DEMOGRAPHIC

AND

HEALTH

SURVEYS

DHS WORKING PAPERS

2017 No. 130

Maria Paz N. Marquez

Maria Midea M. Kabamalan

Elma P. Laguna

July 2017

This document was produced for review by the United States Agency for 

International Development.

Ten Years of Traditional Contraceptive Method Use 

in the Philippines: Continuity and Change

Working Paper WP130 

Ten Years of Traditional Contraceptive Method Use in the 

Philippines: Continuity and Change 

Maria Paz N. Marquez1

Maria Midea M. Kabamalan1

Elma P. Laguna1

ICF 

Rockville, Maryland USA 

July 2017 

1

 Population Institute, College of Social Sciences and Philosophy, University of the Philippines – Diliman 

Corresponding author: Maria Paz N. Marquez, Population Institute, University of the Philippines – 

Diliman, Quezon City. Email: mnmarquez1@up.edu.ph 
Acknowledgments

We would like to thank our colleagues in the Population Institute for their support, especially 

Dr. Josefina N. Natividad for her inputs in preparing the concept paper. Shireen Assaf and 

Tesfayi Gebreselassie provided insightful comments. We appreciate also the patience and 

commitment of Wenjuan Wang, Bupe Bwalya, and Mulenga Chonzi during the 2017 DHS 

Fellows Data Users and Report Writing Workshops. We also thank our fellow workshop 

participants for their comments on the earlier version of our paper. 

Funding support for this analysis is provided by USAID through the 2017 DHS Fellows Program 

implemented by ICF. 

Editor: Nancy Johnson 

Document Production: Joan Wardell 

The DHS Working Papers series is a prepublication series of papers reporting on research in 

progress that is based on Demographic and Health Surveys (DHS) data. This research is carried 

out with support provided by the United States Agency for International Development (USAID) 

through The DHS Program (#AID-OAA-C-13-00095). The views expressed are those of the 

authors and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and 

evaluate population, health, and nutrition programs. For additional information about The DHS 

Program, contact DHS Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA. 

Phone: +1 301-407-6500; Fax: +1 301-407-6501; Email: reports@dhsprogram.com; Internet: 

www.dhsprogram.com. 

Recommended citation: 

Marquez, M. P. N., M. Kabamalan, and E. Laguna. 2017. Ten Years of Traditional Contraceptive 

Method Use in the Philippines: Continuity and Change. DHS Working Papers No. 130. 

Rockville, Maryland, USA: ICF. 
iii

Abstract

The Philippines has a contraceptive prevalence rate of 55%, based on the 2013 Philippines 

National Demographic and Health Survey (NDHS). Most contraceptive users rely on modern 

methods, but over the past 10 years traditional method use has continued to comprise about a 

third of all contraceptive users in the country. This study examines recent levels, patterns, and 

determinants of traditional contraceptive method use, based on pooled data from the 2003, 2008, 

and 2013 Philippines DHS surveys.

Results from the multinomial logistic regression analyses show that among users of traditional 

rather than modern contraceptive methods, women in 2003 and 2008 were more likely to use 

rhythm over modern contraceptive methods compared with women in 2013, while withdrawal 

rather than modern contraceptive methods were preferred more by women in 2013 than in 2003. 

The results identify several factors that are significant in predicting use of either rhythm or 

withdrawal rather than modern contraceptive methods. Women in the lowest wealth quintile 

relative to those in the highest (wealthiest) quintile, as well as women who want more children 

relative to those who do not, are more likely to use either of the two traditional rather than 

modern contraceptive methods. Furthermore, women who are undecided about whether to have 

another child are more likely to use the rhythm method compared with modern contraceptives. 

Having correct knowledge of the fertile period increases the relative risk of a woman using 

rhythm than using modern contraceptive methods. 

The characteristics of women who use traditional methods have changed little over the past 

decade. While most program efforts have focused on new acceptors of modern contraception, 

many Filipino women continue to rely on traditional methods. Knowing the characteristics of 

traditional contraceptive method users can help policies and programs to promote more effective 

contraceptive use, including encouraging users of traditional contraceptive methods to switch to 

the more effective modern methods. 

Keywords: Philippines, Traditional Contraceptive Use, Rhythm, Withdrawal 

1

1. Introduction

1.1. Background 

In 2013, according to the most recent survey data available, 55% of currently married Filipino 

women of reproductive age (15-49) were using any form of contraceptive method. This 

continues the upward trend in use found in earlier Philippines National Demographic and Health 

Surveys (NDHS), from 49% in 2003 to 51% in 2008 (Philippine Statistics Authority and ICF 

International 2014). The increase in contraceptive use across the surveys is attributed to an 

increase in both modern and traditional contraceptive use, although there has been higher uptake 

of modern contraceptive methods. In 2013, 38% of currently married women were using a 

modern contraceptive method compared with 17% who reported traditional contraceptive 

method use (PSA and ICF International 2014; NSO and Macro ORC 2009; NSO and Macro 

ORC 2004). 

Notwithstanding the improvement in the level of contraceptive use in the Philippines, unmet 

need for family planning remains substantial. In 2013, about 18% of currently married Filipino 

women, roughly 5.5 million, wanted to limit or space their pregnancies but were not currently 

using any family planning method (PSA and ICF International 2014). If traditional contraceptive 

method use is classified as nonuse, the level of unmet need for modern family planning methods 

is estimated to be higher, at 33% among married/in-union women (FP2020 2015). 

Recognizing the importance of family planning, the Sustainable Development Goals (SDGs) 

have incorporated as targets the attainment of universal access to sexual and reproductive health 

and reproductive rights (Goal 3.7), as well as reproductive health care services (Goal 5.6). Under 

these targets are indicators such as contraceptive prevalence and the proportion of women of 

reproductive age who have their need for family planning satisfied with modern methods. The 

Philippines is committed to the attainment of the SDGs, as well as earlier international 

commitments such as the Millennium Development Goals (MDGs). 

With regard to the promotion of family planning and contraceptive use, several administrations 

have taken different directions on the implementation of the population program. The enactment 

of the Population Act (Republic Act 6365) in 1971 formally established the official family 

planning program of the country under the Commission on Population. However, beginning in 

the 1980s the family planning program was transferred to the Department of Health and became 

one of the components of the public health program. During the administration of President 

Gloria Macapagal-Arroyo (2001-2010), there was a strong focus on natural family planning 

(NFP) methods endorsed by the Catholic Church. In general, the shifts and turns in the direction 

of the family planning program are attributed to the position of the incumbent President on 

artificial contraception, the strong influence of the Catholic Church, the devolution of health 

services to local government units, and the reproductive health framework and commitment 
2

made at the International Conference on Population and Development (ICPD) in Cairo in 1994 

(Melgar et al. 2012). Moreover, external factors such as the gradual withdrawal of support of the 

United States government on the provision of contraceptive commodities also influenced the 

course of action taken by the government on the family planning program. The passage of 

Republic Act RA 10354, or the Responsible Parenthood and Reproductive Health Act (RPRH 

Law) in 2013, despite strong opposition from the Catholic Church, civil society, and other 

organizations, is considered a major achievement toward the provision of comprehensive 

reproductive health services and programs, including family planning. 

Both modern and traditional contraceptive methods contribute to overall contraceptive use, but 

there is more emphasis given to the promotion of modern contraceptive methods because of their 

greater effectiveness in preventing unintended pregnancies. An analysis of data from 43 

countries shows that 12-month contraceptive failure rates are highest for traditional methods 

such as withdrawal and periodic abstinence, with 13.9 and 13.4 failures per 100 episodes of use, 

respectively (Polis et al. 2016). 

In comparison, longer-acting modern contraceptive methods such as implants, IUDs, and 

injectables have the lowest failure rates, while short-term resupply methods such as pills and 

male condoms have intermediate failure rates. Use of traditional contraceptive methods has also 

been associated with increased odds of having undesired pregnancy (Sullivan et al. 2006). In the 

Philippines, unintended pregnancy accounts for around half of the reasons why use of rhythm 

and withdrawal was discontinued, evidence of their low level of effectiveness (Abejo et al. 

