DHS ANALYTICAL 

STUDIES 63

Trends, Determinants, and 

Dynamics of Traditional 

Contraceptive Method Use

August 2017

This publication was produced for review by the United States Agency for International Development. It was prepared by 

Tesfayi Gebreselassie, Kristin Bietsch, Sarah Staveteig, and Thomas Pullum.

DHS Analytical Studies No. 63 

Trends, Determinants, and Dynamics of Traditional 

Contraceptive Method Use 

Tesfayi Gebreselassie1

Kristin Bietsch2

Sarah Staveteig2

Thomas Pullum1

ICF 

Rockville, Maryland, USA 

August 2017 

1

 ICF 

2

 Avenir Health 

Corresponding author: Tesfayi Gebreselassie, Health, Research, Informatics and Technology Division, 

ICF, 3 Corporate Square NE, Suite 370, Atlanta, GA 30329; telephone: 404-592-2208; fax: 404-321-3688; 

email: tesfayi.gebreselassie@icf.com 
Acknowledgments: The authors wish to thank Bill Winfrey for a thoughtful review, Trevor Croft for 

compiling customized event data files and providing data support, and Shireen Assaf for assistance with 

charts. 

Editor: Diane Stoy 

Document Production: Joan Wardell 

This study was 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: The 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: 

Gebreselassie, Tesfayi, Kristin Bietsch, Sarah Staveteig, and Thomas Pullum. 2017. Trends, Determinants, 

and Dynamics of Traditional Contraceptive Method Use. DHS Analytical Studies No. 63. Rockville, 

Maryland, USA: ICF. 
iii

Contents 

Tables ................................................................................................................................................................. v

Figures ................................................................................................................................................................vi

Preface ...............................................................................................................................................................vii

Abstract ..............................................................................................................................................................ix

1. Introduction ........................................................................................................................................... 1

1.1. What are traditional methods of family planning? .................................................................... 1

1.2. Traditional methods in international family planning dialogue ................................................. 2

1.3. Preference for traditional methods ............................................................................................. 3

1.4. Current use of traditional methods ............................................................................................ 3

1.5. Effectiveness of traditional methods ......................................................................................... 4

1.6. Discontinuation of traditional methods ..................................................................................... 5

1.7. Underreporting of traditional methods ...................................................................................... 5

1.8. Research questions .................................................................................................................... 6

2. Data and methods .................................................................................................................................. 7

3. Levels and trends in traditional method use.....................................................................................13

3.1 Traditional method use ............................................................................................................13

3.1.1 Method mix................................................................................................................15

3.2 Multiple method use ................................................................................................................18

3.3. Levels and trends of traditional contraceptive use by sociodemographic factors ....................19

3.3.1 Age .............................................................................................................................19

3.3.2 Parity ..........................................................................................................................24

3.3.3 Education ...................................................................................................................27

3.3.4 Residence ...................................................................................................................30

3.3.5 Wealth ........................................................................................................................32

3.3.6 Fertility intentions ......................................................................................................36

4. Case studies ..........................................................................................................................................39

4.1. Method mix .............................................................................................................................39

4.2. Determinants of contraceptive use and choice of traditional methods ....................................40

Peru ...................................................................................................................................40

Jordan ...................................................................................................................................44

Ghana ...................................................................................................................................47

Indonesia ................................................................................................................................. 50

5. Discontinuation and switching ...........................................................................................................55

5.1. Reasons for discontinuation .....................................................................................................55

5.2. Rates of discontinuation, failure, and switching ......................................................................59

5.3. Events prior to starting a family planning method ..................................................................62

6. Summary and policy implications .....................................................................................................65

References ..........................................................................................................................................................69

Appendix ...........................................................................................................................................................73
iv
v

Tables 

Table 2.1. Percentage of married women using any method of contraception and women using 

any traditional or folkloric method, unweighted number of currently married women 

age 15-49, by country and DHS survey year................................................................................. 9

Table 3.1. Percentage of currently married women who used traditional methods (with 95% 

confidence interval [95% CI]) by age and survey year, 16 countries with at least 

five DHS.........................................................................................................................................20

Table 3.2. Percentage of currently married women who used traditional methods (with 95% 

confidence interval [95% CI]) by parity and survey year, 16 countries with at least 

five DHS.........................................................................................................................................25

Table 3.3. Percentage of currently married women who used traditional methods (with 95% 

confidence interval [95% CI]) by education level and survey year, 16 countries 

with at least five DHS ...................................................................................................................28

Table 3.4. Percentage of currently married women who used traditional methods (with 95% 

confidence interval [95% CI]) by residence and survey year, 16 countries with at least 

five DHS.........................................................................................................................................31

Table 3.5. Percentage of currently married women who used traditional methods (with 95% 

confidence interval [95% CI]) by wealth quintiles and survey year, 16 countries 

with at least five DHS ...................................................................................................................33

Table 3.6. Percentage of currently married women who used traditional methods (with 95% 

confidence interval [95% CI]) by fertility desires and survey year, 16 countries with 

at least five DHS............................................................................................................................37

Table 4.1. Percent distribution of currently married women age 15-49 not using and currently 

using contraceptive methods by DHS survey year......................................................................40

Table 4.2. Predictors of current contraceptive use by survey year, adjusted odds ratios and 95% 

confidence interval (CI) from binary logistic regression, Peru ..................................................41

Table 4.3. Predictors of current contraceptive use by survey year, adjusted odds ratios and 95% 

confidence interval (CI) from binary logistic regression, Jordan...............................................45

Table 4.4. Predictors of current contraceptive use by survey year, adjusted odds ratios and 95% 

confidence interval (CI) from binary logistic regression, Ghana ...............................................48

Table 4.5. Predictors of current contraceptive use by survey year, adjusted odds ratios and 95% 

confidence interval (CI) from binary logistic regression, Indonesia..........................................51

Table 5.1. Percent distribution of discontinuations of traditional and modern contraceptive 

methods in the 5 years before the survey by main reason stated for discontinuation, 

most recent DHS with contraceptive calendar data.....................................................................57

Table 5.2. One-year contraceptive stopping, failure, all reasons for discontinuation, and switching 

rates by survey year and country, among currently married women age 15-49........................60

Table 5.3. Percentage distribution of prior events before starting traditional method and most 

 popular destination traditional method, currently married women age 15-49..........................62

Table 5.4. Percentage distribution of prior events before starting any modern contraceptive method 

and most popular destination modern method, currently married women age 15-49...............63

Appendix A.1. Percent of married women 15-49 using any modern method, periodic abstinence, 

withdrawal, folkloric methods, and not using a method of family planning .............................73
vi 

Figures 

Figure 3.1. Trends in traditional method use in Sub-Saharan Africa ......................................................... 13

Figure 3.2. Trends in traditional method use in Asia, the Middle East and North Africa, Latin 

America, and the Caribbean .................................................................................................... 14

Figure 3.3. Percentage of currently married women not using any family planning method and 

method-mix of those using any modern, traditional, and folkloric family planning 

methods in Sub-Saharan Africa ............................................................................................... 16

Figure 3.4. Percentage of currently married women not using any family planning method and 

method-mix of those using any modern, traditional, and folkloric family planning 

methods in Asia, Middle East and North Africa, and Latin America, and the Caribbean ....... 17

Figure 3.5. Percent of currently married women age 15-49 using multiple traditional methods and 

simultaneous modern and traditional method .......................................................................... 19
vii 

Preface 

The Demographic and Health Surveys (DHS) Program is one of the principal sources of international data 

on fertility, family planning, maternal and child health, nutrition, mortality, environmental health, 

HIV/AIDS, malaria, and provision of health services. 

One of the objectives of The DHS Program is to analyze DHS data and provide findings that will be useful 

to policymakers and program managers in low- and middle-income countries. DHS Analytical Studies serve 

this objective by providing in-depth research on a wide range of topics, typically including several 

countries, and applying multivariate statistical tools and models. These reports are also intended to illustrate 

research methods and applications of DHS data that may build the capacity of other researchers. 

The topics in the DHS Analytical Studies series are selected by The DHS Program in consultation with the 

U.S. Agency for International Development. 

It is hoped that the DHS Analytical Studies will be useful to researchers, policymakers, and survey 

specialists, particularly those engaged in work in low- and middle-income countries. 

Sunita Kishor 

Director, The DHS Program

ix

Abstract 

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. 

Key words: Traditional method, withdrawal, periodic abstinence, trends, discontinuation, currently married 

women 

1

1. Introduction 

1.1. What are traditional methods of family planning? 

Traditional methods of contraception were fundamental to fertility declines in Europe in the 19th and early 

20th centuries (Rogow and Horowitz 1995; Tietze 1965; Santow 1995). Although their popularity declined 

after the introduction of more effective methods, traditional methods of family planning are still used by 

6% of the world’s women. In 2017, this included 71 million women and of these, 59 million lived in 

developing countries (United Nations 2016). 

Much discussion has centered on the characteristics that define a method as modern, traditional, or folkloric. 

In general, modern and traditional methods are distinguished from one another based on effectiveness. The 

World Health Organization (WHO) (2017) classifies periodic abstinence and withdrawal as the only 

traditional methods of family planning, with a longer list of modern methods that include combined oral 

contraceptives (“the pill”), progestogen only pills, implants, progestogen only injectables, monthly or 

combined injectables, combined contraceptive path, combined contraceptive ring, intrauterine device 

(IUD), male and female condoms, male sterilization (vasectomy), female sterilization (tubal ligation), 

Lactational Amenorrhea Method (LAM), emergency contraception pills, Standard Days Method (SDM), 

basal body temperature method (BBT), TwoDay method, and the symptothermal method. 

Other authors have argued for different delineations between modern and traditional methods. Hubacher 

and Trussell (2015) consider modern methods as “a product or medical procedure that interferes with 

reproduction from acts of sexual intercourse.” They do not define traditional methods, but categorize any 

method that is not modern as “non-modern.” This definition does not include effectiveness. Therefore, 

methods such as SDM and LAM would be considered “non-modern” under the Hubacher and Trussell 

classification. Malarcher and colleagues from the US Agency for International Development (USAID) note 

that some women are “unwilling or unable to use devices or drugs” and have invested in research on 

modern, nonmedical methods of fertility regulation such as SDM and LAM (Malarcher et al. 2016a). They 

caution against labeling these methods non-modern because the methods are more likely to be excluded 

from programming and contraceptive counseling. 

In contrast, Cates, Stanback, and Maggwa (2014) believe that methods of contraception should be classified 

primarily on effectiveness—and should not be differentiated as being modern or traditional. They argue 

that the definition of the modern contraceptive prevalence rate (mCPR) is outdated because long acting 

reversible methods (LARCs) are much more effective than short term modern methods, and some modern 

methods have similar levels of effectiveness as traditional methods. The authors suggest creating a weighted 

contraceptive prevalence rate that incorporates typical rates of effectiveness and continuation of methods. 

Austad et al. (2016) argue that the classification of methods into traditional and modern is obsolete and that 

methods should be classified only by their effectiveness. Folkloric methods are not included in the above 

discussions because they have unproven effectiveness (Rutstein and Rojas 2006). Folk methods vary by 

country, but often include amulets, herbs, abdominal massages, and spiritual methods that people believe 

prevent conception or end pregnancy (Guerrero 1977; Quijano 1986; Lans 2007; Rutstein and Rojas 2006). 

In the DHS, folk methods are recorded only when reported spontaneously by the interview subject and are 

often grouped with traditional methods (Rutstein and Rojas 2006). 

This report classifies methods as traditional or modern based on the Demographic Health Survey’s Guide 

to Statistics (Rutstein and Rojas 2006). This guide includes periodic abstinence (rhythm or calendar 

method), withdrawal (coitus interruptus), and country-specific traditional methods of proven effectiveness 

(such as prolonged breastfeeding in the 1990 Jordanian DHS) as traditional methods. Our analysis also 

groups the small number of users of folkloric methods with the traditional method users. 
2

Withdrawal involves removal of the penis from the vagina prior to ejaculation (Kowal 2011). In the best of 

circumstances, users of periodic abstinence (sometimes referred to as the rhythm method) limit the risk of 

conception by avoiding sexual intercourse during a woman’s “fertile window”—the days during a 

menstrual cycle when intercourse is most likely to result in pregnancy (Jennings and Burke 2011). Some 

practices considered as traditional methods of family planning, such as prolonged breastfeeding or 

abstinence, are not considered contraceptive methods (Rutstein and Rojas 2006), although qualitative 

research in Ghana finds that women employ abstinence (even when married) to space or avoid pregnancy 

(Staveteig 2016). 

Some natural methods are considered modern when practiced in certain ways. The Lactational Amenorrhea 

Method (LAM) focuses on exclusive (or nearly exclusive) breastfeeding for the first 6 months after birth 

with maximum suckling by the infant (Kennedy and Trussell 2011; Institute for Reproductive Health 2013). 

While LAM was classified as traditional in earlier versions of DHS surveys (Rutstein and Rojas 2006), 

USAID has always considered LAM a modern method (Malarcher et al. 2016a). Standard Days Method 

(also referred to as Cycle Beads) is a fertility awareness method that helps women track their menstrual 

cycle and avoid unprotected intercourse on the days when conception is most likely (Institute for 

Reproductive Health 2010). Because of the scientific research that studied the fertile window and its high 

efficacy rate, Standard Days Method (SDM) is considered a modern method (Institute for Reproductive 

Health. 2010; Malarcher et al. 2016a). However, this classification is not without controversy (Austad et 

al. 2016; Malarcher et al. 2016b). 

1.2. Traditional methods in international family planning dialogue 

The Millennium Development Goals, the framework for international development from 2000 to 2015, 

included reducing the unmet need for contraception as a measure of improving maternal health (United 

Nations Statistics Division 2015). Women are considered to have an unmet need for contraception if they 

do not want to have a child in the next 2 years, but are not using a contraceptive method to avoid pregnancy 

(See Bradley, Croft, Fishel, and Westoff 2012 for a detailed explanation). Traditional methods of family 

planning, such as withdrawal and periodic abstinence, are counted as methods that can meet a woman’s 

need for contraception. Others have rejected the inclusion of traditional methods in this definition. For 

example, Singh, Darroch, and Ashford (2014) define women who use traditional methods as having an 

unmet need for contraception because these women face a higher risk of pregnancy. 

