Abstract Background: Early hearing detection and intervention (EHDI) services are essential for the timely identification and management of hearing loss in children. Family-centered early intervention (FCEI), which prioritizes caregiver involvement and culturally responsive care, is associated with improved developmental and psychosocial outcomes. However, in low- and middle-income countries such as South Africa, systemic barriers such as linguistic mismatches, fragmented service delivery, and inadequate caregiver engagement hinder the effective implementation of FCEI principles. Limited paternal involvement and inconsistent informational support further compromise service accessibility and quality. Objective: This study evaluated the family-centeredness of EHDI services in South Africa from the perspective of caregivers, with a focus on their experiences and the systemic, linguistic, and cultural challenges affecting service delivery. Methods: A mixed-methods convergent design was used. The qualitative strand involved narrative interviews with nine caregivers of children who are deaf or hard of hearing (DHH), analyzed using reflexive thematic analysis. The quantitative strand employed the modified measurement of the processes of care-56 (MPOC-56) to assess family-centeredness across five domains, with 16 caregivers completing the survey. Descriptive statistics summarized survey responses, and findings from both strands were integrated to provide a comprehensive evaluation of caregiver experiences. Results: Caregivers reported the varying levels of satisfaction across the MPOC-56 domains. Providing specific information and coordinated and comprehensive care received the highest scores, indicating positive caregiver experiences with information provision and care integration. However, respectful and supportive care and enabling and partnership domains had lower scores, revealing critical gaps in service delivery. Key challenges included: (1) healthcare providers dismissing caregiver concerns, (2) language barriers where English is used as the primary language for services despite caregivers speaking African languages, (3) fragmented service delivery, (4) limited paternal involvement, and (5) inadequate follow-up support. Conclusion: While South Africa’s EHDI services are gradually adopting family-centered principles, systemic, linguistic, and cultural barriers continue to undermine equitable access and caregiver engagement. Addressing these barriers requires training healthcare providers in cultural competence, recruiting multilingual professionals, fostering interdisciplinary collaboration, developing strategies to involve fathers, and expanding services to rural and under-resourced areas. These measures are essential to improve the accessibility, responsiveness, and effectiveness of South Africa’s EHDI services, ensuring equitable, family-centered care for all children who are DHH.