using a semi-structured interview guide, audio-recorded, transcribed verbatim, and translated into English. Thematic analysis was conducted using both inductive and deductive coding in NVivo 13. Five overarching themes emerged: (1) Health System Barriers, including poor access to health facilities, transport challenges, and mistreatment by health workers; (2) Perceived Benefits of TBA Care, such as affordability, emotional support, privacy, and flexible payment options; (3) Traditional Practices and Beliefs, with participants emphasizing cultural alignment, spiritual care, and birth rituals provided by TBAs; (4) Health Risks and Limits of TBA Care, reflecting awareness of complications, delayed referrals, and lack of emergency support; and (5) Community Influence, where social norms, peer recommendations, and collective trust in TBAs shaped decision-making. A cross-cutting theme of husband and family involvement also significantly influenced birth location choices. The continued reliance on TBAs is shaped by a complex interplay of structural barriers, cultural values, perceived advantages, and community dynamics. Interventions to improve maternal health in rural Uganda should address health system gaps, promote respectful and culturally sensitive facility-based care, and engage families and communities in birth preparedness efforts.