Family Planning 2020 (FP2020 2016), a major international partnership established in 2012 to empower 

women and couples to determine their fertility goals autonomously and to improve contraceptive prevalence 

worldwide, aims to increase the number of modern contraceptive users by 120 million by the year 2020. 

The goal omits users of traditional methods. The FP2020 definition of unmet need also counts traditional 

method users as having an unmet need for family planning (Brown et al. 2014). In addition to this goal, 

FP2020 has emphasized a human rights-based approach to family planning that offers accessible, 

acceptable, high-quality services that are respectful of clients and actively supported by local communities 

(FP2020 2016; Hardee et al. 2014). The discussion of rights-based family planning implicitly emphasizes 

modern methods, but uses terms such as “high-quality reproductive health commodities” and “scientifically 

and medically appropriate methods”—that in principle empower women, men, and couples to choose the 

best-suited method and provide respectful services that should not necessarily preclude the inclusion of 

traditional methods. 

In 2015, a new international development agenda was developed—the Sustainable Development Goals 

(United Nations 2015) that included a measure of reproductive health, demand satisfied for family planning 

in which modern contraceptive prevalence (mCPR) was divided by the sum of contraceptive prevalence 

and unmet need. This focuses on the use of modern methods by women with a need for family planning. 

The measure includes only modern methods because of their higher level of effectiveness in preventing 

unwanted pregnancies (Fabic et al. 2015). Traditional methods are not included as part of the current 
3

international family planning goal, although they are still used by millions of women worldwide to delay 

or avoid pregnancies. 

1.3. Preference for traditional methods 

Evidence indicates that some women and couples, including those who may be knowledgeable about and 

have access to modern methods, have a distinct preference for traditional methods. They perceive several 

benefits to traditional methods of family planning, such as the methods being always available, free of 

charge, do not require visiting a medical professional, and have no physical side effects (Rogow and 

Horowitz 1995; Kowal 2011). Johnson-Hanks (2002) argues that while some people may believe that 

traditional method users are “not committed to contraception” or are “uninformed about the availability and 

low cost of biomedical contraception,” this is not the case. Her research in southern Cameroon finds that 

users of periodic abstinence have desires to delay pregnancy and are informed about modern methods. The 

reasons given by women for using periodic abstinence are the lack of negative “reproductive, sexual, or 

social” side effects (especially fear of future subfecundity), and the belief that the method is modern and 

honorable because it relies on the “local notions of self-discipline, temporal management, and measured 

self-restraint.” Respondents were reluctant to use methods which “disrupt normal sexual functions,” such 

as condoms, or the pill (because of an associated decrease in sexual desires). Periodic abstinence, however, 

is associated with the identity of a “disciplined, educated, and modern woman” because knowledge of the 

fertile period is necessary to use the method successfully. 

In a follow-up study to the 2014 Ghana Demographic and Health Surveys (GDHS), Staveteig (2016; 2017) 

found that the survey respondents who were asked about their reasons for not using a modern method 

typically gave three times as many reasons for nonuse of modern methods in an extended follow-up 

discussion. The most frequently cited reasons were fear of side effects, religious opposition, personal 

opposition, and opposition from a partner. A number of respondents rejected any future modern method 

use entirely and stated that they would only consider traditional methods or complete abstinence. While 

limited to a single country, the study suggests that opposition to modern methods may be more substantial 

than is apparent from surveys such as DHS. 

1.4. Current use of traditional methods 

The United Nations estimates that 5% of currently married women worldwide use a traditional method of 

family planning in 2017 (United Nations 2016). This compares to 58% of married women who currently 

use a modern method. Regional rates vary from 3% in Oceania, 4% in North America and Africa, 5% in 

Latin America and the Caribbean and Asia, and 9% in Europe. Country level estimates vary even more, 

from less than 1% in 23 countries to over 30% in Albania, Azerbaijan, Bosnia and Herzegovina, Macedonia, 

and Serbia. Traditional methods are most common in Central Africa, Western Asia, and Eastern and 

Southern Europe, where over 10% of women rely on traditional methods. 

In an analysis of surveys from 123 countries, Ross, Keesbury, and Hardee (2015) find that 22% of

contraceptive users practice traditional methods, which is the same level as the most common method—the 

pill (22%). Darroch and Singh (2013) estimate that in 2012, traditional method users were almost equally 

divided between periodic abstinence (47%) and withdrawal (42%).

In 29 Sub-Saharan African countries, Rossier and Corker (2017) find that 4% of women use periodic 

abstinence or withdrawal, while 60% report knowledge of at least one of the methods. Knowledge of 

traditional methods is lower than modern methods across Sub-Saharan Africa, except in Central Africa, the 

region with the most prevalent traditional method use. 

In an examination of the demographics of traditional method users, Ross et al. (2015) finds that globally, 

traditional method use, as a share of the method mix, remains stable across age groups—at around 20% of 
4

methods used. Rossier and Corker’s (2017) analysis of Sub-Saharan African countries shows reliance on 

traditional methods lower at the beginning and end of women’s reproductive ages, and higher in the middle. 

They also find lower use of traditional methods among Muslim women compared with women of other 

religions. Higher use is found among the more highly educated, urban, and wealthier African women. This 

pattern was driven by these women’s higher overall levels of contraceptive use. In an analysis of 15 low 

and middle income countries, Che et al. (2004) find that women who use periodic abstinence are more 

educated and reside in urban areas, compared with users of other methods. 

In many countries, the use of traditional methods has declined since the 1970s as modern methods became 

more available. Globally, the United Nations estimates that traditional method use decreased from 11% of 

married women in 1970 to 5% today. During the same time, 19 countries saw a decline in traditional use 

by over 30 percentage points, and in an additional 20 countries by at least 10 percentage points. Much of 

the decline took place in Europe, where traditional methods of family planning were instrumental in the 

early fertility declines. However, some developing countries, such as Zimbabwe and Togo, have also 

experienced large declines. Seventy-two countries are estimated to have experienced an increase in 

traditional method use between 1970 and 2017, including over a 10 percentage point increase in Bolivia, 

Armenia, Cambodia, and Azerbaijan. 

1.5. Effectiveness of traditional methods 

Withdrawal requires the male partner to anticipate orgasm (Ortayli et al. 2005). For those perfectly 

practicing withdrawal, the probability of pregnancy within 1 year is 4% (based on research with American 

couples). However, many couples do not practice perfect withdrawal. Typical use among American couples 

results in a 22% probability of pregnancy within 1 year, which leads to the classification of withdrawal in 

the bottom tier of contraceptive effectiveness (Kowal 2011). 

A review of the literature about withdrawal (Rogow and Horowitz 1995) highlights the belief among 

individuals and family planning professionals that withdrawal may be an ineffective method because of the 

presence of sperm in pre-ejaculatory fluid. The studies to support this theory are inconsistent (Ilaria et al. 

1992; Zukerman, Orvieto, and Weiss 2003; Pudney et al. 1992; Killick et al. 2011). Jones, Fennell, Higgins, 

and Blanchard (2009) argue that health care providers and educators should discuss withdrawal as a 

legitimate option with clients, especially when used with other methods, such as hormonal and barrier 

methods. 

Periodic abstinence is a fertility awareness based (FAB) method. Some FAB methods, such as the Standard 

Days Method require women to track their cycle to correctly predict ovulation (Arévalo, Jennings, and Sinai 

2002). Because of the scientific research on the effectiveness of Standard Days Method, most organizations 

classify it as a modern method of family planning. Another FAB method, calendar rhythm, involves women 

tracking their cycle for 6 to 12 months before using the method to pinpoint the fertile window (Jennings 

and Burke 2011). In a study of 15 DHS surveys, many women and couples say that they are using the 

rhythm method, although they often have not tracked their cycle beforehand, and are abstaining on the days 

that they believe they are most likely to be fertile (Che, Cleland, and Ali 2004). The study also finds, that 

among periodic abstinence users, correct knowledge of the fertile period varies dramatically, from 8% in 

Zimbabwe to 91% in Kazakhstan; on average 24 of 100 women conceived within a year of using periodic 

abstinence (Che, Cleland, and Ali 2004). While some users of periodic abstinence abstain from sex on days 

most likely to result in conception, other couples use another method (such as a condom or withdrawal) on 

these days (Sheon and Stanton 1989). 

An analysis of 43 countries with DHS surveys finds 13.4 pregnancies within 1 year per 100 women who 

use withdrawal, and 13.9 pregnancies per 100 women who use periodic abstinence ̶ the highest of any 

contraceptive method (Polis et al. 2016). The high rates of unintended pregnancies in women who report 
5

periodic abstinence may result in part from women’s incorrect knowledge of the timing of ovulation. Che 

et al. (2004) found that with correct knowledge, the probability of contraceptive failure fell by 12%. 

By definition, folkloric methods have unproven effectiveness (Rutstein and Rojas 2006) and are excluded 

from much literature about contraception, including Contraceptive Technology (Hatcher, et al. 2011), a 

book now in its 20th edition, which has served as a family planning reference for more than 30 years. 

1.6. Discontinuation of traditional methods 

Studies have documented the high rates of discontinuation of traditional methods in many different settings. 

In an analysis of countries with DHS, Staveteig, Mallick, and Winter (2015) find that of all contraceptive 

methods, traditional and folkloric methods have the highest rate of discontinuation with 28% of women 

discontinuing use in the first year. Of the women who discontinued traditional and folkloric methods in the 

previous 5 years, 28% stated that they discontinued because they became pregnant, while an additional 37% 

stopped using a method because they wanted to become pregnant, and only 11% reported discontinuing in 

order to switch to a more effective method. These findings are consistent with an earlier analysis of DHS 

data that found the same three most common reasons for traditional method discontinuation (Bradley, 

Schwandt, and Khan 2009). 

Research from the United States shows that women begin, end, and change traditional methods quickly. 

Three quarters of women who used withdrawal discontinued within 1 year, although 85% of these women 

were using a contraceptive method again within a year, while the majority began a new method within 1 

month. One third of women who discontinued the use of withdrawal restarted in 1 year (Vaughan et al. 

2008). 

1.7. Underreporting of traditional methods 

A follow-up study to the 2014 Ghana Demographic and Health Survey (GDHS) re-interviewed 129 GDHS 

respondents in three regions. In response to questions about traditional method use, 20% of those classified 

by GDHS as having an unmet need indicated that they were currently using a traditional method of family 

planning (Staveteig 2016; 2017). Among those asked about the discrepancy, all stated that they had 

understood the GDHS question about method use as pertaining to modern methods only and thus did not 

report periodic abstinence or withdrawal. 

In addition, a number of respondents classified as having unmet need reported the use of complete 

abstinence as a method to delay or avoid pregnancy. Abstinence is typically omitted from consideration as 

a method of family planning by surveys such as the GDHS. 

Another study that investigated underreporting of traditional methods was conducted by Rossier, 

Senderowicz, and Soura (2014) in the capital of Burkina Faso, Ouagadougou. The authors included both 

the standard contraceptive use questions from the DHS, which do not prompt women with method names, 

and follow-up questions that specifically asked if women were using the LAM, rhythm, or withdrawal, in

a survey of women conducted by the Health and Demographic Surveillance System of Ouagadougou in 

2010. The reports of modern method use were almost identical to the DHS conducted in Burkina Faso, 

although the reported use of natural methods (LAM, withdrawal, and periodic abstinence) was five times 

greater (26% versus 5%).

The structure of DHS questionnaires may lead to underreporting of traditional methods. For current method 

use, women in DHS surveys are first asked “Are you or your partner currently doing something or using 

any method to delay or avoid getting pregnant?” If a woman answers yes, she is then asked “Which method 

are you using?” Since withdrawal and periodic abstinence are coitus dependent methods, they may not be 

considered when a woman is asked if she is “currently using a method.” The current questions may also 
6

cause underreporting when multiple methods are used. While the interviewer is instructed to record all 

methods, the phrasing of the question asks the interview subject about “method,” and not “methods.” 

Therefore, women who use multiple methods may report what they consider to be the most effective 

method. In DHS surveys that record contraceptive use and reproductive events in a calendar, women are 

asked about each month of the previous 5 years. Dual use of methods (such as periodic abstinence and 

condoms) is not recorded, and interviewers are instructed to record the most effective method (Staveteig, 

Mallick, and Winter 2015).

In addition, a number of respondents classified as having unmet need reported the use of complete 

abstinence as a method to delay or avoid pregnancy. Abstinence is typically omitted from consideration as 

a method of family planning by surveys such as the DHS. 

1.8. Research Questions 

As global family planning dialogue has shifted to focus on modern method users only, contemporary 

literature about family planning—with few exceptions—is largely silent on traditional method use. 

However, understanding traditional method use is important for a number of reasons. First, since traditional 

method users are motivated to use contraception, they may be a key population for targeted efforts to 

increase modern contraceptive use—and, to the extent that they are undercounted by extant surveys, these 

users may be an even larger subpopulation than studies indicate. Hence, understanding the size and 

characteristics of this population is important. Users of periodic abstinence may be easily transitioned to 

the similar but more effective and modern Standard Days Method. Second, understanding the reasons for 

discontinuation and how often women are switching between modern and traditional methods may enable 

further discussion of programmatic interventions to maintain continuity of use. To that end, this report seeks 

to answer several questions about traditional method use in countries with at least five DHS. These 

questions include: 

 What are the levels of traditional (and folkloric) methods used? 

 How has the level of use changed over time? 

 What is the composition of traditional method use, and how often are they used with other 

traditional methods or with modern methods? 

 Who uses traditional methods and how have the sociodemographic characteristics of traditional 

users changed over time? 

 After accounting for failure, do people discontinue using traditional methods more than modern 

methods (switching/stopping) and why do people discontinue use of traditional methods/compared 

with modern methods? 