2006). 

Despite the clear distinction in effectiveness between modern and traditional contraceptive 

methods, a significant number of Filipino women still use traditional family planning methods. 

When the first demographic survey in the Philippines was conducted in 1968, 81% of all 

contraceptive users were using traditional contraceptive methods (Abejo et al. 2006; NSO and 

Macro ICF 2009). Currently, about one in every three women who are currently using a 

contraceptive method rely on traditional contraceptive methods, a level that has remained nearly 

constant over the past 10 years. Across Southeast Asia, the Philippines ranks second to 

Cambodia in the share of traditional contraceptive method use among currently married women 

using contraceptive methods (Figure 1). 
3

Figure 1. Percentage of traditional contraceptive method use among currently 

married women who are using contraceptives, Southeast Asia, 2015

1.2. The use of traditional contraceptive methods 

Traditional contraceptive methods include periodic abstinence or rhythm, withdrawal, and 

folkloric methods. Periodic abstinence or the calendar method (rhythm) has been widely used 

among Filipino couples. Earlier studies on family planning behavior have noted that even 

without any effort from the government to promote periodic abstinence as part of the family 

planning program, it was a popular method among Filipino couples (Laing 1987). It was often 

practiced in combination with withdrawal and with modern methods such as condom or foam. In 

a study on contraceptive use in 1978, more than a quarter of Filipino couples were practicing one 

form or another of this method (Verzosa et al. 1984). 

Alongside periodic abstinence, there was also high reliance on withdrawal as a family planning 

method. This stems from the fact that withdrawal does not entail cost and can be used 

spontaneously by couples. Withdrawal as a method also upholds the belief of men’s power in 

reproductive decision-making (Verzosa et al. 1984). 

More recent studies have looked into the reasons why women or couples shy away from more 

effective modern methods of contraception (e.g., Abejo et al. 2006; Williamson et al. 2009; PSA 

and ICF International 2014; Cruz, Marquez, and Kabamalan 2016). The most common reasons 

are fear of their side effects, lack of knowledge on different methods, and inconvenience of use, 

in contrast to the relative ease in adopting traditional contraceptive methods. A study of urban 

poor women in Manila found that traditional contraceptive methods, particularly withdrawal, are 

preferred because of their absence of side effects, safety, agreeability with partner, and ease of 

30.2 29.9

27.0

15.0 13.8

6.3 6.0

2.4

Cambodia Philippines Malaysia Vietnam Lao

People's

Republic

Myanmar Indonesia Thailand

Source: Calculated from United Nations Department of Economic and Social Affairs, Population Division (2015) Annex Table III
4

use (Cruz, Marquez, and Kabamalan 2016). Similarly, in a study of the use of periodic 

abstinence among Beti women in Cameroon, Johnson-Hanks (2002) found that women preferred 

the method because of the absence of negative side effects as well as a perception that periodic 

abstinence is an indicator of one’s self-discipline. 

A review of qualitative studies on nonuse of modern contraceptive methods among young 

women in developing countries pointed to factors such as lack of knowledge and poor access to 

services, a common perception that modern family planning methods and services are only for 

married women, as well as the negative social norms around premarital sexual activity. The 

difficulties that young women often encounter in accessing modern contraceptive methods lead 

many to use traditional methods instead (Williamson et al. 2009). Such observations are 

pertinent to the Philippines, where social norms discourage sexual activity outside of marriage. 

In addition, reproductive health services are provided mainly to married women/couples. The 

RPRH Law requires parental consent for women below age 18 to access family planning services 

from public health facilities. Thus, it is not surprising to find that a larger proportion of sexually 

active unmarried women than currently married women are using traditional contraceptive 

methods (PSA and ICF International 2014). 

An analysis of traditional contraceptive method use in India found higher likelihood of 

traditional contraceptive method use among highly educated, urban, non-poor women (Ram, 

Shekhar, and Chowdhury 2014). Similar characteristics have been associated with use of rhythm 

in Bangladesh, where older, more educated women, those with higher socioeconomic status 

(SES), and those with at least one living son are more likely to use rhythm as a family planning 

method (Kamal et al. 2005). Such a pattern debunks a common assumption that traditional 

contraceptive methods are preferred more by poor and less educated women. The choice of 

traditional contraceptive methods among educated women indicates their understanding of how 

methods such as rhythm work, as well as their knowledge of the ovulation cycle. In contrast, 

withdrawal use in Turkey was found to be associated with rural women, and women with less 

education, lower socioeconomic status, and living in more crowded households (Cindoglu, 

Sirkeci, and Sirkeci 2008). 

A similar study by Hubacher and colleagues in Honduras in 1996, found that among women 

using contraception, the choice of withdrawal versus modern contraceptive methods was 

significantly predicted by their distance from a health facility, marital status, residence, age, 

number of living children, and education. The decision to use rhythm relative to modern methods 

was associated with distance from a health facility. Also, women who wanted another child were 

more likely than women who did not want more children to prefer rhythm than modern methods 

(Hubacher et al. 1996). 

With this as background, a study on the levels, patterns, and determinants of traditional 

contraceptive method use can provide valuable information on the dynamics of contraceptive use 
5

in the Philippines. In this paper, we focus on traditional contraceptive method use and explore 

why its prevalence has remained substantial over the past 10 years. By using data from three 

DHS surveys, the paper attempts to capture the effect of time as well as a different family 

planning program focus on contraceptive method use. 

1.3. Research questions 

While contraceptive prevalence has increased in the Philippines, the rise has been gradual. This 

has led to a steady but slow decrease in fertility. Results from the Philippines NDHS surveys 

show that use of both modern and traditional contraceptive methods increased across survey 

years. Among current contraceptive users, however, the share of traditional contraceptive method 

use has been consistent, at around 30%. With the present administration’s focus on addressing 

unmet need for modern family planning methods, an understanding of the trends and levels of 

traditional contraceptive method use is imperative. No study in recent years has looked into this 

specific topic. 

In this paper, we explore the following research questions: 

1) What characteristics of women are associated with the use of traditional contraceptive 

methods? 

2) Given that the share of traditional contraceptive method use among all contraceptive 

users has remained the same in the last 10 years, have the characteristics of traditional 

contraceptive method users been similar throughout the years? 

Understanding the characteristics of traditional contraceptive method users provides a valuable 

input to the development and implementation of programs, particularly information education 

and communication (IEC) campaigns that address the needs of these users. Moreover, this 

information is important for designing programs and policies that could encourage couples to 

switch from traditional contraceptive methods to more reliable and efficient modern methods. 

1.4. Conceptual Framework 

 This study considers contraceptive method use, and in particular preference for traditional 

contraceptive methods, to be a function of several factors: the background characteristics of the 

woman herself, those of her husband or partner, her fertility intentions, and her exposure to 

family planning messages. Figure 2 graphically presents the link between these factors and the 

choice of contraceptive method. 

In addition, we explore the possible association of these factors to type of contraceptive method 

used within the changing context of family planning program implementation in the Philippines, 

as measured in the recent DHS surveys.
6

Socio-demographic 

characteristics

Age

Type of marital union

Education

Wealth quintile

Work status

Urban-rural residence

Religion

Age difference between woman 

and husband/partner 

Husband/partner’s education

Fertility-related characteristics

Number of living children

Fertility intention

Knowledge of fertile period

Media sources of family planning

knowledge 

Type of 

contraceptive 

method used

Year

Figure 2. Conceptual framework examining the association between women’s socio-demographic 

and fertility-related characteristics and type of contraceptive method used 
7

2. Data and Methods

2.1. Data

This study used pooled data from the 2003, 2008, and 2013 Philippines National Demographic 

and Health Surveys (NDHS), particularly the women’s file, which contains information on 

background characteristics, fertility, and family planning practices of women of reproductive age 

15-49. The 2003 NDHS was a sample of 13,633 respondents, while the 2008 and 2013 surveys 

covered 13,594 and 16,155 respondents, respectively. 

