# Catching babies, carrying traditions: the voices and practices of traditional birth attendants in Mayuge District, East central Uganda

## TL;DR

Traditional birth attendants in Uganda provide essential maternal care in rural areas but face challenges due to lack of formal support and integration into the health system.

## Contribution

This study provides a detailed qualitative analysis of the practices, challenges, and socio-cultural influences on traditional birth attendants in Mayuge District, Uganda.

## Key findings

- TBAs use a mix of traditional and modern methods for maternal and newborn care.
- Limited resources and inconsistent health system support hinder infection prevention and referral processes.
- Socio-cultural factors like community trust and gender roles significantly influence TBA services.

## Abstract

Traditional Birth Attendants (TBAs) continue to support maternal and newborn care in rural Uganda, particularly where access to formal health facilities is limited. Their roles are deeply embedded in local culture and community trust, yet national policies provide inconsistent guidance on their engagement within the formal health system.

To explore the evolution, experiences, practices, challenges, and perceived support needs of TBAs in Mayuge District, and examine their interaction with formal health structures.

A qualitative narrative study was conducted with 15 purposively selected TBAs from all sub-counties of Mayuge District. In-depth interviews lasting 60 to 90 min were held at participants’ homes or workplaces. Participants described and demonstrated their maternal care practices. Audio recordings were transcribed, translated, and analyzed thematically.

Seven key themes emerged from the study: (1) Historical Developments and Evolution of TBAs, highlighting diverse pathways into practice such as apprenticeship, family mentorship, formal Ministry of Health training, and community programs; (2) Practices, Methods, and Approaches, detailing TBAs’ provision of antenatal, delivery, and postnatal care, and management of maternal and newborn complications using both traditional and modern methods including newborn resuscitation; (3) Infection Prevention and Control, revealing variable use of personal protective equipment and inconsistent waste disposal practices constrained by limited resources; (4) Maternal and Perinatal Death Surveillance and Response (MPDSR) Process, illustrating TBAs’ limited participation in formal death notifications and reviews; (5) Referral Process, highlighting complex referral behaviors involving health facilities, fellow TBAs, and traditional healers; (6) Socio-Cultural Influences on TBA Services, encompassing the impact of poverty, gender roles, community trust, and cultural norms; and (7) Challenges in Providing Safe and Effective Care, including barriers such as negative attitudes from health workers, transport difficulties, competition, and lack of formal support.

TBAs in Mayuge District play a vital role in culturally grounded maternal care but face numerous challenges due to limited formal integration and support. Strategies are needed to strengthen collaboration, provide targeted training, and clarify policy to improve maternal and newborn health outcomes in underserved areas.

The online version contains supplementary material available at 10.1186/s12978-025-02251-3.