In this report, we explore levels and trends in the use of traditional methods, multiple traditional methods 

and simultaneous modern and traditional method use, discontinuation and switching, by using nearly three 

decades of DHS data from 16 countries: Bangladesh, Colombia, the Dominican Republic, Egypt, Ghana, 

Indonesia, Jordan, Kenya, Malawi, Peru, the Philippines, Rwanda, Senegal, Tanzania, Zambia, and 

Zimbabwe.
7

2. Data and Methods 

The data for this study come from 16 countries that have completed at least five DHS for which the data 

were publicly available by April 2017. The rationale for using five surveys from each country is to assess 

trends over a long-term period. The countries that qualified for the analysis include three from Asia, 

(Bangladesh, Indonesia, and the Philippines); two from the Middle East and North Africa (Egypt and 

Jordan); three from Latin America and the Caribbean (Colombia, Dominican Republic, and Peru); and eight 

from Sub-Saharan Africa (Ghana, Kenya, Malawi, Rwanda, Senegal, Tanzania, Zambia, and Zimbabwe).

We use the data on individual women and the contraceptive calendar data for this report. Analyses of trends 

in current contraceptive use of modern and traditional methods use are based on data from individual 

women in each country, while the data from the contraceptive calendar are used to calculate discontinuation 

and switching rates. 

In standard DHS surveys, women who are not pregnant at the time of the survey—and in older surveys, 

women who have never been sterilized1 — are typically asked, “Are you currently doing something or 

using any method to delay or avoid getting pregnant?” Respondents who give a positive answer are then 

asked, “Which method are you using?” In some older DHS surveys, respondents were instead asked “What 

was the last method you used?” The DHS questionnaire includes a standard list of contraceptive methods 

(typically arranged in order of effectiveness) and an “other method” category. In addition, each country that 

conducts a DHS survey is encouraged to add any country specific methods that are commonly known or 

used in their country. With women who report use of more than one method at the time of the survey, the 

composite method use variable tabulated in the DHS surveys and provided in the DHS datasets reflects 

only the most effective method. In recent DHS surveys in which women were allowed to name more than 

one method of contraception, an inventory of yes/no use for each method is typically included in the 

published DHS datasets. 

We use data from the contraceptive calendar to calculate discontinuation and switching rates. The 

contraceptive calendar records monthly retrospective information on episodes of live births, pregnancies, 

and terminations; contraceptive use or non-use; and the reason for discontinuation if the respondent reported 

interruptions of a method use. The format of the contraceptive calendar allows only one reason for 

discontinuation. Collection of the contraceptive calendar data has varied over the survey phases. Since the 

early rounds of the DHS included countries with high contraceptive prevalence only, earlier surveys 

conducted in most Sub-Saharan African countries and others with low contraceptive prevalence did not 

collect calendar data. In addition, some countries adapted the calendar to collect only births, pregnancies, 

and terminations, and to exclude episodes of contraceptive use.2

 For this reason, not all countries have 

complete calendar data for the five surveys in this analysis. 

For the purpose of this study, contraceptive methods are categorized into two broad categories, modern and 

traditional family planning methods, as follows: 

 Modern methods: IUDs, implants; pills, injectables, condoms (male or female), Lactational 

Amenorrhea Method (LAM), vaginal barrier methods and spermicides, the contraceptive patch, the 

vaginal ring, sterilization (male or female), emergency contraception, basal body temperature, 

 

1

 In more recent DHS surveys, women are asked about current method use immediately after the contraceptive 

knowledge inventory. In older DHS surveys, women were first asked if they had ever used contraception and if so, 

which methods. Anyone who had ever been sterilized was not asked the current method question. Consult individual 

DHS survey reports for the precise ordering and wording of questions in that survey. 

2

 In some countries, between approximately 2004 and 2009, the DHS core questionnaire did not include information 

on the reasons for discontinuing use in the contraceptive calendar. 
8

Billings ovulation, the symptothermal method, Standard Days Methods, and other modern methods 

such as diaphragms, cervical caps, and suppositories3

 Traditional methods: periodic abstinence (the rhythm method), withdrawal (coitus interruptus), 

prolonged breastfeeding, herbs, massage, other folkloric methods, and any other method not 

specifically classified as modern 

The analysis includes only currently married women age 15-49. Table 2.1 shows the number of all women 

interviewed for the survey, currently married women age 15-49, contraceptive prevalence (any method) 

among married women, and demand for family planning satisfied by modern methods. Since two countries 

(Peru since 2004 and Senegal since 2012) are conducting continuous DHS surveys every year, individual 

data files were appended into up to 3-year ranges. 

 

3

 “Other modern methods” is a category available for interviewers to select in most DHS surveys. Prior to the 

survey, interviewers are instructed on which methods may be included in the category. However, the full list may 

not be available to analysts. 
9

Table 2.1. Percentage of married women using any method of contraception and 

women using any traditional or folkloric method, unweighted number of currently 

married women age 15-49, by country and DHS survey year

Country

DHS

Survey year

Married 

women 

currently 

using any 

method of 

contraception 

(%)1

Married 

women 

currently 

using any 

traditional or 

folk method of 

contraception 

(%)

Demand for 

family 

planning 

satisfied by 

modern 

methods (%)1

Currently 

married 

women 

age 15-49 

Bangladesh

1999/2000 54.3 10.3 60.6 9,530

2004 58.5 10.8 64.8 10,417

2007 55.8 8.3 65.4 10,146

2011 61.2 9.2 69.7 16,616

2014 62.4 8.4 72.6 16,830

Indonesia

1994 54.7 2.7 74.3 26,220

1997 57.4 2.7 77.1 26,833

2002/03 60.3 3.6 77.1 27,784

2007 61.4 4.0 77.0 30,869

2012 61.9 4.0 79.0 32,706

The Philippines

1993 40.0 15.1 35.4 9,145

1998 47.8 19.6 39.0 8,634

2003 48.9 15.5 46.7 8,764

2008 50.7 16.7 46.8 8,564

2013 55.1 17.5 51.8 9,866

Jordan

1990 40.0 13.1 40.4 6,181

1997 52.6 14.9 51.9 5,340

2002 55.8 14.6 58.3 5,727

2007 57.1 15.2 59.1 10,360

2012 61.2 17.3 58.0 10,746

Egypt

1995 47.9 2.4 66.8 13,718

2000 56.1 2.2 77.2 14,393

2005 59.2 2.7 79.0 18,134

2008 60.3 2.7 80.1 15,406

2014 58.5 1.6 80.0 20,430

Colombia

1990 66.1 11.5 68.4 4,542

1995 72.2 12.9 71.0 6,131

2000 76.9 12.9 73.6 6,026

2005 78.2 10.0 78.5 20,087

2010 79.1 6.1 83.8 27,346

Continued...
10

Table 2.1—Continued

Country

DHS 

Survey year

Married 

women 

currently 

using any 

method of 

contraception 

(%)1

Married 

women 

currently 

using any 

traditional or 

folk method of 

contraception 

(%)

Demand for 

family 

planning 

satisfied by 

modern 

methods (%)1

Currently 

married 

women 

age 15-49

Dominican Republic

1991 56.4 4.7 68.2 4,226

1996 63.7 4.4 76.3 5,171

2002 69.8 4.0 80.1 14,504

2007 72.9 2.8 83.3 15,872

2013 71.9 3.2 83.0 5,219

Peru

1996 64.2 22.9 50.5 17,830

2000 68.9 18.5 60.6 16,518

2004/06 71.3 23.7 57.0 10,919

2009 73.2 23.6 59.4 13,420

2012 75.5 23.2 61.1 14,235

Ghana

1993 20.3 10.1 17.7 3,204

1998 22.0 8.7 23.5 3,229

2003 25.2 6.5 31.3 3,694

2008 23.5 6.9 28.0 2,950

2014 26.7 4.5 39.2 5,456

Kenya

1993 32.7 5.5 40.1 7,540

1998 39.0 7.5 47.0 7,881

2003 39.3 7.8 47.3 8,195

2008/09 45.5 6.0 55.5 8,444

2014 58.0 4.8 70.7 31,079

Malawi

1992 13.0 5.6 14.9 4,849

2000 30.6 4.5 43.1 13,220

2004/05 32.5 4.3 44.8 11,698

2010 46.1 3.9 58.4 23,020

2015/16 59.2 1.1 74.6 24,562

Rwanda

1992 21.2 8.3 21.7 3,698

2000 13.2 7.6 11.4 4,891

2005 17.4 7.1 18.4 5,458

2010/11 51.6 6.4 62.4 6,834

2014/15 53.2 5.8 65.8 6,890

Senegal

1992/93 7.5 2.7 13.2 4,450

1997 12.9 4.8 16.9 6,030

2005 11.8 1.5 23.5 10,221

2010/11 13.1 1.0 28.0 10,804

2015 22.2 2.2 42.6 6,048

Continued...
11

Table 2.1—Continued

Country

DHS

Survey year

Married 

women 

currently 

using any 

method of 

contraception 

(%)1

Married 

women 

currently 

using any 

traditional or 

folk method of 

contraception 

(%)

Demand for 

family 

planning 

satisfied by 

modern 

methods (%)1

Currently 

married 

women 

age 15-49

Tanzania

1996 18.4 5.1 30.0 5,404

1999 25.4 8.5 39.3 2,608

2004/05 26.4 6.4 39.5 6,786

2010/11 34.4 7.0 48.3 6,310

2015/16 38.4 6.4 52.9 8,189

Zambia

1992 15.2 6.3 19.6 4,467

1996 25.9 11.5 28.1 4,949

2001/02 34.2 8.9 41.0 4,731

2007 40.8 8.1 48.5 4,316

2013/14 49.0 4.3 63.8 9,649

Zimbabwe

1994 48.1 6.0 62.7 3,777

1999 53.5 3.2 71.6 3,553

2005/06 60.2 1.8 77.2 5,118

2010/11 58.5 1.3 78.3 5,578

2015 66.8 1.0 85.2 6,015

1 Source: Statcompiler. http://dhsprogram.com/data/STATcompiler.cfm

We examine levels and trends in modern and traditional method use across different sociodemographic 

factors—age, educational attainment, residence, wealth status, parity, and fertility intentions—for each 

country in the study. In addition, 1-year (12-month) discontinuation rates and switching rates were 

calculated with the competing risk approach, which is analogous to multiple-decrement lifetable (where 

contraceptive failure is considered as the attrition factor). To avoid the bias that might be introduced by an 

unrecognized pregnancy, the analysis begins 3 months prior to the date of interview and thus extends back 

to 62 months prior to the interview date. Stata 14 is used to estimate the rates using the stcompet command 

by Coviello and Boggess (2004). Discontinuation rates are presented for traditional and modern methods. 

Rates for a method are not shown if there were fewer than 125 episodes of contraceptive use for that method. 

We used individual level sampling weights to produce nationally representative results within each country. 

This report also includes case studies on four countries, which were selected by trends in contraceptive use. 

These include maintaining high levels of traditional methods (Peru), maintaining low levels of traditional 

methods (Indonesia), increasing traditional use (Jordan), and decreasing traditional use (Ghana). For each 

country, we focus on an early and most recent survey. We examine changes in the contraceptive method 

mix and use with a series of binary logistic regressions to investigate the changing importance of different 

sociodemographic characteristics in use of any method (modern or traditional), use of traditional versus 

modern methods (among contraceptive users), and use of withdrawal versus periodic abstinence (among 

traditional method users). The sociodemographic characteristics of interest include age, fertility intentions, 

parity, education, and residence. Results are presented as adjusted odds ratios and 95% confidence intervals. 

13

3. Levels and Trends in Traditional Method Use 

3.1 Traditional Method Use 

The results presented below provide levels and trends for traditional and folk method use among married 

women age 15-49, by country. Figure 3.1 shows that traditional method use declined in seven of the eight 

countries from Sub-Saharan Africa. A study using DHS surveys from Sub-Saharan Africa reported that the 

highest levels of traditional family planning use are observed in middle Africa (Rossier and Corker 2017). 

However, countries with fewer than five DHS surveys are excluded from this report. In the analysis of data 

from the central African countries with at least two DHS (but less than five), the sub-region appears, along 

with other regions in Sub-Saharan Africa, to have experienced declines in traditional use. Traditional 

method use has nearly decreased by half in Gabon between their first and most recent surveys (21% to

12%). Cameroon, Congo, and the Democratic Republic of Congo have also seen declines (from 12% to 9% 

in Cameroon, 32% to 25% in Congo, and 15% to 13% in the Democratic Republic of Congo). 

Figure 3.1. Trends in traditional method use in Sub-Saharan Africa 

The remaining eight countries in this report (Figure 3.2) are from Asia (Bangladesh, Indonesia, and the 

Philippines), Latin America (Colombia, Dominican Republic, and Peru), and the Middle East and North 

Africa (Jordan and Egypt). Within these regions, there are considerable variation in levels and trends of 

traditional method use. 

0

5

10

15

20

25

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Ghana Kenya Malawi Rwanda

Senegal Tanzania Zambia Zimbabwe
14

Figure 3.2. Trends in traditional method use in Asia, the Middle East and North Africa, Latin 

America, and the Caribbean 

Overall, 11 of the 16 countries saw decreases in traditional method use between the 1990s and the most 

recent survey. The largest declines occurred in Ghana, Colombia, Zimbabwe, and Malawi, where traditional 

method use fell by over 4 percentage points. In Ghana in 1993, traditional methods were as popular as 

modern methods (10% each). By 2014, modern method use nearly doubled to 22%. In other countries, the 

decline in traditional methods was associated with a corresponding rise in the popularity in modern 

methods. For example, Malawi’s modern contraceptive prevalence rate (mCPR) increased from 7% to 58% 

over the period, while Zimbabwe saw an increase in modern method use from 42% to 66%, and Colombia 

from 55% to 76%. 