The two earlier surveys used a stratified three-stage sampling design, first, by selecting primary 

sampling units (PSUs) and second, by selecting enumeration areas (EAs), both using probability 

proportional to size. At the third stage, housing units were then selected with equal probability 

within sampled EAs. The 2013 NDHS used a stratified two-stage sampling design involving the 

systematic selection of EAs distributed by stratum (region, urban/rural) at the first stage and then 

the selection of sample housing units from each sample EA, using systematic random sampling 

at the second stage. Both designs provide data that is representative of the country and each of 

the 17 administrative regions. All three surveys were conducted by the Philippine Statistics 

Authority (NSO and ORC Macro 2004; NSO and ICF Macro 2009; PSA and ICF International 

2014). 

The analytic sample is restricted to fecund, currently married (formally or consensually), 

sexually active women (those who reported having had sexual intercourse in the four weeks prior 

to the survey) of reproductive age 15-49 and who were currently using any contraceptive method 

at the time of the survey. Such women are assumed to be exposed to the chance of pregnancy 

and are therefore likely to need a family planning method if they want to space or limit births. 

Women who reported using folkloric methods (98 cases for all survey years) were excluded from 

the analytic sample. These criteria resulted to a total of 11,815 women in the study, distributed as 

follows: 3,613 women in 2003, 3,663 women in 2008, and 4,539 women in 2013. Before the 

datasets were merged, all variables used in the analysis were harmonized across the three survey 

years. 

2.2. Key Variables and Measures 

The outcome variable is type of contraceptive method currently used, which was derived from 

the following question: “Are you or your husband/partner currently doing something or using 

any method to delay or avoid getting pregnant?” A positive response leads to the follow-up 

question on the particular contraceptive method used. In case there is more than one method 

reported, the more effective method is recorded. Contraceptive methods are classified into 

modern and traditional methods. Modern contraceptive methods include female sterilization, 

male sterilization, pill, IUD, injectables, male condom, and natural family planning (NFP) 

methods. The modern NFP methods include fertility awareness-based methods such as cervical 
8

mucus/Billing’s ovulation method, basal body temperature, symptothermal method, standard 

days method, and lactational amenorrhea method (LAM)1. 

Traditional contraceptive method use refers to use of any of the following: rhythm or periodic 

abstinence, withdrawal, and folkloric methods (e.g., use of herbs). Since the focus of the study is 

on traditional contraceptive methods and also due to the small number of women using folkloric 

methods, the outcome variable includes only three categories: the use of rhythm, withdrawal, and 

modern contraceptive methods. 

 Explanatory variables are categorized into socio-demographic and fertility-related 

characteristics of women as outlined in the conceptual framework. The socio-demographic 

characteristics that are likely to be associated with the type of contraceptive method use were 

measured as follows: Age refers to the age of the woman as of her last birthday. For this analysis, 

age is treated as a categorical variable, thus the 5-year age groups 15-19, 20-24, 25-29, 30-34, 

35-39, 40-44 and 45-49 are used. Type of marital union distinguishes between formal union and 

cohabitation (live-in arrangement or consensual union). Highest educational attainment refers to 

the highest level of schooling completed by the respondent and is categorized into no education, 

elementary, high school, and college or higher. Wealth quintile is an aggregate measure of the 

socioeconomic status of the household where the woman resides. It is measured in quintiles:

lowest, second, middle, fourth, and highest. Work status of the woman is a bivariate measure on 

whether or not she has done any work in the past seven days. Urban-rural residence refers to 

whether the woman’s place of residence is an urban or a rural area. Religion refers to the 

woman’s religious affiliation, whether Catholic or non-Catholic. 

Some basic characteristics of the husband/partner were also identified as possible factors that 

could affect the contraceptive method used. Husband/partner’s age refers to the age as of last 

birthday and grouped into five broad categories: 15-19, 20-29, 30-39, 40-49, and 50 years and 

over. This variable, however, was excluded in the multivariate analysis since it is highly 

correlated with the woman’s age. Age difference between the woman and her husband/partner

was grouped into three categories: husband/partner is older by at least four years, 

husband/partner is of the same age or older by up to three years, and woman is older than 

husband/partner. Husband/partner’s education follows the same four categories as for women’s 

educational attainment. 

Fertility-related characteristics of the women were also identified as factors associated with 

contraceptive method use. The couple’s number of living children is grouped into none, 1-2, 3-4, 

and 5 and over. Fertility intention is a measure of the woman’s desire for additional children, 

with three categories: want no more children, undecided, and want more children. Knowledge of 

 

1

 This classification of NFP methods is based on Administrative Order No. 125 s. 2002 issued by the Secretary of 

the Department of Health, which outlines the national strategy for the implementation of natural family planning in 

Year 2002 - 2006. 
9

fertile period measures awareness of the fertile window in the menstrual cycle and is 

dichotomized into two categories: correct knowledge and incorrect knowledge. Women with 

correct knowledge refers to those who answered that a woman is more likely to get pregnant 

halfway between two menstrual cycles, while women with incorrect knowledge refers to those 

who mentioned otherwise or responded that they do not know when the fertile period is. 

Finally, exposure to family planning messages was also included, particularly women’s exposure 

through the radio, television, and print media, such as newspaper or magazine, poster, or leaflet 

or brochure in the past few months. It should be noted that the variable representing print media 

for the year 2003 is a composite variable from three questions inquiring about family planning 

exposure through newspaper or magazine, poster, or leaflet or brochure separately, whereas all 

these were included as one question in the 2008 and 2013 surveys. The 2013 survey also asked 

about the Internet as a source of family planning messages but, although the Internet has become 

an important media form, these data are not included in the analysis because there are no 

comparable data from the two earlier surveys. 

Survey year is included as a factor in analyzing use of traditional contraceptive methods among 

Filipino women over time. 

2.3. Methods of Analysis 

Cross-tabulations and tests of proportions were employed in comparing the characteristics of 

women using traditional and modern contraceptive methods and in ascertaining statistical 

significance in the differences. Multinomial logistic regression was used to predict the 

determinants of current use of rhythm (periodic abstinence) or withdrawal (both traditional 

methods) relative to current use of modern contraceptive method (base group). The relative risk 

ratios (RRR) are reported. A parameter estimate of RRR more than 1 indicates that the 

explanatory variable is associated with greater probability of outcome than that of the base 

group, while RRR of less than 1 indicates smaller probability of outcome than the base group. 

Prior to the multivariate analyses, the explanatory variables were tested for multicollinearity 

using variance inflation factor (VIF). 

Respondents with missing information were excluded from the analyses. Results from statistical 

analyses were adjusted for complex survey design. Stata version 14 was used for data 

management and analysis. 

11

3. Results

3.1. Trends in contraceptive use: 2003-2013

Table 1 shows the contraceptive method mix among the sample of currently married, fecund, and 

sexually active current users for the three survey years and the percentage point differences for 

three time periods: 2003-2008, 2008-2013, and 2003-2013. Modern contraceptive methods 

comprise the largest share of contraceptive prevalence across all survey periods. However, the 

use of traditional methods also accounts for nearly one-third of contraceptive use from 2003 to 

2013.

