Understanding the Preference for Traditional Birth Attendants Over Health Care Centers Among Mothers in Budondo Sub- County, Jinja District Uganda: A Qualitative Inquiry

Background Maternal mortality remains a significant public health challenge in Uganda, where only 58% of deliveries occur in health facilities despite high antenatal care attendance exceeding 90%. Persistent reliance on Traditional Birth Attendants (TBAs) in rural communities contributes to preventable maternal and neonatal deaths, yet the underlying drivers of this preference in Budondo Sub-County, Jinja District remain inadequately understood at the local level. Methods A qualitative, cross-sectional exploratory-descriptive study was conducted, rooted in the interpretivist paradigm and guided by an ecological conceptual framework examining influences at the individual, interpersonal, and community levels. Thirteen participants were purposively recruited: nine mothers (aged 20–28 years) who participated in in-depth interviews and four key informants (two TBAs and two midwives) who participated in key informant interviews. Data were collected using semi-structured interview guides administered in Lusoga and Luganda, and analysed using Braun and Clarke’s six-phase reflexive thematic analysis framework supported by NVivo software. Methodological triangulation strengthened the credibility of findings. Results Nine themes emerged across three analytical domains. At the individual level, fear of caesarean sections, emotional safety provided by TBAs, structural access barriers, and conditional trust in health facilities drove TBA preference. At the interpersonal level, husbands and mothers-in-law exercised decisive authority over delivery decisions, while peer narratives functioned as powerful social proof. At the community level, exclusion of cultural birthing practices from health facilities, TBAs’ deep social embeddedness, and an almost complete absence of TBA–facility referral collaboration collectively sustained reliance on TBAs. Conclusions Maternal preference for TBAs is a rational, contextually situated response to healthcare system failures and unmet emotional and cultural needs, rather than ignorance. Key recommendations include TBA registration and structured integration into the formal referral system, mandatory respectful maternity care training for health workers, culturally inclusive facility protocols, strengthened Village Health Teams, and targeted household engagement programmes for male partners and mothers-in-law.