Three countries in the report have more than 10% of women who report use of traditional or folkloric 

methods in their most recent survey: Jordan (19%), Peru (24%), and the Philippines (18%). These countries 

have all experienced an increase in traditional method use, ranging from less than 1 percentage point in 

Peru to over 5 percentage points in Jordan, while at the same time, all three countries saw modern method 

use grow by more than 10 percentage points. 

Popularity of specific traditional methods varies by country and over time. In 1990, Jordanian women were 

equally likely to report the use of periodic abstinence and withdrawal. More recently, withdrawal increased 

in popularity, while periodic abstinence use remained relatively unchanged. In the most recent survey 

(2012), three times as many women report using withdrawal (13%) compared with periodic abstinence 

(4%). In Peru, periodic abstinence is more popular than withdrawal (15% versus 8% in the 2012 survey)—

although the percentage of women reporting withdrawal has more than doubled from the first to most recent 

DHS survey, while periodic absence has decreased. In almost all countries, folk methods are much less 

common than traditional methods. The one exception is Senegal, which has low use of both traditional and 

folk methods. In most surveys, across country and time, use of folk methods is reported by less than 1% of 

the adult female population. 

0

5

10

15

20

25

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Bangladesh Colombia Dominican Republic Egypt

Indonesia Jordan Peru Philippines
15

3.1.1 Method mix

Figures 3.3 and 3.4 present the distribution of currently married women age 15-49 who did not use any 

family planning method and current users of any modern and traditional family planning methods in five 

DHS surveys in the 16 countries in this report. Overall, the use of modern methods increased substantially 

over time in all countries. In seven of the eight countries from Asia, the Middle East, and Latin America, 

the most recent DHS surveys showed that more than 50% of women used modern contraceptives, whereas 

only three of the eight countries in Sub-Saharan Africa (Kenya, Malawi, and Zimbabwe) achieved a 

comparable level of use. 

Trends in traditional family planning use by specific method (periodic abstinence, withdrawal, and folkloric 

methods) are inconsistent. Decline in the use of periodic abstinence was reported in seven countries (Ghana, 

Kenya, Malawi, the Philippines, Colombia, Peru, and Dominican Republic). In Ghana, for example, use of 

periodic abstinence declined from 8% in 1993/94 to 3% in 2015, while in Colombia, it decreased from 6% 

to 2%, and in Peru from 19% in 1996 to 15% in 2012. In contrast, women in Tanzania increased their use 

of periodic abstinence from 2% in 1996 to 4% in 2015/16. 

The use of withdrawal increased in the Philippines from 7% in 1993 to 12% in 2013, by more than 3 times 

in Jordan—from 4% in 1990 to 14% in 2012, and more than doubled in Peru (3% in 1996 to 8% in 2012). 

A decline in use of withdrawal was observed in Bangladesh (from 4% to 2%) and Colombia (from 5% to 

3%).

Examination of the traditional family planning method mix shows that in six countries (Dominican 

Republic, Ghana, Kenya, Rwanda, and Peru), the proportion of currently married women who use periodic 

abstinence is somewhat greater than that of withdrawal. In Jordan, the Philippines, Zambia, and Zimbabwe, 

more women practice withdrawal compared with periodic abstinence. 

Overall, traditional methods represented a much smaller proportion of the method mix. However, only in 

three (Peru, the Philippines, and Jordan) of the 16 countries in the analysis, traditional methods had above 

10% users. The highest proportion of traditional family planning users were in Peru (between 19% and 

24%), followed by the Philippines (between 15% and 20%), and Jordan (ranging between 13% and 19%). 

In Bangladesh, the Philippines, and Peru, users were shifting from periodic abstinence to withdrawal, with 

a decrease in one method balanced by an increase in the other. (See Appendix 1 for details.) 
16

Figure 3.3. Percentage of currently married women not using any family planning method and 

method-mix of those using any modern, traditional, and folkloric family planning methods in SubSaharan Africa 

Kenya 

Rwanda 

Malawi 

Tanzania 

Zambia Zimbabwe 

Ghana Senegal 

Note: In some countries the percentage of traditional method users (withdrawal, periodic abstinence, and folkloric) is too small to label the pertinent 

bars in the graph.

67.3 61.0 60.7 54.5

42.0

27.3 31.5 31.5 39.4 53.2

0

10

20

30

40

50

60

70

80

90

100

1993 1998 2003 2008/09 2014

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

78.8 86.8 82.6

48.4 46.8

12.9 5.7 10.3

45.2 47.5

0

10

20

30

40

50

60

70

80

90

100

1992 2000 2005 2010/11 2014/15

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

87.0

69.4 67.5

53.9

40.8

7.4

26.1 28.2

42.2 58.1

0

10

20

30

40

50

60

70

80

90

100

1992 2000 2004/05 2010 2015/16

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

81.6 74.6 73.6 65.7 61.6

13.3 18.7 20.0 27.4 32.0

0

10

20

30

40

50

60

70

80

90

100

1996 1999 2004/05 2010/11 201/16

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

85.0 74.1 65.8 59.2 51.0

8.9

14.4 25.3 32.7 44.8

0

10

20

30

40

50

60

70

80

90

100

1992 1996/97 2001/02 2007 2013/14

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

51.9 46.5 39.8 41.5 33.2

42.2 50.4 58.4 57.3 65.8

0

10

20

30

40

50

60

70

80

90

100

1994 1999 2005/06 2010/11 2015

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

79.7 78.0 74.8 76.5 73.3

10.1 13.3 18.7 16.6 22.2

0

10

20

30

40

50

60

70

80

90

100

1993 1998 2003 2008 2014

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

92.5 87.1 88.2 86.9 76.7

4.8 8.1 10.3 12.1

21.2

0

10

20

30

40

50

60

70

80

90

100

1992/93 1997 2005 2010/11 2015/16

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any

modern

Not using
17

Figure 3.4. Percentage of currently married women not using any family planning method and 

method-mix of those using any modern, traditional, and folkloric family planning methods in Asia, 

Middle East and North Africa, and Latin America, and the Caribbean 

Bangladesh Indonesia 

Philippines Colombia 

Dominican Republic Peru 

Egypt Jordan 

Note: In some countries the percentage of traditional method users (withdrawal, periodic abstinence, and folkloric) is too small to label the pertinent 

bars in the graph.

46.2 41.9 44.2 38.8 37.6

43.5 47.3 47.5 52.1 54.1

0

10

20

30

40

50

60

70

80

90

100

1999/2000 2004 2007 2011 2014

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

45.3 42.6 39.7 38.6 38.1

52.1 54.7 56.7 57.4 57.9

0

10

20

30

40

50

60

70

80

90

100

1994 1997 2002/03 2007 2012

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

60.0 52.2 51.1 49.3 44.9

24.9 28.2 33.4 34.1 37.6

0

10

20

30

40

50

60

70

80

90

100

1993 1998 2003 2008 2013

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

7.4 8.9 8.2 9.8 12.1

33.9 27.8 23.1 21.9 21.0

54.6 59.3 64.0 68.1 72.9

0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

43.6 36.3 30.2 27.1 28.2

51.7 59.5 65.8 70.0 68.6

0

10

20

30

40

50

60

70

80

90

100

1991 1996 2002 2007 2013

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

35.8 31.1 28.6 26.8 24.5

41.4 50.4 47.4 50.0 51.8

0

10

20

30

40

50

60

70

80

90

100

1996 2000 2004/06 2009 2012

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

18.0 14.4 18.3 15.6 15.1

52.1 43.9 40.8 39.7 44.6

45.5 53.9 56.5 57.6 53.6

0

10

20

30

40

50

60

70

80

90

100

1995/96 2000 2005 2008 2014

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

60,1

47,4 44,2 43,0 38,8

26,9

37,7 41,2 42,1 42,3

0

10

20

30

40

50

60

70

80

90

100

1990 1997 2002 2007 2012

Percent

Survey Year

Folkloric

Withdrawal

Periodic

Abstinence

Any modern

Not using

4.0 7.6 9.3 10.8 14.3
18

3.2 Multiple Method Use 

To examine the use of multiple traditional methods and simultaneous modern and traditional method use, 

we classified married current traditional method users age 15-49 into three groups based on their itemspecific use: users of a single traditional method, users of multiple traditional methods, and simultaneous 

users of traditional and modern methods. In 28 early DHS surveys, only a single family planning method 

was recorded because respondents were typically asked only about the last method used. In ten additional 

surveys, there were internal discrepancies between item-specific method inventories and the composite 

contraceptive use variable. These surveys were excluded from this analysis. Thus, our estimates of multiple 

traditional method use and dual modern-traditional use are limited to 42 of 80 surveys. The results of this 

analysis are shown in Figure 3.5. As shown, except in Malawi in 2000 and to some extent in the Philippines 

2008, the vast majority of traditional method use reported in the composite method use variable reflects a 

single traditional method. In Malawi 2000, multiple traditional method use nearly always involved 

withdrawal and strings and in the Philippines 2008, a combination of periodic abstinence and withdrawal. 

The level of simultaneous traditional and modern method use among married women ages 15-49 is shown 

by the red bar in Figure 3.5. The extent of dual modern-traditional use ranges from 0% in Egypt 20004 to 

2% in Philippines 2008 and 2013. In the Philippines 2008 and 2013 surveys, dual modern-traditional use 

was typically withdrawal and either pills or condoms. The median value of dual modern-traditional use is 

two-tenths of one percent. These respondents are excluded from all other analyses of traditional method use 

in this report because they are classified as users of their more effective (modern) method. 

 

4

 Although the Egypt DHS 2000 questionnaire allows the interviewer to record multiple family planning methods, 

only one respondent is coded as using more than one method (both modern). 
19

Figure 3.5. Percent of currently married women age 15-49 using multiple traditional methods and 

simultaneous modern and traditional method 

3.3. Levels and trends of traditional contraceptive use by sociodemographic factors 

3.3.1 Age 

As shown in Table 3.1, traditional use in 13 of the 16 countries is most popular among women over age 35. 

Three patterns emerge from the relationship between age and traditional method use across surveys. The 

first are countries (Bangladesh, Indonesia, Peru and Tanzania) where the level of traditional use by age 

changes little over time. Most age groups in Jordan also follow this pattern. Although a slight rise occurs 

in most age groups between the last two surveys, a decline occurred among married women age 15-19, 

which separated them from the other age groups. 

In Senegal and Zambia, changes occur between surveys, although age groups tend to move similarly. In 

Senegal, traditional use among all ages rises between survey one and two, then decreases by survey three. 

Similar changes occur in Zambia. 

Finally, early surveys in many countries show large disparities in traditional method use by age group, 

although these gaps decrease with time. Colombia, Dominican Republic, Egypt, Malawi, Philippines, and 

Zimbabwe all have more similar levels of traditional use among the different ages in the more recent 

surveys. 
20

Table 3.1. Percentage of currently married women who used traditional methods (with 95% confidence inte

age and survey year, 16 countries with at least five DHS

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country Age % 95% CI % 95% CI % 95% CI % 95% CI 

Bangladesh

15-19 6.9 [5.6, 8.5] 8.1 [6.7, 9.8] 4.3 [3.2, 5.6] 4.7 [3.8, 5.9] 4

20-24 7.0 [5.7, 8.5] 6.2 [5.0, 7.5] 4.9 [4.0, 6.1] 4.5 [3.8, 5.4] 4

25-29 9.0 [7.6, 10.7] 7.0 [5.8, 8.5] 5.6 [4.5, 6.9] 5.8 [5.0, 6.8] 5

30-34 11.1 [9.5, 13.0] 12.1 [10.4, 14.0] 8.7 [7.2, 10.4] 9.8 [8.6, 11.1] 9

35-39 13.9 [11.7, 16.4] 15.2 [13.3, 17.4] 14.2 [12.1, 16.6] 14.8 [13.1, 16.7] 12

40-44 18.3 [15.8, 21.2] 20.9 [18.2, 23.9] 15.0 [12.8, 17.6] 17.7 [15.8, 19.8] 15

45-49 11.5 [9.2, 14.2] 15.1 [12.6, 18.0] 10.7 [8.4, 13.5] 12.8 [10.9, 14.9] 13

Indonesia

15-19 0.8 [0.3, 2.2] 0.2 [0.1, 0.5] 0.5 [0.2, 1.6] 0.7 [0.3, 1.4] 0

20-24 1.5 [1.1, 2.1] 1.3 [0.9, 1.9] 1.8 [1.2, 2.8] 1.6 [1.1, 2.2] 1

25-29 1.8 [1.4, 2.3] 2.1 [1.6, 2.8] 2.3 [1.7, 3.0] 3.3 [2.7, 4.1] 3

30-34 3.4 [2.8, 4.2] 3.3 [2.7, 4.1] 3.7 [3.0, 4.7] 4.4 [3.6, 5.3] 3

35-39 3.5 [2.9, 4.3] 3.6 [2.9, 4.5] 5.0 [4.0, 6.2] 5.5 [4.7, 6.5] 5

40-44 3.9 [3.1, 4.8] 3.5 [2.8, 4.5] 5.6 [4.5, 6.9] 5.0 [4.2, 6.0] 5

45-49 2.8 [2.1, 3.7] 3.0 [2.3, 3.8] 3.8 [2.8, 5.0] 3.9 [3.1, 4.8] 4

The Philippines

15-19 7.6 [4.7, 11.8] 10.4 [7, 15.2] 12.3 [8.6, 17.5] 11.6 [8.2, 16] 15

20-24 12.9 [11, 15.2] 16.3 [13.8, 19.2] 12.6 [10.5, 15] 13.8 [11.6, 16.2] 16

25-29 15.6 [13.9, 17.4] 21.5 [19.4, 23.9] 16.1 [14.2, 18.2] 15.7 [13.9, 17.7] 16

30-34 16.7 [15, 18.6] 20.3 [18.4, 22.4] 15.4 [13.7, 17.3] 18.6 [16.7, 20.8] 17

35-39 18.8 [16.9, 20.9] 23.7 [21.4, 26.2] 18.0 [16.1, 20.1] 17.5 [15.6, 19.7] 18

40-44 16.2 [14.2, 18.3] 20.4 [18, 23.1] 18.4 [16.2, 20.8] 20.3 [17.9, 23] 19

45-49 7.9 [6.3, 9.8] 12.8 [10.8, 15.2] 11.4 [9.5, 13.6] 14.0 [11.8, 16.5] 16

Colombia

15-19 5.0 [2.5, 9.7] 14.0 [10.3, 18.8] 12.2 [9.1, 16.0] 10.0 [7.8, 12.8] 5

20-24 8.3 [6.3, 11.0] 13.2 [11.1, 15.7] 12.3 [10.1, 14.9] 10.5 [9.1, 12.0] 5

25-29 10.1 [7.8, 13.1] 13.4 [11.5, 15.5] 13.5 [11.4, 15.9] 10.5 [9.2, 11.9] 5

30-34 11.7 [9.3, 14.6] 13.0 [11.0, 15.3] 10.8 [9.0, 13.0] 9.4 [8.2, 10.7] 5

35-39 13.9 [10.7, 17.8] 13.1 [11.1, 15.4] 13.7 [11.5, 16.3] 10.1 [8.9, 11.4] 5

40-44 14.9 [10.7, 20.5] 13.1 [10.6, 16.0] 14.7 [12.3, 17.5] 9.8 [8.5, 11.4] 7

45-49 13.8 [9.6, 19.3] 10.1 [7.9, 12.8] 13.0 [10.6, 15.8] 10.1 [8.6, 11.8] 6
21

Table 3.1—Continued

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country Age % 95% CI % 95% CI % 95% CI % 95% CI 