Table 1. Percent distribution of currently married women age 15-49 who are 

using a contraceptive method by type of contraceptive method currently used 

and percentage point difference, Philippines 2003, 2008, and 2013

Contraceptive method

Percentage Percentage point difference

2003 2008 2013 2003-2008 2008-2013

Overall 

2003-2013

Traditional method 31.8 32.7 32.0 0.9 -0.7 0.2

Rhythm (Periodic 

abstinence) 13.4 12.4 9.3 -1.0 -3.1 -4.1

Withdrawal 17.2 19.4 22.2 2.2 2.8 5.0

Folkloric method 1.2 0.9 0.4 -0.3 -0.5 -0.8

Modern method 68.2 67.3 68.0 -0.9 0.7 -0.2

Female sterilization 18.5 16.2 14.0 -2.3 -2.2 -4.5

Male sterilization 0.2 0.1 0.2 -0.1 0.1 0.0

Pill 29.2 32.9 36.5 3.7 3.6 7.3

IUD 8.5 7.2 6.3 -1.3 -0.9 -2.2

Injectables 6.7 5.3 6.4 -1.4 1.1 -0.3

Male condom 4.3 4.8 3.5 0.5 -1.3 -0.8

Natural family planning 

(NFP) method1 0.8 0.9 1.0 0.1 0.1 0.2

Other modern method 0.1 0.0 0.1 -0.1 0.1 0.0

Total 100.0 100.0 100.0

Number of women 3,657 3,696 4,560

Note: Excludes women who declared themselves as infecund, pregnant or who were not 

sexually active in the 4 weeks preceding the survey

1

Includes Mucus/Billings/Ovulation method, Standard Days Method, Lactational amenorrhea 

method (LAM), basal body temperature (BBT), and symptothermal methods

As Figure 3 illustrates, the contraceptive method mix has changed little from 2003 to 2013, with 

only the pill posting statistically significant changes over the 10-year period. The pill is the most 

widely used contraceptive method in all survey years and recorded the largest increase in both 5-

year survey intervals, with an overall increase of 7.3 percentage points from 2003 to 2013. Next 

to the pill, the most preferred method is withdrawal; its prevalence increased from 17% in 2003 

to 22% in 2013—an increase of 5 percentage points over the 10-year period, with the largest

share of the increase occurring between 2008 and 2013. In contrast, use of rhythm decreased in 
12

prevalence, from 13% in 2003 to 12% five years later and further to 9% in 2013. After female 

sterilization, rhythm use recorded the highest decline, at 4.1 percentage points. 

Figure 3. Percentage and 95% confidence intervals of currently married women 

age 15-49 by contraceptive method currently used, Philippines 2003, 2008, and 

2013

The use of natural family planning (NFP) methods posted a 0.2 percentage point increase from 

2003 to 2013, while the IUD, injectables, and male condom recorded modest decreases in 

prevalence. Male sterilization remains negligible, at a level even lower than that of folkloric 

methods. 

In all survey years, use of withdrawal is more prevalent than the rhythm method. From a 3.8 

percentage point difference in 2003, the gap between these two methods widened such that by 

2013, prevalence of withdrawal (22%) is more than twice than that of rhythm (9%). 

3.2. Distribution of women who are current contraceptive users: 2003-2013

The succeeding analyses are on a total of 11,815 cases. As mentioned in the data section, women 

who reported use of folkloric methods were excluded because of the small number of cases in all 

survey years (98). 

The distribution of fecund, currently married (formally or consensually), sexually active 

contraceptive users has not changed substantially from 2003 to 2013 (Table 2). Most of these 

women were in the peak of childbearing age 25-34, while a few were teenagers. Over the survey 

period, however, the percentage of cohabiting women more than doubled, from 9% in 2003 to 

22% in 2013.

0

5

10

15

20

25

30

35

40

45

Rhythm WithdrawalFolkloric methodFemale

sterilization

Male

sterilization

Pill IUD InjectablesMale

condom

NFP Other modern method

2003 2008 2013

Note: Excludes women who declared themselves as infecund, pregnant or who were not sexually active in the 4 weeks 

preceding the survey
13

Table 2. Percent distribution of currently married women age 15-49 who are currently using a 

contraceptive method, by sociodemographic characteristics, Philippines 2003, 2008, and 2013

Sociodemographic 

characteristic

Survey year

2003 2008 2013

%

Number of 

women %

Number of 

women %

Number of 

women

Age

15-19 1.6 57 1.8 64 2.4 108

20-24 11.6 419 11.7 429 12.0 545

25-29 19.7 711 19.8 724 17.0 770

30-34 21.7 784 21.8 800 22.1 1,004

35-39 22.0 794 20.2 740 19.7 894

40-44 14.9 538 16.0 586 17.1 775

45-49 8.6 310 8.7 319 9.8 444

Mean, s.d. 33.5, 7.5 33.5, 7.7 33.8, 7.8

Type of marital union

Formally married 91.0 3,287 85.4 3,128 77.8 3,530

Cohabiting 9.0 326 14.6 535 22.2 1,010

Education

No education * 16 * 16 (0.8) 35

Elementary 25.6 925 20.9 765 19.5 886

High School 43.7 1,580 46.9 1,716 50.8 2,307

College or higher 30.2 1,093 31.8 1,165 28.9 1,312

Wealth quintile

Lowest 14.7 533 15.9 584 18.5 840

Second 20.8 752 21.0 769 21.2 963

Middle 22.2 802 22.2 812 21.9 993

Fourth 22.7 821 22.3 818 21.6 978

Highest (Ref.) 19.5 705 18.5 679 16.9 765

Work status1

Working 50.5 1,820 55.0 2,007 53.7 2,430

Not working 49.5 1,780 45.0 1,641 46.3 2,098

Residence

Urban 53.5 1,934 53.1 1,946 49.4 2,243

Rural 46.5 1,679 46.9 1,717 50.6 2,297

Religion2

Catholic 81.7 2,951 80.7 2,956 80.1 3,631

Non-Catholic 18.3 659 19.3 706 19.9 905

Husband/partner’s age1

15-19 * 16 * 12 * 19

20-29 22.3 806 21.9 803 21.5 976

30-39 41.3 1,490 41.2 1,506 40.1 1,815

40-49 30.6 1,104 30.1 1,101 30.3 1,372

50 and over 5.4 194 6.5 237 7.7 351

Mean, s.d. 36.4, 8.2 36.7, 8.5 36.9, 8.5

Age difference between woman 

(W) and husband/partner (H)

H older than W by 4+ years 37.8 1,366 41.6 1,520 41.2 1,869

Same age or H older than W by 

1-3 years 42.9 1,550 39.3 1,439 40.4 1,832

W older than H 19.2 694 19.1 699 18.3 831

Mean, s.d. 2.9, 4.9 3.1, 5.1 3.1, 5.0

Husband/partner’s education2

No education (0.9) 31 (0.6) 22 (0.9) 43

Elementary 30.3 1,094 26.8 977 27.2 1,232

High School 38.9 1,404 41.0 1,495 44.5 2,018

College or higher 29.9 1,077 31.7 1,156 27.4 1,243

Total 100.0 3,613 100.0 3,663 100.0 4,539

Note: Excludes women who declared themselves as infecund or pregnant or not sexually active in the 4 weeks 

preceding the survey; 

1 Excludes “No information”

Numbers in parentheses are based on 25-49 unweighted cases; an asterisk denotes a figure based on fewer than 25 

unweighted cases that has been suppressed.
14

Among current users of a contraceptive method, the percentage of women who have finished at 

least the basic education (high school) increased between 2008 and 2013, while the percentage 

with college or more declined. There was also an increase between 2003 and 2008 in the 

percentage of women working, but the percentage then declined slightly, from 55% in 2008 to 

54% in 2013. Between 2003 and 2013, the percentage of women in rural areas using 

contraception increased, while it decreased slightly among followers of the Catholic religion. 

Filipino couples are mostly in the same age group, although, on average, men are older than their 

partners by three years. Nonetheless, in 2013, 41% of women had husbands who were at least 

four years older, slightly more than the percentage of women whose husbands were the same 

age. Education level of the husband/partner generally improved over the survey years. High 

school seems to be the terminal level for most, since the percentage with elementary education 

and the percentage with college education or more has declined over time. 

