Factors influencing skilled birth attendant utilization among teenage mothers in Lira District, Northern Uganda: a cross-sectional study

Background: In Uganda, many teenage mothers deliver without skilled assistance, contributing to high maternal and perinatal mortality. Despite national interventions, home deliveries persist in rural areas like Lira District. This study aimed to determine the utilization level of skilled birth attendants (SBAs) and its associated factors among teenage mothers in this region. Methods: A community-based cross-sectional study was conducted in Lira District from June 2023 to June 2024. Using quota sampling, 316 teenage mothers (aged 13-19 years) who had delivered within the past 12 months were recruited from health facility young child clinics and community immunization outreach posts. Data were collected through interviewer-administered structured questionnaires. Analysis was performed using STATA version 17, employing multivariate logistic regression to identify independent predictors at a 95% confidence interval and p<0.05. Results: Of the 316 participants, 57.3% utilized an SBA for their most recent delivery. Multivariate analysis revealed three key independent predictors. Firstly, educational attainment was a strong enabler: teenage mothers with secondary education had over four times higher odds of SBA use compared to those with no education (AOR=4.45, 95% CI: 1.39-14.25, p=0.012). Secondly, health system trust was critical; a reported lack of trust in providers reduced the odds of SBA utilization by 88% (AOR=0.12, 95% CI: 0.04-0.36, p<0.001). Thirdly, socio-cultural influence was paramount: when family members (versus community elders) influenced the delivery location decision, the odds of choosing a traditional birth attendant over an SBA increased ninefold (AOR=9.04, 95% CI: 3.16-25.81, p<0.001). Conclusions: While over half of teenage mothers utilized SBAs, significant barriers persist. Educational attainment, trust in the health system, and socio-cultural dynamics, particularly family influence, are critical modifiable factors. Interventions must prioritize building respectful, adolescent-friendly health services, enhancing community and family education, and developing pragmatic policies regarding traditional birth practices to improve skilled birth attendance and reduce maternal risks.