Dominican Republic

15-19 4.0 [1.8, 9.1] 6.1 [4.0, 9.3] 3.9 [2.6, 5.9] 2.0 [1.2, 3.3] 2

20-24 6.7 [4.6, 9.5] 6.9 [5.1, 9.1] 5.7 [4.6, 7.1] 4.1 [2.9, 5.8] 4

25-29 4.8 [3.1, 7.3] 4.2 [2.9, 6.0] 5.0 [4.0, 6.3] 4.2 [3.1, 5.8] 4

30-34 6.4 [4.3, 9.5] 5.9 [4.4, 7.9] 4.0 [3.0, 5.4] 2.5 [1.7, 3.5] 3

35-39 4.2 [2.4, 7.2] 2.7 [1.6, 4.4] 3.4 [2.6, 4.6] 2.9 [1.9, 4.3] 2

40-44 1.4 [0.6, 2.9] 2.5 [1.4, 4.4] 2.8 [1.8, 4.4] 2.4 [1.6, 3.7] 2

45-49 1.8 [0.7, 4.8] 1.3 [0.5, 3.4] 1.9 [1.1, 3.2] 1.0 [0.5, 1.7] 2

Peru

15-19 15.0 [12.2, 18.3] 11.6 [9, 14.7] 15.0 [11.2, 19.9] 17.5 [13.9, 21.7] 16

20-24 18.5 [16.7, 20.4] 13.6 [12, 15.5] 19.0 [16.5, 21.7] 17.5 [15.3, 19.9] 20

25-29 21.5 [19.7, 23.4] 16.5 [14.8, 18.3] 23.2 [20.7, 25.9] 22.3 [20.1, 24.6] 22

30-34 23.8 [21.9, 25.7] 18.6 [17, 20.3] 26.0 [23.6, 28.7] 23.3 [21.1, 25.6] 25

35-39 26.6 [24.7, 28.6] 20.5 [18.6, 22.6] 27.4 [24.8, 30.2] 24.8 [22.7, 27.1] 25

40-44 28.9 [26.5, 31.4] 23.8 [21.7, 26] 26.4 [23.7, 29.3] 29.5 [26.9, 32.2] 28

45-49 18.9 [16.7, 21.4] 18.0 [15.9, 20.4] 18.8 [16.4, 21.5] 20.9 [18.6, 23.4] 19

Jordan

15-19 8.4 [5.5, 12.7] 6.7 [3.9, 11.1] 7.9 [4.0, 15.0] 9.3 [4.6, 17.9] 5

20-24 11.7 [10.0, 13.8] 12.9 [10.6, 15.6] 14.1 [11.4, 17.4] 11.4 [8.8, 14.6] 16

25-29 13.7 [11.8, 16.0] 17.0 [14.8, 19.4] 14.0 [11.9, 16.5] 14.2 [12.1, 16.7] 20

30-34 15.1 [12.9, 17.7] 14.7 [12.7, 17.0] 13.6 [11.4, 16.1] 15.7 [13.5, 18.2] 19

35-39 14.5 [12.3, 17.0] 15.7 [13.2, 18.4] 15.2 [12.8, 17.9] 16.2 [13.9, 18.8] 20

40-44 14.5 [11.9, 17.6] 15.2 [12.8, 18.1] 16.6 [13.8, 19.9] 19.1 [16.2, 22.4] 19

45-49 9.5 [7.3, 12.1] 15.2 [12.1, 18.8] 16.2 [12.9, 20.1] 13.1 [10.4, 16.4] 17

Egypt

15-19 0.3 [0.0, 1.3] 1.4 [0.7, 2.9] 2.2 [1.2, 4.0] 3.7 [2.3, 5.7] 1

20-24 2.3 [1.6, 3.2] 2.1 [1.5, 3.0] 3.4 [2.7, 4.3] 3.8 [3.1, 4.6] 1

25-29 1.9 [1.3, 2.7] 2.5 [2.0, 3.3] 3.1 [2.4, 3.8] 3.5 [2.8, 4.3] 1

30-34 1.9 [1.4, 2.6] 2.6 [1.9, 3.5] 2.6 [2.0, 3.4] 2.7 [2.1, 3.5] 1

35-39 2.4 [1.8, 3.2] 1.9 [1.4, 2.5] 2.2 [1.6, 2.9] 1.9 [1.4, 2.5] 1

40-44 4.0 [3.0, 5.4] 2.0 [1.4, 2.9] 2.5 [1.8, 3.4] 1.9 [1.3, 2.6] 1

45-49 2.9 [2.0, 4.2] 2.0 [1.4, 3.0] 2.5 [1.8, 3.5] 1.4 [0.9, 2.2] 1
22

Table 3.1—Continued

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country Age % 95% CI % 95% CI % 95% CI % 95% CI 

Ghana

15-19 5.0 [2.5, 9.7] 6.6 [3.2, 13.2] 1.6 [0.4, 5.3] 6.0 [2.2, 15.5] 1

20-24 9.5 [7.2, 12.3] 9.2 [6.9, 12.1] 6.0 [4.1, 8.6] 5.1 [3.2, 8.0] 4

25-29 11.0 [8.6, 14.0] 9.6 [7.4, 12.5] 7.1 [5.2, 9.5] 8.8 [6.5, 11.9] 3

30-34 9.9 [7.7, 12.5] 10.9 [8.4, 14.1] 7.4 [5.5, 9.9] 6.0 [4.2, 8.6] 4

35-39 12.1 [9.4, 15.4] 8.7 [6.4, 11.8] 7.2 [5.3, 9.8] 7.1 [4.9, 10.1] 5

40-44 11.8 [8.6, 15.8] 6.1 [3.9, 9.7] 7.1 [4.9, 10.2] 8.6 [5.8, 12.5] 5

45-49 7.5 [4.8, 11.6] 5.6 [3.5, 9.0] 4.5 [2.7, 7.2] 5.4 [3.3, 8.7] 2

Kenya

15-19 4.1 [2.1, 8.0] 7.9 [5.0, 12.3] 3.7 [2.0, 6.7] 2.9 [1.2, 6.8] 3

20-24 5.3 [3.7, 7.5] 6.4 [4.9, 8.5] 5.4 [4.1, 7.2] 5.2 [3.7, 7.3] 3

25-29 5.7 [4.2, 7.7] 8.0 [6.2, 10.2] 8.0 [6.3, 10.2] 4.0 [2.6, 6.1] 3

30-34 6.5 [4.8, 8.8] 9.7 [7.7, 12.1] 8.4 [6.6, 10.6] 6.0 [4.1, 8.7] 4

35-39 4.3 [2.8, 6.5] 6.8 [5.0, 9.2] 10.4 [7.8, 13.6] 10.0 [6.4, 15.2] 5

40-44 5.5 [3.6, 8.3] 7.8 [5.4, 11.1] 7.0 [4.9, 9.9] 5.9 [3.5, 9.8] 6

45-49 5.5 [3.3, 9.0] 5.0 [2.9, 8.4] 11.7 [8.2, 16.4] 8.0 [4.6, 13.4] 8

Malawi

15-19 3.9 [2.3, 6.7] 2.3 [1.4, 3.6] 2.3 [1.4, 3.9] 2.4 [1.5, 3.8] 0

20-24 6.7 [4.8, 9.3] 3.6 [2.9, 4.5] 3.7 [2.9, 4.8] 3.8 [3, 4.9] 0

25-29 6.4 [4.7, 8.6] 4.7 [3.7, 6] 4.6 [3.5, 6] 2.8 [2.1, 3.6] 0

30-34 8.0 [5.9, 10.6] 5.5 [4.1, 7.4] 3.9 [2.9, 5.4] 4.3 [3.5, 5.3] 1

35-39 5.0 [3.3, 7.6] 5.2 [4, 6.6] 4.8 [3.6, 6.5] 4.4 [3.5, 5.6] 2

40-44 3.9 [2.2, 6.7] 6.0 [4.4, 8.2] 6.2 [4.4, 8.7] 5.4 [4.2, 7] 1

45-49 2.1 [0.8, 5] 5.3 [3.8, 7.2] 6.3 [4.2, 9.4] 5.2 [3.9, 7] 1

Rwanda

15-19 3.7 [1.4, 9.6] 3.5 [1.5, 8] 50.0 [, ] 2.2 [0.6, 8.6] 2

20-24 7.0 [5, 9.6] 5.5 [4.2, 7.3] 5.1 [3.7, 6.8] 2.4 [1.6, 3.6] 3

25-29 6.3 [4.6, 8.6] 7.4 [6, 9.2] 6.5 [5, 8.2] 4.5 [3.5, 5.6] 3

30-34 9.1 [7.1, 11.5] 7.9 [6.2, 9.9] 7.7 [6.1, 9.5] 6.1 [4.9, 7.6] 3

35-39 7.1 [5.3, 9.4] 7.7 [5.8, 10] 7.3 [5.6, 9.5] 6.8 [5.4, 8.6] 6

40-44 12.3 [9.3, 16] 9.8 [7.6, 12.6] 9.7 [7.5, 12.3] 8.9 [7, 11.3] 10

45-49 11.5 [8.2, 15.7] 10.0 [7.4, 13.5] 8.2 [6.1, 10.9] 15.1 [12.6, 18] 12
23

Table 3.1—Continued

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country Age % 95% CI % 95% CI % 95% CI % 95% CI 

Senegal

15-19 1.7 [0.8, 3.6] 4.0 [2.4, 6.6] 0.4 [0.1, 0.9] 0.8 [0.3, 2.4] 0

20-24 2.6 [1.7, 4.1] 5.4 [3.8, 7.6] 1.1 [0.6, 2.0] 0.7 [0.3, 2.1] 1

25-29 3.5 [2.3, 5.2] 5.3 [3.9, 7.1] 1.6 [1.0, 2.4] 0.8 [0.5, 1.4] 2

30-34 2.7 [1.6, 4.3] 3.5 [2.4, 4.8] 1.7 [1.1, 2.6] 1.2 [0.6, 2.2] 2

35-39 2.6 [1.6, 4.2] 6.1 [4.6, 8.1] 2.3 [1.4, 3.7] 1.4 [0.7, 2.7] 2

40-44 2.7 [1.6, 4.6] 4.5 [3.1, 6.5] 1.7 [1.1, 2.6] 1.3 [0.6, 2.7] 2

45-49 2.3 [1.1, 5.0] 3.8 [2.2, 6.7] 1.7 [0.9, 3.3] 1.1 [0.5, 2.1] 2

Tanzania

15-19 3.0 [1.5, 6.1] 3.0 [1.2, 7.3] 2.7 [1.4, 5.1] 2.9 [1.3, 6.6] 1

20-24 5.3 [4.0, 6.9] 5.6 [2.7, 11.3] 6.5 [5.0, 8.6] 5.7 [4.2, 7.7] 5

25-29 5.4 [4.1, 7.2] 7.0 [4.7, 10.4] 7.4 [5.8, 9.3] 7.3 [5.6, 9.4] 5

30-34 6.2 [4.6, 8.2] 8.2 [5.2, 12.6] 7.0 [5.3, 9.3] 8.7 [6.8, 11.1] 8

35-39 5.2 [3.7, 7.4] 6.9 [4.2, 11.0] 7.8 [5.7, 10.4] 7.0 [5.3, 9.2] 6

40-44 5.0 [3.3, 7.6] 12.3 [8.0, 18.5] 5.0 [3.4, 7.2] 9.1 [6.7, 12.4] 8

45-49 3.4 [2.1, 5.5] 3.1 [1.2, 7.9] 5.3 [3.5, 7.9] 5.5 [3.5, 8.5] 7

Zambia

15-19 5.2 [3.6, 7.6] 8.1 [5.6, 11.6] 6.5 [4.6, 9.1] 6.1 [3.5, 10.4] 1

20-24 5.5 [4.0, 7.3] 10.0 [8.2, 12.1] 8.8 [7.0, 10.9] 7.7 [5.8, 10.2] 2

25-29 6.6 [5.0, 8.7] 12.3 [10.1, 15.0] 8.8 [6.9, 11.1] 7.8 [5.7, 10.5] 4

30-34 7.6 [5.7, 10.1] 13.8 [11.2, 16.8] 11.1 [8.8, 13.8] 7.4 [5.4, 10.1] 3

35-39 8.4 [6.3, 11.2] 14.0 [11.3, 17.2] 9.8 [7.6, 12.5] 9.3 [6.7, 12.7] 4

40-44 6.4 [4.4, 9.2] 11.9 [9.3, 15.3] 8.7 [6.3, 11.8] 10.6 [7.7, 14.5] 7

45-49 2.7 [1.4, 5.3] 9.3 [6.7, 12.8] 6.1 [4.0, 9.2] 8.3 [5.6, 12.0] 5

Zimbabwe

15-19 1.6 [0.7, 3.8] 3.5 [2.0, 6.3] 1.0 [0.3, 3.1] 0.8 [0.3, 2.5] 0

20-24 2.5 [1.6, 3.9] 1.4 [0.8, 2.5] 1.1 [0.7, 1.8] 1.1 [0.6, 2.0] 0

25-29 5.1 [3.6, 7.1] 1.5 [0.7, 3.0] 1.2 [0.7, 2.2] 1.4 [0.8, 2.3] 0

30-34 7.9 [5.4, 11.3] 2.1 [1.2, 3.8] 1.8 [1.1, 2.9] 0.9 [0.4, 1.8] 0

35-39 8.7 [6.5, 11.6] 3.1 [1.8, 5.4] 2.8 [1.8, 4.5] 1.0 [0.4, 2.3] 1

40-44 9.6 [6.8, 13.5] 7.8 [5.6, 10.8] 3.7 [2.3, 5.9] 1.5 [0.7, 3.2] 1

45-49 6.7 [4.2, 10.6] 9.0 [5.6, 14.2] 2.7 [1.5, 5.0] 3.0 [1.7, 5.4] 2

1 Survey 1 to Survey 5 refer to the earliest to the most recent DHS data. To match with the survey year, please refer to Table 2.1.
24