Across the three survey years, the percentage of women with one or two children increased by 6 

percentage points, to 47%, while the average number of children remained at three (Table 3). A 

large majority of women want no more children. Only about a third of women have correct 

knowledge of a woman’s fertile period. This percentage increased from 2003 to 2008 and then 

declined from 2008 to 2013. 
15

Table 3. Percent distribution of currently married women age 15-49 who are currently 

using a contraceptive method, by fertility-related characteristics, Philippines 2003, 

2008, and 2013

Fertility-related 

characteristic

Survey year

2003 2008 2013

%

Number 

of women %

Number 

of women %

Number 

of women

No. of living children

2 (1.0) 36 (1.2) 44 (1.0) 47

1-2 41.0 1,480 44.0 1,612 47.2 2,144

3-4 39.8 1,439 37.0 1,356 36.1 1,636

5+ 18.2 658 17.8 652 15.7 712

Mean, s.d. 3.1, 1.8 3.0, 1.8 2.9, 1.8

Fertility intention1

Want no more children 70.3 2,540 69.4 2,541 69.5 3,156

Undecided 4.2 150 4.0 147 4.1 185

Want more children 25.5 921 26.6 975 26.4 1,197

Knowledge of fertile period1

With correct knowledge 30.9 1,116 39.8 1,456 34.3 1,558

With incorrect knowledge 69.1 2,497 60.2 2,206 65.7 2,980

Heard about FP on the radio 

in the past few months1

Yes 63.4 2,289 53.3 1,953 49.7 2,258

No 36.6 1,323 46.7 1,709 50.3 2,282

Seen about FP on TV in the 

past few months1

Yes 67.7 2,446 79.1 2,897 72.8 3,303

No 32.3 1,165 20.9 766 27.2 1,236

Read about FP in newspaper/

magazine/poster/leaflet in 

the past few months1

Yes 57.5 2,078 29.9 1,097 32.6 1,478

No 42.5 1,533 70.1 2,566 67.4 3,062

Total 100.0 3,613 100.0 3,663 100.0 4,539

Note: Excludes women who declared themselves as infecund or pregnant or not sexually active in the 

4 weeks preceding the survey

1 Excludes “No information”

Numbers in parentheses are based on 25-49 unweighted cases

The popularity of radio as a source of knowledge of family planning among women has waned, 

but television remains a popular source. Print media such as newspapers, magazines, posters, 

leaflets, or brochures are not as popular in 2013 as 10 years earlier, although the change could be 

due to a measurement issue since the question was asked differently in the earlier survey (see 

Key Variables and Measures). In 2013, one of every six women reported the Internet as a source 

of family planning information (data not shown). 
16

3.3. Association between type of contraceptive method used and socio-demographic and 

fertility-related characteristics 

The succeeding bivariate and multivariate analyses were based on pooled data for women 

currently using a contraceptive method. Generally, the characteristics of these women have not 

changed significantly over the three survey periods. Additionally, separate analyses were made 

for rhythm and withdrawal because of the divergent temporal patterns that these methods show 

in the trend analysis. 

Table 4 compares the socio-demographic and fertility-related characteristics of current users of 

rhythm, withdrawal, and modern methods. Rhythm and withdrawal users are significantly 

different in all characteristics with the exception of religion, age difference between the woman 

and her husband/partner, and family planning exposure on television. More importantly, 

examination of the characteristics of traditional and modern contraceptive method users reveals 

interesting findings. 
17

Table 4. Percent distribution and 95% confidence intervals (CIs) of currently married women age 

15-49 who are using a contraceptive method by sociodemographic and fertility-related 

characteristics according to contraceptive method currently used, Philippines pooled data

Sociodemographic and fertilityrelated characteristic

Rhythm Withdrawal Modern method

% 95% CI % 95% CI % 95% CI

Sociodemographic 

characteristic

Age

15-19 1.1 0.7 - 1.8 3.8 3.0 - 4.8 1.6 1.3 - 1.9

20-24 5.9 4.7 - 7.3 14.3 12.9 - 15.9 12.1 11.3 - 12.8

25-29 11.9 10.2 - 13.9 20.2 18.5 - 22.0 19.3 18.5 - 20.3

30-34 19.1 17.0 - 21.4 20.6 18.8 - 22.5 22.8 21.8 - 23.8

35-39 23.3 21.0 - 25.8 17.7 16.1 - 19.3 20.9 20.0 - 21.9

40-44 23.5 21.3 - 26.0 14.9 13.4 - 16.5 15.1 14.3 - 16.0

45-49 15.1 13.2 - 17.3 8.5 7.4 - 9.8 8.2 7.6 - 8.9

Mean, s.d. 36.5, 7.3 32.6, 7.8 33.4, 7.6

Type of marital union

Formally married 90.4 88.6 - 92.0 78.2 76.2 - 80.1 84.8 83.9 - 85.8

Cohabiting 9.6 8.0 - 11.4 21.8 19.9 - 23.8 15.2 14.2 - 16.1

Education

No education 0.8 0.4 - 1.5 0.7 0.5 - 1.1 0.5 0.4 - 0.6

Elementary 21.3 19.0 - 23.7 21.0 19.3 - 22.9 22.1 21.0 - 23.2

High School 38.4 35.7 - 41.1 52.4 50.2 - 54.6 47.5 46.3 - 48.7

College or higher 39.6 36.8 - 42.4 25.8 23.9 - 27.8 29.9 28.7 - 31.1

Wealth quintile

Lowest 18.4 16.3 - 20.7 16.6 15.0 - 18.3 16.2 15.2 - 17.3

Second 18.5 16.4 - 20.7 21.2 19.4 - 23.1 21.4 20.4 - 22.5

Middle 18.6 16.5 - 20.9 23.7 21.7 - 25.7 22.2 21.2 - 23.2

Fourth 20.1 17.8 - 22.7 22.9 20.9 - 25.0 22.3 21.2 - 23.4

Highest 24.4 21.8 - 27.3 15.7 14.0 - 17.5 17.9 16.8 - 19.0

Work status

Working 62.1 59.4 - 64.7 45.1 42.9 - 47.4 53.9 52.7 - 55.2

Not working 37.9 35.3 - 40.6 54.9 52.6 - 57.1 46.1 44.8 - 47.3

Residence

Urban 48.6 45.6 - 51.7 57.4 54.8 - 60.0 50.7 49.2 - 52.3

Rural 51.4 48.3 - 54.4 42.6 40.0 - 45.2 49.3 47.7 - 50.8

Religion2

Catholic 81.0 78.8 - 83.1 83.0 81.3 - 84.6 80.1 79.0 - 81.1

Non-Catholic 19.0 16.9 - 21.2 17.0 15.4 - 18.7 19.9 18.9 - 21.0

Husband/partner’s age

15-19 0.1 0.0 - 0.5 0.8 0.5 - 1.2 0.3 0.2 - 0.5

20-29 12.0 10.3 - 14.0 28.5 26.5 - 30.5 21.7 20.7 - 22.7

30-39 38.5 35.8 - 41.4 37.1 35.0 - 39.2 42.2 41.1 - 43.4

40-49 39.7 37.0 - 42.5 27.6 25.7 - 29.6 29.5 28.4 - 30.6

50 and over 9.6 8.2 - 11.2 6.1 5.2 - 7.2 6.3 5.7 - 6.9

Mean, s.d. 39.1, 7.9 35.6, 9.0 36.6, 8.5

Continued...
18

Table 4—Continued

Sociodemographic and fertilityrelated characteristic

Rhythm Withdrawal Modern method

% 95% CI % 95% CI % 95% CI

Sociodemographic 

characteristic

Age difference between woman 

(W) and husband/partner (H)

