Millions of women worldwide use a traditional method of family planning for fertility regulation. As global family planning dialogue has shifted to focus on modern method users only, the contemporary literature
about family planning is largely silent on traditional method use. However, evidence from qualitative studies indicates that some women—even those who have access to modern methods — have a distinct preference for traditional methods. This study investigates levels and trends of traditional method use, multiple traditional methods and simultaneous modern and traditional method use; and discontinuation and switching in countries with at least five Demographic and Health Surveys (DHS). Data come from DHS surveys from the early 1990s to present in 16 countries—Bangladesh, Colombia, the Dominican Republic, Egypt, Ghana, Indonesia, Jordan, Kenya, Malawi, Peru, the Philippines, Rwanda, Senegal, Tanzania, Zambia, and Zimbabwe. The analysis includes currently married women age 15-49.
This report also includes case studies of four countries—Peru, Jordan, Indonesia, and Ghana—chosen by patterns of contraceptive use. We examine changes in the contraceptive method mix and run a series of binary logistic regressions to investigate the changing importance of different sociodemographic characteristics in the use of any method (modern versus traditional), traditional versus modern methods (among contraceptive users), and withdrawal versus periodic abstinence (among traditional method users).
In most countries in this study, married women over age 35, with five or more children, those who want no more children, those with more education, and urban residents have generally higher levels of use of traditional methods than their counterparts. The analysis by wealth quintile indicates two distinct patterns.
In some countries, traditional method use is more common among richer women, while in others, women in the low quintiles who are poorer are more likely to use traditional methods. Findings from the multivariate analyses for the four countries in the case studies illustrate that much of the
high level of traditional method use found in the descriptive analysis was driven by certain groups of women’s higher overall contraceptive use. When restricted to contraceptive users, many of these groups (the more educated and those who want no more children) were more likely to use modern than traditional methods.
The analysis of contraceptive discontinuation indicates that in 15 of the 16 countries, over 25% of women stopped using a modern method because of health concerns or side effects. In contrast, fewer than 2% of users of traditional methods discontinued for the same reason. Overall, traditional method users in the majority of countries in this study have lower discontinuation and switching rates compared with modern method users.
Traditional methods have two key disadvantages compared with modern methods. First, they are less effective and second, the two most popular traditional methods (withdrawal and periodic abstinence) require cooperation of the male partner. However, these methods continue to play a role in the lives of millions of women. We recommend a two-pronged policy strategy, one that ensures traditional method users are aware of more effective modern methods that can be used covertly, and —consistent with a rightsbased approach to family planning—one that also does not completely exclude traditional method users from the opportunity to obtain respectful support and education about their method of choice.