3.3.2 Parity 

Table 3.2 provides the proportion of currently married women who used traditional method by parity. Six 

countries had the highest level of traditional use among women with five or more children. In five of these 

six countries, high parity women have experienced a decline in traditional method use (Bangladesh, 

Colombia, Malawi, Zambia, and Zimbabwe), while traditional use in high parity women in Rwanda has 

remained high and declines are seen among women with lower parities. One group that witnessed a large 

decrease in traditional method use is high parity women in Zimbabwe. While use at low parity has 

consistently been around 1%, at parity 2-4, traditional use fell from 5% to 1% between survey one and five, 

and even further from 11% to 2% for women with five or more children. In four countries (Indonesia, 

Jordan, Peru, and Philippines), women with two to four children and those with five or more have 

maintained similar levels of traditional method use, with women with no or one child at lower levels of use. 

In only one country, the Dominican Republic, has traditional method use been higher among low parity (0-

1) women than higher parity women (2-4 and 5+). 
25

Table 3.2. Percentage of currently married women who used traditional methods (with 95% confidence inte

parity and survey year, 16 countries with at least five DHS

Parity

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI % 

Bangladesh

0-1 7.9 [6.8, 9.1] 7.3 [6.3, 8.5] 5.2 [4.4, 6.1] 5.4 [4.7, 6.1] 5.1 

2-4 9.7 [8.7, 10.9] 10.5 [9.5, 11.5] 8.7 [7.8, 9.8] 9.7 [9.0, 10.6] 9.6 

5+ 14.4 [12.7, 16.2] 16.1 [14.3, 18.1] 12.4 [10.7, 14.3] 15.1 [13.3, 17.0] 11.6 

Indonesia

0-1 1.5 [1.2, 1.9] 1.4 [1.1, 1.8] 1.8 [1.4, 2.3] 2.4 [1.9, 3.0] 2.4 

2-4 3.3 [2.9, 3.9] 3.4 [3.0, 4.0] 4.4 [3.7, 5.3] 4.7 [4.2, 5.3] 4.8 

5+ 2.7 [2.2, 3.3] 2.8 [2.3, 3.5] 4.3 [3.3, 5.5] 5.0 [4.2, 6.1] 5.2 

The Philippines

0-1 9.4 [8.1, 11.0] 14.0 [12.2, 15.9] 12.1 [10.6, 13.8] 13.3 [11.8, 14.9] 14.4 

2-4 17.1 [15.8, 18.4] 21.2 [19.8, 22.7] 16.4 [15.3, 17.5] 18.2 [16.9, 19.5] 18.4 

5+ 15.7 [14.3, 17.2] 21.2 [19.3, 23.2] 17.3 [15.4, 19.3] 17.4 [15.6, 19.3] 19.4 

Colombia

0-1 9.6 [7.8, 11.8] 12.5 [10.9, 14.3] 12.6 [10.9, 14.4] 11.2 [10.2, 12.4] 7.0 

2-4 11.8 [10.0, 13.8] 12.2 [11.0, 13.5] 11.9 [10.7, 13.2] 9.1 [8.4, 9.8] 5.5 

5+ 13.2 [9.9, 17.4] 16.0 [13.7, 18.6] 18.4 [15.6, 21.6] 12.1 [10.5, 14.0] 7.2 

Dominican Rep.

0-1 6.7 [4.9, 9.1] 5.8 [4.5, 7.5] 5.6 [4.6, 6.7] 4.3 [3.4, 5.4] 4.1 

2-4 3.9 [2.9, 5.2] 4.3 [3.5, 5.4] 3.6 [3.1, 4.3] 2.5 [2.0, 3.1] 2.9 

5+ 4.2 [2.7, 6.6] 2.8 [1.9, 4.3] 2.7 [1.9, 3.9] 1.6 [0.9, 2.8] 2.4 

Peru

0-1 20.1 [18.5, 21.8] 16.1 [14.6, 17.7] 20.1 [18.1, 22.2] 19.8 [18.0, 21.6] 20.2 

2-4 24.3 [23.1, 25.5] 18.9 [17.8, 20.1] 24.4 [22.8, 26.0] 24.1 [22.7, 25.5] 24.0 

5+ 22.6 [21.1, 24.2] 19.7 [18.1, 21.4] 26.2 [24.0, 28.6] 26.2 [24.0, 28.4] 29.4 

Egypt

0-1 1.2 [0.8, 1.7] 1.0 [0.7, 1.5] 2.0 [1.6, 2.6] 2.2 [1.8, 2.8] 1.1 

2-4 3.0 [2.5, 3.7] 2.7 [2.3, 3.2] 3.0 [2.6, 3.5] 3.0 [2.6, 3.4] 1.7 

5+ 2.2 [1.7, 2.7] 2.2 [1.7, 2.8] 2.7 [2.2, 3.4] 2.3 [1.8, 2.9] 2.0 

Jordan

0-1 7.7 [6.2, 9.6] 8.8 [7.1, 10.9] 9.8 [8.0, 12.0] 8.8 [6.8, 11.3] 10.7 

2-4 14.6 [12.9, 16.3] 16.7 [15.0, 18.5] 15.6 [14.0, 17.4] 16.6 [15.0, 18.3] 21.6 

5+ 14.2 [12.9, 15.6] 15.8 [14.3, 17.5] 15.7 [14.0, 17.6] 16.7 [15.0, 18.6] 19.9 

Ghana

0-1 7.8 [5.9, 10.2] 8.5 [6.5, 11.0] 6.0 [4.3, 8.1] 6.8 [4.9, 9.3] 6.0 

2-4 11.8 [10.1, 13.9] 10.2 [8.4, 12.2] 6.8 [5.5, 8.4] 7.3 [5.8, 9.1] 4.8 

5+ 9.4 [7.6, 11.5] 6.7 [4.9, 9.0] 6.5 [5.0, 8.3] 6.5 [4.6, 9.1] 2.9 

Kenya

0-1 5.5 [3.8, 7.7] 6.9 [5.3, 9.1] 4.9 [3.5, 6.7] 4.9 [3.4, 7.2] 3.9 

2-4 5.4 [4.2, 6.8] 8.5 [7.1, 10.2] 7.6 [6.4, 9.0] 6.0 [4.6, 7.7] 4.9 

5+ 5.5 [4.4, 6.9] 6.6 [5.3, 8.2] 9.8 [8.0, 11.9] 6.8 [5.2, 8.9] 5.1 
26

Table 3.2—Continued

Parity

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI % 

Malawi

0-1 3.4 [2.3, 5.1] 2.1 [1.5, 2.9] 1.8 [1.3, 2.5] 2.7 [2.0, 3.7] 0.7 

2-4 6.5 [4.9, 8.6] 4.0 [3.3, 4.7] 4.2 [3.4, 5.2] 3.5 [2.9, 4.2] 1.0 

5+ 6.1 [4.8, 7.8] 7.0 [5.9, 8.1] 6.4 [5.3, 7.7] 5.0 [4.3, 5.8] 1.6 

Rwanda

0-1 5.0 [3.5, 6.9] 5.3 [4.1, 7.0] 4.4 [3.2, 6.1] 3.4 [2.6, 4.5] 2.9 

2-4 7.7 [6.3, 9.5] 7.7 [6.5, 9.0] 6.8 [5.8, 8.0] 5.7 [4.8, 6.7] 4.4 

5+ 10.0 [8.4, 11.9] 8.6 [7.4, 10.1] 8.5 [7.2, 10.1] 9.1 [8.0, 10.4] 10.1 

Senegal

0-1 0.9 [0.5, 1.8] 2.7 [1.8, 4.1] 1.0 [0.6, 1.7] 0.9 [0.4, 2.1] 1.1 

2-4 3.3 [2.4, 4.6] 5.4 [4.1, 7.0] 1.2 [0.8, 1.7] 1.0 [0.7, 1.6] 2.3 

5+ 3.0 [2.1, 4.2] 5.4 [4.4, 6.7] 2.3 [1.7, 3.1] 1.1 [0.6, 2.0] 2.9 

Tanzania

0-1 3.5 [2.5, 4.8] 4.0 [2.4, 6.6] 4.0 [2.9, 5.4] 5.6 [4.1, 7.6] 5.1 

2-4 6.2 [5.1, 7.7] 5.8 [3.8, 8.7] 6.6 [5.3, 8.2] 7.1 [5.9, 8.6] 7.5 

5+ 5.0 [3.9, 6.4] 9.6 [7.4, 12.5] 7.7 [6.0, 9.9] 7.6 [6.2, 9.2] 5.7 

Zambia

0-1 3.2 [2.2, 4.6] 4.3 [3.1, 6.0] 5.1 [3.8, 6.7] 5.4 [3.8, 7.8] 1.7 

2-4 5.5 [4.4, 7.0] 11.6 [9.9, 13.7] 8.6 [7.3, 10.2] 8.0 [6.4, 10.0] 3.7 

5+ 8.8 [7.4, 10.6] 15.7 [13.8, 17.9] 11.4 [9.7, 13.4] 9.4 [7.7, 11.5] 6.1 

Zimbabwe

0-1 1.2 [0.6, 2.2] 1.6 [0.9, 2.8] 0.8 [0.5, 1.5] 1.0 [0.5, 1.7] 0.7 

2-4 4.7 [3.6, 6.1] 1.4 [0.9, 2.1] 1.5 [1.1, 2.1] 1.1 [0.8, 1.7] 0.8 

5+ 11.0 [9.0, 13.3] 8.4 [6.4, 10.9] 4.0 [2.9, 5.5] 2.4 [1.4, 4.0] 1.9 

1 Survey 1 to Survey 5 refer to the earliest to the most recent DHS data. To match with the survey year, please refer to Table 2.1.
27

3.3.3 Education 

Education plays a role in determining the use of traditional methods among women in many countries. 

Table 3.3 presents trends in traditional contraceptive use (proportion and 95% confidence interval) by 

education level of married women for each country. One common pattern shown in Table 3.3 is that the 

higher use of traditional methods among the most educated women in the earlier surveys (Bangladesh., 

Dominican Republic, Egypt, Ghana, Indonesia, Jordan, Kenya, Philippines, Rwanda, Senegal, Tanzania), 

followed by a decrease in the later surveys among this group (in 8 of the 11 surveys, education classified 

as secondary plus is no longer the most common educational group for traditional use). The decline in 

traditional method use is also accompanied by an increase in modern methods. In some countries (Malawi, 

Peru, and Zambia), changes in traditional method use are similar for all education groups. 
28

Table 3.3. Percentage of currently married women who used traditional methods (with 95% confidence interval [95

level and survey year, 16 countries with at least five DHS

Education

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI 

Bangladesh

None 9.5 [8.5, 10.7] 10.6 [9.4, 11.8] 8.3 [7.0, 9.7] 11.2 [10.1, 12.5] 

Primary 10.1 [8.8, 11.5] 11.5 [10.2, 12.9] 8.5 [7.4, 9.7] 10.1 [9.1, 11.1] 

Secondary+ 12.0 [10.6, 13.5] 10.5 [9.4, 11.7] 8.2 [7.3, 9.3] 7.3 [6.6, 8.1] 

Indonesia

None 1.5 [1.0, 2.2] 1.5 [0.9, 2.5] 2.3 [1.4, 3.6] 2.2 [1.4, 3.4] 

Primary 2.0 [1.7, 2.4] 1.8 [1.6, 2.2] 2.7 [2.1, 3.5] 2.8 [2.4, 3.3] 

Secondary+ 5.1 [4.4, 5.9] 5.0 [4.3, 5.8] 5.1 [4.4, 5.9] 5.4 [4.9, 6.1] 

The Philippines

None 3.6 [1.8, 6.8] 7.7 [4.7, 12.4] 6.3 [3.1, 12.5] 9.8 [6.0, 15.8] 

Primary 13.0 [11.8, 14.2] 17.0 [15.5, 18.6] 13.8 [12.3, 15.3] 15.0 [13.4, 16.7] 

Secondary+ 17.2 [16.0, 18.4] 21.3 [20.1, 22.6] 16.5 [15.5, 17.6] 17.4 [16.3, 18.6] 

Colombia

None 8.6 [3.7, 18.5] 12.6 [9.4, 16.7] 17.2 [12.9, 22.6] 9.7 [7.6, 12.4] 

Primary 11.5 [9.2, 14.3] 13.8 [12.4, 15.3] 14.9 [13.1, 16.9] 11.0 [10.1, 12.0] 