H older than W by 4+ years 37.4 34.6 - 40.3 39.3 37.2 - 41.4 41.1 39.9 - 42.3

Same age or H older than W by 

1-3 years 41.5 38.7 - 44.2 39.6 37.6 - 41.7 41.1 40.0 - 42.2

W older than H 21.1 18.8 - 23.6 21.1 19.4 - 22.9 17.8 16.9 - 18.7

Mean, s.d. 1.8, 0.7 1.8, 0.7 1.8, 0.7

Husband/partner’s education

No education 1.2 0.7 - 1.9 1.1 0.7 - 1.6 0.7 0.5 - 0.9

Elementary 28.7 26.2 - 31.3 26.4 24.5 - 28.4 28.4 27.2 - 29.6

High School 31.2 28.7 - 33.8 44.8 42.6 - 46.9 42.6 41.4 - 43.8

College or higher 39.0 36.1 - 42.0 27.7 25.7 - 29.8 28.4 27.2 - 29.6

Fertility-related characteristic

No. of living children

0 2.0 1.3 - 3.0 2.8 2.2 - 3.6 0.4 0.3 - 0.6

1-2 41.2 38.4 - 44.1 49.4 47.3 - 51.5 43.4 42.2 - 44.6

3-4 36.5 33.9 - 39.2 29.6 27.6 - 31.6 40.0 38.8 - 41.2

5+ 20.3 18.2 - 22.6 18.3 16.6 - 20.0 16.2 15.4 - 17.1

Mean, s.d. 3.2, 1.9 2.9, 1.9 3.0, 1.7

Fertility intention

Want no more children 69.9 67.3 - 72.3 62.9 60.7 - 64.9 71.7 70.7 - 72.7

Undecided 4.9 3.8 - 6.3 4.4 3.6 - 5.4 3.8 3.4 - 4.3

Want more children 25.2 22.9 - 27.7 32.8 30.8 - 34.8 24.4 23.5 - 25.4

Knowledge of fertile period

With correct knowledge 46.2 43.5 - 49.0 32.4 30.3 - 34.5 33.8 32.5 - 35.1

With incorrect knowledge 53.8 51.0 - 56.5 67.6 65.5 - 69.7 66.2 64.9 - 67.5

Heard about FP on the radio in 

the past few months

Yes 55.6 52.8 - 58.4 50.3 48.0 - 52.6 56.3 55.0 - 57.5

No 44.4 41.6 - 47.2 49.7 47.4 - 52.0 43.7 42.5 - 45.0

Seen about FP on TV in the past 

few months

Yes 71.9 69.2 - 74.5 71.4 69.3 - 73.4 73.9 72.7 - 75.1

No 28.1 25.5 - 30.8 28.6 26.6 - 30.7 26.1 24.9 - 27.3

Read about FP in newspaper/

magazine/poster/leaflet in the 

past few months

Yes 42.4 39.6 - 45.4 34.9 32.8 - 37.2 40.2 38.8 - 41.6

No 57.6 54.6 - 60.4 65.1 62.8 - 67.2 59.8 58.4 - 61.2

Total 100.0 100.0 100.0

Number of women 1,375 2,358 8,082

Note: Excludes women who declared themselves as infecund or pregnant or who were not sexually active in the 4 

weeks preceding the survey, and women who are using a folkloric method

Compared with modern contraceptive method users, women who use rhythm are more likely to 

be older, formally married, college-educated, in the highest wealth quintile, working, with either 

no children or five or more children, and older than their husbands. Considering characteristics 
19

of the husband, the use of rhythm is more common among women whose husbands are at least 

age 40 and women whose husbands are college-educated. As expected, proportionately more 

women with correct knowledge of the fertile period use the rhythm method compared with users 

of either withdrawal or modern contraceptive methods. 

A comparison of users of withdrawal versus users of modern contraceptive methods reveals 

different patterns than for users of rhythm versus modern contraceptive methods. A higher 

proportion of withdrawal users than modern contraceptive method users is found among women 

age 15-29, but the pattern reverses at age 30-44, when modern contraceptive methods become 

more prevalent. At age 45-49, there is greater preference for withdrawal again. However, only 

the differences in the use of withdrawal relative to modern contraceptives methods in ages 15-19, 

20-24, and 35-39 are statistically significant. Women who reported use of withdrawal tend to be 

cohabiting, with a high school education, not working, rural, Catholic, married to a 

husband/partner age 20-39, and older than their husband/partner. 

Compared with modern contraceptive method users, users of withdrawal are also more likely to 

have fewer children (0-2), want additional children, and not to have had exposure to family 

planning messages on radio or print media in the past few months. 

3.4. Determinants of use of traditional contraceptive methods 

Tables 5 and 6 present results from the multinomial logistic regression on the use of rhythm and 

withdrawal compared with modern contraceptive methods by socio-demographic and fertilityrelated characteristics. 

As an initial step towards modeling estimation, explanatory variables were tested for 

multicollinearity. Using the VIF as indicator, the age of the husband/partner was dropped from 

the regression model since it is highly correlated with the woman’s age. The exclusion of the age 

of husband/partner resulted to a final mean VIF score of 1.4, which confirms the absence of 

multicollinearity among the remaining explanatory variables. 

Because the analysis is based on pooled data of three survey years, time (with survey year as 

proxy) was incorporated as an explanatory variable in the regression models. Three models were 

constructed. Model 1 presents bivariate associations between survey year and the type of 

contraceptive method used (unadjusted model). Model 2 shows the multivariate association 

between survey year and the women’s characteristics with the type of contraceptive method 

being used (adjusted model). Model 3 examines the association between the women’s 

characteristics alone (without survey year) and contraceptive method. 

The results of Model 2 and Model 3 are similar (i.e., nearly equal RRRs and identical 

significance levels for almost all explanatory variables), suggesting that the inclusion of the 

survey year in Model 2 has no effect on the estimates. The only difference between the two 
20

models is that marital union is not statistically significant in Model 2 although the coefficients 

remained the same. Thus, subsequent analyses are based only on Models 1 and 2. 

Comparing Model 1 and Model 2, survey year is significantly associated with rhythm use in both 

models (Table 5). Women in both 2003 and 2008 surveys have higher risk of using rhythm 

relative to any modern contraceptive method compared with women in 2013 (RRR = 1.43, 95% 

CI: 1.22-1.67 for 2003; RRR = 1.34, 95% CI: 1.14-1.58 for 2008). This supports the finding that, 

over time, rhythm use has been declining in the Philippines. The statistical significance of survey 

year persisted even when the other background characteristics were incorporated, with relative 

risk ratios even higher in Model 2 than in Model 1. 

Table 5. Unadjusted and adjusted relative risk ratios (RRR) and 95% confidence intervals (CI) of survey 

year with the type of contraceptive method currently used among currently married women age 15-49 

who are using a contraceptive method, Philippines pooled data

Survey year

Rhythm vs. Modern method (Ref.) Withdrawal vs. Modern method (Ref.)

Model 1 Model 2 Model 1 Model 2

Unadjusted 

RRR 95% CI

Adjusted 

RRR1 95% CI

Unadjusted 

RRR 95% CI

Adjusted 

RRR1 95% CI

2003 1.43*** 1.22 - 1.67 1.63*** 1.37 - 1.93 0.77** 0.67 - 0.88 0.81** 0.70 - 0.93

2008 1.34** 1.14 - 1.58 1.37** 1.16 - 1.63 0.88 0.77 - 1.00 0.90 0.79 - 1.03

2013 (Ref.)

Number of 

women 11,860 11,773 11,860 11,773

Note: Excludes women who declared themselves as infecund, pregnant or who were not sexually active in the 4 weeks 

preceding the survey, and women who are using a folkloric method

1 Adjusted for the sociodemographic and fertility-related characteristics of the woman and her husband/partner (complete 

results are shown in Table 6)

** p < 0.01, *** p < 0.001

In contrast, only women in 2003 are significantly different from women in 2013 as far as 

selecting withdrawal over modern contraceptive methods is concerned. This holds true for 

Model 1 and Model 2, with no difference in the relative risk ratio for both models. Compared 

with women in 2013, women in 2003 have 23% lower relative risk of using withdrawal as a 

contraceptive method versus using modern contraceptives (RRR = 0.77, 95% CI: 0.67-0.88). 

Table 6 presents the complete results of Model 2. Age, education, wealth quintile, 

husband/partner’s education, number of living children, fertility intention, and knowledge of 

fertile period are significant determinants of using rhythm compared with modern contraceptive 

methods. With the exception of husband/partner’s education and knowledge of fertile period, all 

of these significant predictors for rhythm also significantly explain the variation in use of the 

withdrawal method. In addition, age difference between the couple, work status of the woman, 

residence, religion, and family planning exposure on radio are significant predictors of use of 

withdrawal over modern contraceptive methods. 
21

Table 6. Adjusted relative risk ratios (RRR) and 95% confidence 

intervals (CI) of survey year and sociodemographic and fertility-related 

characteristics associated with the type of contraceptive currently used 

among currently married women age 15-49 who are using a 

contraceptive method, Philippines pooled data (Model 2)

Sociodemographic and fertilityrelated characteristic

Rhythm vs. 

