'I have a child i need to live for': a qualitative study of parenthood and the TB experience in South Africa

Existing research highlights TB’s economic and social stigma burdens and impacts behavior in households, but virtually unexplored is the dynamics of TB and parenthood. This qualitative study examines the interplay between TB diagnosis and treatment, and parenting experiences, focusing on the intersections of individual agency, societal expectations, and access to resources. From March 2021 to January 2022, we conducted in-depth interviews with 98 TB patients in Buffalo City, South Africa, including 44 mothers and 54 fathers. Guided by the Network-Individual-Resource (NIR) model, we applied layered coding, memoing, and causal mapping to analyze experiences through the lens of agency and societal expectations. Mothers reported primary caregiving responsibilities, drawing motivation from their children, and relying on multigenerational family support for childcare and treatment-adherence. Children frequently provided emotional and practical care, such as cooking and medication reminders. Fathers more often distanced themselves to protect families from infection, faced isolation, and struggled to fulfill provider roles due to job loss. Extended family support for fathers was limited, with financial pressures exacerbating treatment challenges. These results illustrate how gender norms and resources structure the TB experience. Strengthening maternal caregiving networks and reimagining fatherhood beyond economic provision can foster better adherence and more equitable health outcomes.