Secondary+ 11.8 [10.3, 13.5] 12.1 [10.9, 13.5] 11.2 [10.1, 12.4] 9.5 [8.8, 10.2] 

Dominican Republic

None 3.7 [1.9, 7.3] 2.5 [1.4, 4.4] 2.4 [1.5, 4.0] 1.8 [0.7, 4.3] 

Primary 2.9 [2.1, 3.9] 3.4 [2.8, 4.2] 3.2 [2.7, 3.8] 1.9 [1.4, 2.5] 

Secondary+ 7.7 [5.8, 10.2] 6.5 [5.2, 8.1] 5.1 [4.3, 6.0] 3.7 [3.1, 4.5] 

Peru

None 19.5 [17.1, 22.1] 17.1 [14.7, 19.9] 26.1 [22.4, 30.2] 24.9 [21.0, 29.2] 

Primary 24.2 [22.8, 25.6] 19.8 [18.4, 21.2] 27.0 [25.0, 29.1] 27.2 [25.5, 29.1] 

Secondary+ 22.5 [21.4, 23.7] 17.8 [16.7, 18.9] 21.6 [20.2, 23.1] 21.2 [19.9, 22.5] 

Jordan

None 10.9 [9.2, 12.9] 10.8 [8.3, 13.8] 7.6 [5.4, 10.7] 7.8 [5.2, 11.5] 

Primary 12.0 [10.3, 14.0] 12.1 [9.8, 14.9] 11.8 [9.3, 14.9] 12.5 [9.3, 16.6] 

Secondary+ 14.4 [13.3, 15.7] 15.9 [14.7, 17.2] 15.4 [14.2, 16.7] 15.7 [14.6, 16.8] 

Egypt

None 1.5 [1.2, 2.0] 1.8 [1.4, 2.4] 2.5 [2.0, 3.2] 2.2 [1.7, 2.7] 

Primary 2.4 [1.9, 3.1] 2.2 [1.7, 3.0] 2.2 [1.6, 3.1] 2.4 [1.7, 3.3] 

Secondary+ 3.4 [2.7, 4.2] 2.5 [2.1, 3.1] 3.0 [2.6, 3.4] 3.0 [2.6, 3.5] 

Ghana

None 4.6 [3.5, 5.9] 4.3 [3.2, 5.7] 4.2 [3.1, 5.8] 2.7 [1.7, 4.5] 

Primary 12.9 [11.1, 14.9] 7.4 [5.3, 10.2] 5.3 [3.8, 7.4] 8.7 [6.5, 11.4] 

Secondary+ 23.3 [18.8, 28.6] 12.5 [10.6, 14.7] 9.1 [7.4, 11.2] 8.7 [7.2, 10.5] 

Kenya

None 4.2 [2.8, 6.4] 6.7 [4.4, 10.2] 4.0 [2.5, 6.3] 2.1 [1.1, 4.1] 

Primary 5.5 [4.4, 6.8] 6.4 [5.3, 7.6] 7.7 [6.4, 9.4] 5.9 [4.7, 7.4] 

Secondary+ 6.7 [5.2, 8.7] 10.3 [8.7, 12.3] 10.1 [8.4, 12.2] 7.7 [5.9, 10.0] 
29

Table 3.3—Continued

Education

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI 

Malawi

None 5.2 [4.1, 6.7] 4.2 [3.5, 5.1] 4.0 [3.2, 5.1] 3.1 [2.4, 4.1] 

Primary 6.2 [5.0, 7.6] 4.8 [4.2, 5.6] 4.7 [3.9, 5.6] 3.9 [3.4, 4.4] 

Secondary+ 5.1 [2.8, 9.1] 3.5 [2.1, 5.6] 3.2 [1.9, 5.2] 4.7 [3.7, 5.9] 

Rwanda

None 6.8 [5.5, 8.5] 5.8 [4.8, 7.1] 5.0 [3.9, 6.2] 6.0 [4.8, 7.5] 

Primary 9.4 [8.0, 11.1] 7.2 [6.2, 8.4] 7.6 [6.6, 8.7] 6.3 [5.6, 7.1] 

Secondary+ 9.8 [6.8, 14.0] 15.5 [13.0, 18.3] 11.2 [8.6, 14.6] 8.0 [6.3, 10.1] 

Senegal

None 1.9 [1.3, 2.9] 4.5 [3.5, 5.6] 1.0 [0.8, 1.4] 0.8 [0.5, 1.3] 

Primary 6.5 [4.6, 8.9] 4.8 [3.6, 6.5] 1.9 [1.3, 2.9] 1.6 [0.9, 2.7] 

Secondary+ 7.2 [4.3, 12.0] 8.5 [5.5, 12.9] 4.2 [2.6, 6.8] 1.4 [0.6, 3.6] 

Tanzania

None 2.3 [1.6, 3.3] 6.9 [4.7, 10.1] 5.1 [3.2, 8.2] 4.4 [3.1, 6.3] 

Primary 6.1 [5.1, 7.4] 6.2 [4.7, 8.2] 6.4 [5.4, 7.7] 6.8 [5.8, 8.0] 

Secondary+ 13.7 [9.6, 19.3] 11.3 [7.0, 17.7] 12.4 [8.9, 17.0] 16.5 [12.1, 22.0] 

Zambia

None 5.3 [3.7, 7.5] 11.4 [8.9, 14.6] 12.2 [9.7, 15.3] 7.9 [5.4, 11.5] 

Primary 6.5 [5.4, 7.8] 12.0 [10.4, 13.7] 9.1 [7.9, 10.5] 8.9 [7.3, 10.6] 

Secondary+ 6.7 [5.1, 8.8] 10.3 [8.3, 12.6] 6.4 [5.0, 8.1] 6.4 [5.0, 8.1] 

Zimbabwe

None 6.9 [4.8, 9.9] 5.7 [3.6, 8.9] 4.5 [2.5, 7.8] 1.0 [0.1, 6.4] 

Primary 7.5 [6.2, 9.2] 4.4 [3.3, 6.0] 1.9 [1.4, 2.6] 1.6 [1.0, 2.6] 

Secondary+ 3.0 [2.1, 4.3] 1.5 [0.9, 2.4] 1.5 [1.1, 2.0] 1.1 [0.8, 1.5] 

1Survey 1 to Survey 5 refer to the earliest to the most recent DHS data. To match with the survey year, please refer to Table 2.1.
30

3.3.4 Residence 

Results of the relationship between residence and traditional method use show that urban women tend to 

have a higher percentage of use compared with those who live in rural areas. Table 3.4 shows that in 10 of 

the 16 countries, the relationship between urban and rural traditional method use remained unchanged ̶ 

either both increased (Indonesia and Philippines), both decreased (Bangladesh, Dominican Republic, 

Ghana, Malawi, Rwanda, Zambia, and Zimbabwe), or stayed the same (Kenya). Only one country, Jordan, 

experienced a shift with traditional methods being more common in urban areas to rural areas. In the second 

to last survey, there was no statistical difference between women in rural and urban areas. However, 

between the last two surveys, the prevalence in urban areas grew by 3 percentage points, while rural areas 

grew by almost 6 percentage points. 
31

Table 3.4. Percentage of currently married women who used traditional methods (with 95% confidence interval [95

survey year, 16 countries with at least five DHS

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country Residence % 95% CI % 95% CI % 95% CI % 95% CI 

Bangladesh

Urban 11.3 [10.1, 12.7] 11.4 [10.2, 12.6] 9.6 [8.5, 10.8] 10.0 [9.1, 11.0] 

Rural 10.1 [9.1, 11.2] 10.7 [9.8, 11.7] 8.0 [7.1, 8.9] 8.9 [8.1, 9.7] 

Indonesia

Urban 4.4 [3.7, 5.2] 4.6 [3.9, 5.4] 4.1 [3.5, 4.7] 5.3 [4.6, 6.1] 

Rural 2.0 [1.7, 2.3] 2.0 [1.7, 2.4] 3.2 [2.4, 4.2] 3.0 [2.6, 3.5] 

Urban 15.4 [14.1, 16.7] 20.3 [19.0, 21.7] 16.3 [15.1, 17.5] 18.0 [16.6, 19.5] 

The Philippines Rural 14.9 [13.8, 16.0] 18.9 [17.6, 20.2] 14.7 [13.4, 16.1] 15.3 [14.1, 16.5] 

Colombia

Urban 11.4 [10.2, 12.7] 11.8 [10.7, 12.9] 11.4 [10.4, 12.6] 9.7 [9.0, 10.3] 

Rural 11.6 [8.3, 15.9] 15.4 [13.6, 17.4] 16.8 [14.6, 19.2] 11.1 [10.1, 12.1] 

Dominican Republic

Urban 5.0 [4.0, 6.4] 5.1 [4.2, 6.1] 4.2 [3.6, 4.9] 3.5 [2.9, 4.1] 

Rural 4.1 [2.8, 5.9] 3.5 [2.7, 4.4] 3.5 [2.9, 4.2] 1.5 [1.1, 2.0] 

Peru

Urban 22.5 [21.4, 23.6] 16.9 [15.9, 18.0] 21.0 [19.5, 22.6] 21.2 [19.9, 22.6] 

Rural 23.8 [22.2, 25.4] 21.2 [19.6, 22.8] 28.3 [26.2, 30.5] 27.7 [25.8, 29.8] 

Jordan

Urban 13.6 [12.5, 14.8] 15.0 [13.8, 16.2] 14.5 [13.3, 15.9] 15.1 [14.0, 16.2] 

Rural 11.6 [9.8, 13.6] 14.6 [12.4, 17.2] 14.6 [12.5, 17.0] 15.6 [13.7, 17.8] 

Egypt

Urban 2.7 [2.2, 3.4] 2.3 [1.8, 2.8] 2.8 [2.4, 3.3] 2.7 [2.3, 3.2] 

Rural 2.0 [1.7, 2.5] 2.1 [1.7, 2.6] 2.7 [2.3, 3.1] 2.7 [2.3, 3.1] 

Ghana

Urban 14.8 [12.6, 17.4] 13.0 [10.6, 15.9] 7.2 [5.6, 9.2] 8.5 [6.9, 10.5] 

Rural 7.9 [6.6, 9.5] 6.7 [5.5, 8.1] 6.0 [4.8, 7.5] 5.8 [4.5, 7.4] 

Kenya

Urban 5.5 [3.8, 7.9] 8.6 [6.7, 11.0] 7.7 [6.1, 9.6] 6.5 [4.7, 8.8] 

Rural 5.4 [4.5, 6.5] 7.2 [6.1, 8.5] 7.8 [6.6, 9.2] 5.9 [4.7, 7.4] 

Malawi

Urban 5.6 [4.2, 7.5] 3.0 [2.0, 4.6] 2.5 [1.6, 3.9] 4.1 [3.2, 5.3] 

Rural 5.6 [4.7, 6.8] 4.8 [4.2, 5.4] 4.7 [4.0, 5.5] 3.8 [3.4, 4.4] 

Rwanda

Urban 8.7 [6.5, 11.4] 10.8 [9.0, 12.9] 10.4 [7.9, 13.6] 6.0 [4.8, 7.7] 

Rural 8.2 [7.1, 9.5] 7.0 [6.2, 8.0] 6.6 [5.8, 7.5] 6.5 [5.8, 7.2] 

Senegal

Urban 4.3 [3.3, 5.6] 4.4 [3.4, 5.8] 2.3 [1.7, 3.1] 1.8 [1.2, 2.8] 

Rural 1.9 [1.2, 3.1] 5.0 [3.9, 6.5] 1.0 [0.7, 1.4] 0.5 [0.3, 0.7] 

Tanzania

Urban 6.0 [4.6, 7.8] 4.5 [2.7, 7.3] 7.6 [5.9, 9.7] 11.9 [9.4, 14.9] 

Rural 4.9 [3.9, 6.0] 7.3 [5.7, 9.3] 6.0 [4.8, 7.6] 5.4 [4.5, 6.4] 

Zambia

Urban 5.5 [4.4, 6.8] 9.7 [8.1, 11.6] 4.6 [3.5, 6.0] 6.3 [5.0, 8.0] 

Rural 7.0 [5.6, 8.9] 12.7 [10.8, 14.8] 11.2 [9.8, 12.8] 9.0 [7.3, 11.1] 

Zimbabwe

Urban 3.7 [2.3, 5.9] 1.2 [0.6, 2.4] 1.5 [1.0, 2.3] 1.1 [0.7, 1.8] 

Rural 6.9 [5.7, 8.3] 4.3 [3.3, 5.7] 2.0 [1.5, 2.5] 1.3 [0.9, 1.9] 

1 Survey 1 to Survey 5 refer to the earliest to the most recent DHS data. To match with the survey year, please refer to Table 2.1.
32

3.3.5 Wealth 

Two distinct patterns emerge with analysis of traditional method use by wealth quintile in Table 3.5. In 

some countries (Bangladesh, Dominican Republic, Ghana, Indonesia, Rwanda, and Tanzania), traditional 

method use, as with modern method use, is more common among richer women. The top two wealth 

quintiles maintained the highest use of traditional methods across all surveys. The opposite relationship 

between wealth and traditional method use (with poorer women more likely to use traditional methods) was 

found in Colombia, Peru, Zambia, and Zimbabwe. In Egypt, women in the top and bottom wealth quintiles 

have the highest level of use of traditional methods. Decline took place in all wealth groups in Colombia, 

Egypt, Kenya, Zambia, and Zimbabwe. 
33

Table 3.5. Percentage of currently married women who used traditional methods (with 95% confidence 