Modern method (Ref.)

Withdrawal vs. 

Modern method (Ref.)

RRR 95% CI RRR 95% CI

Survey year

2003 1.63*** 1.37 - 1.93 0.81** 0.70 - 0.93

2008 1.37** 1.16 - 1.63 0.90 0.79 - 1.03

2013 (Ref.)

Age 

15-19 0.17*** 0.10 - 0.32 1.12 0.75 - 1.67

20-24 0.13*** 0.09 - 0.18 0.68** 0.52 - 0.89

25-29 0.19*** 0.15 - 0.25 0.75* 0.59 - 0.94

30-34 0.32*** 0.25 - 0.41 0.73** 0.59 - 0.91

35-39 0.50*** 0.41 - 0.62 0.76** 0.62 - 0.94

40-44 0.78* 0.63 - 0.97 0.89 0.72 - 1.10

45-49 (Ref.)

Type of marital union

Formally married 1.20 0.95 - 1.50 0.89 0.77 - 1.03

Cohabiting (Ref.)

Education

No education 0.90 0.41 - 1.96 1.55 0.90 - 2.69

Elementary 0.72** 0.57 - 0.90 1.16 0.97 - 1.40

High School 0.82* 0.68 - 0.98 1.25** 1.09 - 1.43

College or higher (Ref.)

Wealth quintile 

Lowest 1.61** 1.23 - 2.10 1.27* 1.01 - 1.59

Second 1.13 0.89 - 1.44 1.18 0.97 - 1.45

Middle 1.00 0.80 - 1.24 1.21* 1.00 - 1.46

Fourth 0.88 0.71 - 1.09 1.12 0.94 - 1.34

Highest (Ref.)

Work status

Working 1.09 0.95 - 1.23 0.75*** 0.67 - 0.83

Not working (Ref.)

Residence

Urban 0.89 0.77 - 1.02 1.38*** 1.22 - 1.56

Rural (Ref.)

Religion

Catholic 1.09 0.93 - 1.28 1.22** 1.07 - 1.39

Non-Catholic (Ref.)

Age difference between woman 

(W) and husband/partner (H)

H older than W by 4+ years 1.02 0.88 - 1.18 0.96 0.86 - 1.07

W older than H 1.02 0.85 - 1.21 1.28** 1.12 - 1.47

Same age or H older than W by 

1-3 years (Ref.)

Continued...
22

Table 6—Continued

Sociodemographic and fertilityrelated characteristic

Rhythm vs. 

Modern method (Ref.)

Withdrawal vs. 

Modern method (Ref.)

RRR 95% CI RRR 95% CI

Husband/Partner’s education

No education 1.10 0.59 - 2.04 1.49 0.88 - 2.54

Elementary 0.75** 0.61 - 0.92 0.87 0.73 - 1.03

High School 0.63*** 0.53 - 0.74 0.91 0.79 - 1.05

College or higher (Ref.)

No. of living children

0 (Ref.)

1-2 0.16*** 0.09 - 0.30 0.21*** 0.14 - 0.34

3-4 0.12*** 0.06 - 0.22 0.16*** 0.10 - 0.26

5+ 0.13*** 0.07 - 0.26 0.24*** 0.15 - 0.39

Fertility intention

Want more children 1.81*** 1.51 - 2.17 1.42*** 1.24 - 1.64

Undecided 1.85*** 1.36 - 2.51 1.24 0.96 - 1.59

Want no more children (Ref.)

Knowledge of fertile period

With correct knowledge 1.58*** 1.40 - 1.79 0.95 0.86 - 1.06

With incorrect knowledge (Ref.)

Heard about FP on the radio in 

the past few months

Yes 0.91 0.79 - 1.05 0.88* 0.79 - 0.98

No (Ref.)

Seen about FP on TV in the past 

few months

Yes 0.97 0.82 - 1.14 0.92 0.80 - 1.05

No (Ref.)

Read about FP in print media in 

the past few months

Yes 0.93 0.80 - 1.09 0.90 0.80 - 1.02

No (Ref.)

Number of women 11,773 11,773

Note: Excludes women who declared themselves as infecund, pregnant or who were 

not sexually active in the 4 weeks preceding the survey, and women who are using a 

folkloric method

* p < 0.05, ** p < 0.01, *** p < 0.001

For both rhythm and withdrawal, the relative risk ratios of choosing either method over modern 

contraceptive methods by age have values below 1, suggesting that younger women are less 

likely to use these traditional methods over modern contraceptive methods compared with 

women age 45-49, who are approaching the end of their reproductive years. It should be noted 

however that the relative risk ratio increases with age of the woman. The couple’s age difference 

is not statistically significant for rhythm but is a significant predictor for use of withdrawal. 

Women who are older than their husband/partners have 28% higher risk of using withdrawal as a 

method relative to using modern contraceptive methods compared with women the same age or 

younger than their husband/partner (RRR = 1.28, 95% CI: 1.12-1.47).

Education appears to exert contrasting influences on the use of traditional contraceptive methods. 

More educated women are more likely to use rhythm but less likely to use withdrawal compared 
23

with modern contraceptive methods. The relative risk of adopting rhythm rather than modern 

contraceptive methods is significantly lower, by 28% for elementary education (RRR = 0.72, 

95% CI: 0.57-0.90) and 18% for high school education (RRR = 0.82, 95% CI: 0.68-0.98), 

compared with women who have college education. The same pattern holds true for education of 

their husband/partners. In contrast, women with high school education have a 25% higher 

relative risk of using withdrawal than using modern contraceptive methods compared with 

college-educated women (RRR = 1.25, 95% CI: 1.09-1.43). 

By wealth quintile, the direction of influence is similar for rhythm and withdrawal, although not 

all categories show statistically significant estimates. The risks of using rhythm relative to 

modern methods are 61% higher among women in the lowest quintile than among women in the 

highest quintile (RRR = 1.61, 95% CI: 1.23-2.10). A similar pattern is apparent for withdrawal, 

but the relative risk is 27% higher among women in the lowest quintile (RRR = 1.27, 95% CI: 

1.01-1.59) and 21% higher among women in the middle quintile (RRR = 1.21, 95% CI: 1.00-

1.46) compared with the highest quintile. Similarly, working women have lower risk of using 

withdrawal relative to use of modern contraceptive methods. 

Women’s religious affiliation does not influence the use of the rhythm method versus modern 

contraceptive methods, but Catholic women have 22% higher relative risk of using withdrawal 

rather than modern contraceptive methods compared with non-Catholics (RRR = 1.22, 95% CI: 

1.07-1.39).

Women with no children and those who want more children are significantly more likely to use 

rhythm or withdrawal relative to use of modern contraceptive methods compared with their 

counterparts. Relative to women without any children, those who have one or two children 

already (RRR = 0.16, 95% CI: 0.09-0.30), those with three or four children (RRR = 0.12, 95% 

CI: 0.06-0.22), and those with at least five children (RRR = 0.13, 95% CI: 0.07-0.26) have 80%-

90% lower relative risks, respectively, of using rhythm compared with modern contraceptive 

methods. For withdrawal, women with children (regardless of how many) have around an 80% 

lower relative risk of using withdrawal than modern contraception compared with women 

without any children. 

Similarly, women who want more children or are undecided have an 80% higher relative risk of 

using rhythm than modern contraceptive methods compared with women who want more 

children (RRR = 1.81, 95% CI: 1.51-2.17; RRR = 1.85, 95% CI: 1.36-2.51, respectively). For 

withdrawal, women who desire additional children are 42% more likely to use withdrawal rather 

than modern contraceptive methods (RRR = 1.42, 95% CI: 1.24-1.64), but undecided women are 

not significantly different from women who do not want more children. 

As expected, knowledge of fertile period is associated with use of rhythm but not with 

withdrawal. Compared with women who have incorrect knowledge of the fertility cycle, women 
24

with correct knowledge have 58% higher relative risk of using rhythm rather than modern 

contraceptive methods (RRR = 1.58, 95% CI: 1.40-1.79).

Exposure to family planning information on various types of media does not appear to be 

significantly associated with type of contraceptive method used, with the exception of hearing 

about family planning on the radio, which is associated with a 12% lower likelihood of using 

withdrawal compared with no exposure to family planning messages on the radio (RRR = 0.88, 

95% CI: 0.79-0.98). The type of marital union is not a significant predictor of the use of either of 

the two traditional contraceptive methods relative to the use of modern contraceptive methods.
25

4. Discussion and Conclusions

The study shows that prevalence of traditional method use among women who are current 

contraceptive users has remained the same between surveys in 2003 and 2013, at 30%. A closer 

examination of traditional contraceptive method use, however, may suggest changing preference 

across time. Results show that in 2003 and 2008, women were more likely to use the rhythm 

method than use modern methods of contraception compared with women in 2013. Also, in 

2003, women were less likely to use withdrawal relative to using modern methods compared 

with women in 2013. 

The study examined use of traditional contraceptive methods with the aim of identifying the 

characteristics of women who could be encouraged to switch from rhythm and withdrawal to 

more effective modern contraceptive methods. The subgroups with higher likelihood of using 

rhythm are older women, women in the lowest wealth quintile, women who have no children, 

and women who want more children. In addition, users of rhythm are more likely to be college 

educated and to have college-educated husbands, as well as having correct knowledge of the 

fertile period, which is essential in using the rhythm method properly. 

Use of withdrawal, on the other hand, is more likely among women who are older, women in the 

lowest quintile, women without any children, women who want more children, as well as women 

with a high school education, women who are not working, urban women, Catholics, those older 

than their husband/partner, and women who have not received family planning messages from 

the radio. 

The analysis underscores that the characteristics of women who reported use of traditional 

methods have not changed over the years. This implies that there is a group of Filipino women 

who rely on traditional contraceptive methods who could have been targeted by family planning 

programs years ago. However, because most program efforts have focused on new acceptors of 

modern contraceptive methods, this group has been neglected and studies tend to lump them 

together as “undifferentiated mass” (Kulczycki 2004 p. 1020). 

The declining trend of rhythm use across surveys in the Philippines can be framed in several 

ways. First, it could suggest high discontinuation rates due to method failure and eventually 

abandonment of the method. Second, it could also mean that rhythm users are switching to more 

reliable modern contraceptive methods such as pills, which show increasing prevalence over the 

survey years. Unfortunately, there are limited studies on contraceptive switching behavior of 

Filipino women, particularly on specific methods that they switched to. In other countries such as 

Bangladesh, Colombia, Peru, and Jordan, most rhythm users switch to pills (Ali, Cleland, and 

Shah 2012). Finally, this finding could also imply a modest success of current family planning 

program efforts that promote modern method use. 
26

The results on withdrawal use are more difficult to explain, probably because it is a maledependent method and this analysis is limited to women’s reports of contraceptive use. In 

settings where data on men are available, such as in the 1998 Turkey DHS, results show that men 

have a positive view of the withdrawal method, and its use is an outcome of couple’s assessment 

that withdrawal is a better method than the other alternatives (Kulczycki 2004). While both 

rhythm and withdrawal involve male cooperation, the increasing prevalence of withdrawal in 

particular may also imply that men are willing to share in the responsibility for family planning 

and belies the lack of male involvement in family planning that studies (e.g., Guttmacher 

Institute and Likhaan 2010) have identified as one of the main barriers to increasing 

contraceptive use in the Philippines. The Philippine family planning program could, therefore, 

direct more efforts toward intensifying male involvement. One such effort is through stronger 

promotion of condom use, which has the added advantage of helping to prevent HIV 

transmission as well as avoiding pregnancy. Since withdrawal is used as method for birth 

spacing, the permanent method of male sterilization, which continues to be less preferred by 

Filipino males, does not appear to be a viable alternative for men who practice withdrawal. 

The findings suggest that, in general, both rhythm and withdrawal are being used as a method for 

spacing rather than limiting births. The use of less effective traditional contraceptive methods 

suggests that women are open to the possibility of having additional children, or that they have a 

fatalistic attitude toward childbearing or may view traditional methods as “better than nothing.” 

The reliance on traditional contraceptive methods among women in the lowest wealth quintile 

and, for withdrawal, among women who are not working, captures common problems regarding 

access to contraceptive methods. Compared with modern contraceptive methods, these methods 

neither entail cost nor require visits to a health facility. 

Religion, as measured by data on religious affiliation, does not seem to figure in women’s 

decision to use a particular type of method, except for withdrawal, since Catholics are relatively 

more likely than non-Catholics to practice withdrawal. While there is the view that the Catholic 

Church has a strong influence on the reproductive and contraceptive use of Catholics, this is not 

captured in the study. The Catholic Church has been steadfast in its opposition of modern 

contraceptive methods. Pastoral letters are often issued by the Catholic Church hierarchy 

criticizing any effort to promote use of modern contraceptives. 

The low proportion of Filipino women who have correct knowledge of the fertile period over the 

ten years covered in the study suggests that greater efforts should be exerted in education on the 

fertility cycle, especially among women who are using the rhythm method. Rhythm users can be 

encouraged to adopt the more scientific NFP methods, particularly the Standard Days Method, 

which requires similar knowledge of women’s fertility cycle. By identifying which subgroups of 

women are most likely to be using the rhythm method, the task of convincing these women to 

switch to a similar but more scientific method is already half-done. Toward this end, the heavy 
27

promotion of NFP use from 2001 to 2010 could be revived. NFP use also requires a high level of 

male involvement since, just like rhythm use, abstention from sexual intercourse in fertile days 

requires cooperation of both partners. Beyond men’s use of male-dependent methods, campaigns 

on male involvement should also include support for their female partner’s use of modern 

contraceptive methods. 

The decline of radio and print media as sources of family planning messages, as well as the 

absence of the effect of the television and print media on the contraceptive use of women, may 

point to waning popularity of the traditional media. In general, consumption of traditional media 

has declined over time (see various NDHS reports). The traditional forms of media such as radio, 

print, and television do not seem to exert an influence on the contraceptive behavior of women 

(even if a majority of the women get family planning messages from television). Family 

planning program managers could therefore explore other platforms such as information 

communication technology (ICT) and social media such as Facebook, Instagram, and Twitter to 

promote modern contraceptive methods and dispel apprehensions of women regarding the side 

effects and other health concerns attributed to the use of modern contraceptive methods. 

The identification of the characteristics of women who use traditional contraceptive methods can 

provide a basis for more targeted policies and programs to promote the more effective modern 

contraceptive methods, including programs that encourage traditional contraceptive method users 

to switch to the more effective modern contraceptive methods. 

The findings of the study also warrant further research, both quantitative and qualitative, to 

explore the continued preference for traditional contraceptive methods in the Philippines. With 

fear of side effects as the dominant reason for nonuse of contraceptives (Abejo et al. 2006; Cruz, 

Marquez, and Kabamalan 2016) and preference for traditional over modern contraceptive 

methods, there is a need for systematic study to examine this in depth, for instance to answer 

such questions as which specific methods women refer to when they say they fear side effects, 

and what side effects compel women to opt for a traditional contraceptive method over a modern 

method. 

Most studies on contraceptive use focus on women, while the literature on men’s contraceptive 

behavior is more limited. At the national level, only the 2003 NDHS collected data on men and 

there has been no follow up survey since then. Research about contraception from the point of 

view of men should merit equal attention in order to fully understand the continuing popularity 

of traditional contraceptive methods in the Philippines, particularly withdrawal, and the reasons 

behind the apparent resistance of Filipino men to modern male-dependent methods such as the 

condom and vasectomy.

While the study looks at traditional contraceptive method use in three survey years and identifies 

characteristics associated with women’s use of rhythm and withdrawal versus modern 
28

contraceptive use, it cannot establish causality. Rather, it is limited to identifying the patterns and 

trends of traditional contraceptive use between 2003 and 2013. 
29

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