CI]) by wealth quintiles and survey year, 16 countries with at least five DHS

Wealth 

quintiles

2

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI % 

Bangladesh

Lowest 9.0 [7.5, 10.7] 7.9 [6.4, 9.8] 8.6 [7.4, 10.0] 7.4 

Second 10.0 [8.5, 11.8] 7.5 [6.2, 9.2] 9.2 [8.0, 10.5] 8.0 

Middle 11.4 [9.9, 13.0] 8.1 [6.7, 9.7] 9.3 [8.2, 10.5] 8.2 

Fourth 11.1 [9.7, 12.7] 7.6 [6.2, 9.1] 8.9 [7.8, 10.0] 8.2 

Highest 12.6 [11.1, 14.2] 10.5 [9.1, 12.1] 9.8 [8.6, 11.0] 9.9 

Indonesia

Lowest 3.9 [2.5, 6.0] 3.1 [2.6, 3.8] 3.2 

Second 2.2 [1.7, 2.9] 3.0 [2.5, 3.7] 2.9 

Middle 2.9 [2.1, 4.0] 3.5 [2.8, 4.2] 3.6 

Fourth 3.6 [2.8, 4.6] 4.7 [3.9, 5.6] 4.3 

Highest 5.4 [4.5, 6.3] 5.6 [4.7, 6.6] 5.9 

The Philippines

Lowest 13.6 [11.8, 15.6] 14.8 [13.2, 16.7] 16.9 

Second 15.0 [13.3, 16.9] 16.9 [15.2, 18.9] 17.9 

Middle 17.0 [15.2, 19.1] 17.4 [15.6, 19.4] 18.2 

Fourth 16.5 [14.7, 18.5] 17.3 [15.0, 19.9] 17.9 

Highest 15.3 [13.5, 17.3] 16.9 [14.9, 19.1] 16.3 

Colombia

Lowest 12.5 [11.3, 13.9] 7.0 

Second 10.5 [9.4, 11.7] 6.2 

Middle 9.3 [8.2, 10.5] 6.7 

Fourth 9.2 [8.1, 10.5] 5.5 

Highest 8.9 [7.6, 10.4] 5.2 

Dominican Republic

Lowest 1.0 [0.7, 1.5] 2.4 

Second 2.0 [1.4, 2.9] 2.7 

Middle 2.6 [1.9, 3.6] 2.3 

Fourth 4.6 [3.5, 6.1] 4.3 

Highest 3.8 [2.8, 5.1] 4.5 

Peru

Lowest 28.2 [25.6, 31.0] 27.9 [25.7, 30.1] 31.7 

Second 29.5 [27.1, 32.0] 26.4 [24.5, 28.5] 24.5 

Middle 23.4 [21.1, 25.9] 22.8 [20.8, 24.9] 24.7 

Fourth 20.5 [18.3, 22.9] 21.1 [19.1, 23.3] 21.5 

Highest 17.6 [15.2, 20.3] 17.8 [15.6, 20.2] 15.8 
34

Table 3.5—Continued

Wealth 

quintiles

2

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI % 

Jordan

Lowest 13.4 [11.5, 15.5] 17.4 

Second 14.3 [12.5, 16.4] 19.1 

Middle 18.9 [16.4, 21.7] 18.9 

Fourth 14.3 [11.9, 17.0] 19.1 

Highest 14.9 [12.5, 17.6] 19.8 

Egypt

Lowest 3.3 [2.6, 4.3] 3.6 [2.9, 4.4] 1.7 

Second 2.2 [1.6, 3.0] 2.3 [1.8, 3.0] 1.4 

Middle 2.3 [1.8, 2.9] 2.4 [1.9, 3.0] 1.4 

Fourth 2.5 [1.9, 3.2] 2.1 [1.6, 2.8] 1.7 

Highest 3.3 [2.7, 4.0] 3.1 [2.5, 3.9] 2.1 

Ghana

Lowest 5.4 [3.8, 7.6] 2.6 [1.4, 4.8] 0.9 

Second 4.8 [3.3, 7.0] 6.0 [4.1, 8.6] 2.3 

Middle 6.3 [4.4, 8.9] 6.0 [4.0, 8.9] 2.7 

Fourth 7.7 [5.4, 11.1] 9.0 [6.8, 11.8] 6.8 

Highest 8.3 [6.3, 10.8] 10.8 [8.1, 14.1] 8.5 

Kenya

Lowest 6.0 [4.3, 8.5] 3.2 [1.8, 5.4] 3.1 

Second 7.8 [5.8, 10.2] 6.6 [4.7, 9.4] 4.1 

Middle 8.5 [6.4, 11.2] 6.6 [4.7, 9.0] 4.7 

Fourth 9.7 [7.6, 12.3] 6.5 [4.6, 9.3] 5.0 

Highest 7.0 [5.7, 8.7] 6.8 [4.9, 9.3] 6.2 

Malawi

Lowest 3.5 [2.5, 4.8] 3.8 [3.0, 4.9] 0.8 

Second 3.8 [2.9, 4.9] 4.2 [3.4, 5.1] 0.9 

Middle 5.3 [4.2, 6.5] 3.6 [2.9, 4.5] 0.9 

Fourth 5.7 [4.5, 7.2] 3.1 [2.5, 3.9] 1.0 

Highest 3.0 [2.0, 4.6] 4.6 [3.8, 5.6] 1.8 

Rwanda

Lowest 5.0 [3.7, 6.7] 4.6 [3.6, 5.9] 3.5 

Second 7.8 [6.1, 9.8] 6.2 [4.9, 7.7] 4.2 

Middle 7.3 [5.7, 9.2] 5.7 [4.5, 7.2] 6.5 

Fourth 6.4 [4.9, 8.2] 8.0 [6.6, 9.8] 7.7 

Highest 9.4 [7.4, 11.8] 7.6 [6.2, 9.2] 6.9 
35

Table 3.5—Continued

Wealth 

quintiles

2

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI % 

Senegal

Lowest 0.8 [0.5, 1.3] 0.4 [0.2, 0.7] 2.3 

Second 1.5 [1.0, 2.2] 0.6 [0.4, 1.0] 1.8 

Middle 1.2 [0.8, 1.8] 1.0 [0.5, 1.9] 2.8 

Fourth 1.6 [0.9, 2.8] 1.6 [0.9, 3.1] 2.3 

Highest 2.5 [1.7, 3.9] 1.6 [0.9, 2.8] 1.6 

Tanzania

Lowest 4.9 [3.6, 6.6] 3.7 [2.6, 5.3] 2.7 

Second 6.1 [4.2, 8.7] 4.8 [3.4, 6.8] 4.2 

Middle 5.8 [4.2, 8.1] 5.4 [4.0, 7.3] 4.1 

Fourth 5.8 [4.2, 7.9] 8.0 [6.2, 10.2] 5.8 

Highest 9.2 [7.4, 11.2] 12.9 [10.2, 16.2] 13.8 

Zambia

Lowest 9.8 [7.2, 13.2] 7.3 

Second 10.1 [7.8, 13.0] 4.0 

Middle 8.9 [6.7, 11.6] 3.7 

Fourth 5.7 [4.1, 7.9] 3.0 

Highest 5.9 [4.1, 8.4] 3.5 

Zimbabwe

Lowest 2.8 [1.9, 4.2] 1.9 [1.2, 3.1] 1.0 

Second 2.2 [1.4, 3.3] 1.2 [0.6, 2.2] 1.2 

Middle 1.7 [1.0, 2.8] 1.1 [0.6, 2.1] 1.0 

Fourth 1.0 [0.5, 1.7] 1.2 [0.5, 2.6] 0.7 

Highest 1.6 [1.0, 2.5] 1.0 [0.5, 1.8] 1.1 

1 Survey 1 to Survey 5 refer to the earliest to the most recent DHS data. To match with the survey year, please refer to Table 

2 Empty cells indicate that wealth quintiles were not generated for the survey year.
36

3.3.6 Fertility intentions 

In most countries, the highest level of traditional use is among women who say they want no more children 

(see Table 3.6). The proportion of users among this group of women is far above those who want another 

child, either soon or in the future in Bangladesh, Indonesia, and Rwanda. Women who desire to stop 

childbearing have higher contraceptive use overall (data not shown here); traditional methods may be no 

exception. In Ghana, Jordan, the Philippines, Tanzania, and Zambia, traditional use is similar for women 

who want to space (delay their next birth by 2 years) and limit. In a few countries, namely Peru and recent 

surveys in Zimbabwe, no differences are observed in traditional use by fertility intentions. 
37

Table 3.6. Percentage of currently married women who used traditional methods (with 95% confidence inte

fertility desires and survey year, 16 countries with at least five DHS

Future fertility 

desires

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI 

Bangladesh

Want sooner 6.2 [4.8, 8.0] 4.4 [3.3, 5.8] 4.1 [3.0, 5.4] 4.6 [3.6, 5.8] 

Want later 9.0 [7.8, 10.3] 9.0 [7.8, 10.3] 5.9 [5.0, 7.0] 6.3 [5.5, 7.3] 

Want no more 12.2 [11.0, 13.4] 13.6 [12.5, 14.6] 10.4 [9.4, 11.4] 11.2 [10.4, 12.0] 

Indonesia

Want sooner 1.8 [1.4, 2.4] 1.6 [1.2, 2.2] 2.2 [1.6, 3.1] 2.4 [1.8, 3.1] 

Want later 2.2 [1.8, 2.8] 2.3 [1.9, 2.8] 2.4 [1.9, 3.0] 3.8 [3.2, 4.5] 

Want no more 3.3 [2.8, 3.8] 3.3 [2.9, 3.9] 4.7 [4.0, 5.6] 4.5 [4.1, 5.1] 

The Philippines

Want sooner 6.1 [4.6, 8.1] 7.6 [6.0, 9.7] 7.6 [6.0, 9.5] 9.3 [7.5, 11.4] 

Want later 15.9 [14.4, 17.7] 23.0 [20.9, 25.2] 17.8 [15.9, 19.8] 18.3 [16.4, 20.3] 

Want no more 16.7 [15.6, 17.8] 21.1 [19.9, 22.4] 16.7 [15.6, 17.9] 17.7 [16.5, 18.9] 

Colombia

Want sooner 14.8 [11.1, 19.6] 12.6 [10.4, 15.1] 12.2 [9.8, 15.2] 12.1 [10.3, 14.2] 

Want later 11.7 [9.2, 14.7] 17.4 [15.2, 19.9] 14.9 [12.7, 17.5] 13.1 [11.7, 14.6] 

Want no more 11.0 [9.3, 12.9] 12.1 [11.0, 13.2] 12.9 [11.7, 14.1] 9.4 [8.7, 10.0] 

Dominican Republic

Want sooner 4.7 [3.0, 7.4] 6.8 [5.0, 9.3] 8.3 [6.4, 10.6] 2.8 [2.0, 3.8] 

Want later 8.5 [6.0, 12.0] 8.4 [6.5, 10.7] 6.4 [5.3, 7.7] 5.2 [4.1, 6.7] 

Want no more 3.6 [2.8, 4.7] 2.8 [2.2, 3.6] 2.6 [2.2, 3.1] 2.1 [1.6, 2.8] 

Peru

Want sooner 27.0 [24.2, 29.9] 20.8 [18.1, 23.8] 22.8 [19.5, 26.5] 25.1 [22.0, 28.5] 

Want later 22.7 [20.9, 24.8] 18.6 [17.1, 20.3] 26.4 [24.2, 28.8] 23.0 [21.1, 25.0] 

Want no more 23.4 [22.4, 24.4] 18.8 [17.8, 19.9] 23.9 [22.5, 25.5] 24.3 [23.0, 25.7] 

Jordan

Want sooner 8.7 [6.9, 10.9] 10.1 [8.2, 12.5] 10.2 [8.1, 12.7] 11.9 [9.6, 14.7] 

Want later 14.1 [12.4, 16.1] 17.0 [15.2, 19.0] 16.4 [14.7, 18.3] 15.6 [13.7, 17.7] 

Want no more 14.7 [13.4, 16.2] 15.8 [14.3, 17.3] 16.1 [14.6, 17.8] 16.5 [15.1, 18.1] 

Egypt

Want sooner 0.7 [0.3, 1.3] 0.6 [0.3, 1.2] 1.0 [0.6, 1.5] 1.3 [0.9, 1.9] 

Want later 2.3 [1.7, 3.1] 3.1 [2.4, 4.1] 4.1 [3.3, 5.1] 4.5 [3.8, 5.4] 

Want no more 2.8 [2.4, 3.3] 2.3 [1.9, 2.7] 2.8 [2.4, 3.2] 2.5 [2.2, 2.9] 

Ghana

Want sooner 6.9 [5.0, 9.4] 6.9 [4.9, 9.5] 4.3 [2.9, 6.4] 6.8 [4.6, 10.0] 

Want later 10.4 [8.7, 12.4] 9.5 [7.8, 11.5] 7.3 [5.8, 9.2] 6.5 [5.1, 8.3] 

Want no more 12.6 [10.6, 14.9] 9.5 [7.6, 11.8] 7.0 [5.6, 8.8] 7.9 [6.1, 10.2] 

Kenya

Want sooner 5.6 [3.7, 8.3] 8.9 [6.5, 12.1] 5.4 [4.0, 7.3] 4.4 [2.8, 6.7] 

Want later 5.4 [4.1, 7.2] 8.5 [6.9, 10.4] 7.5 [6.2, 9.2] 6.2 [4.5, 8.5] 

Want no more 5.8 [4.7, 7.0] 6.8 [5.7, 8.0] 9.0 [7.6, 10.6] 6.4 [5.2, 8.0] 
38

Table 3.6—Continued

Future Fertility 

Desires

Survey 1

1 Survey 2 Survey 3 Survey 4 

Country % 95% CI % 95% CI % 95% CI % 95% CI 

Malawi

Want sooner 4.7 [3.2, 6.8] 3.7 [2.7, 4.9] 1.8 [1.1, 2.9] 2.7 [1.9, 3.9] 

Want later 6.2 [5.0, 7.7] 3.9 [3.3, 4.8] 4.7 [3.8, 5.8] 4.0 [3.3, 4.7] 

Want no more 6.7 [5.1, 8.9] 5.5 [4.7, 6.5] 4.8 [4.0, 5.9] 4.2 [3.6, 4.8] 

Rwanda

Want sooner 6.5 [4.5, 9.2] 6.2 [4.6, 8.4] 5.9 [4.3, 8.1] 4.0 [2.6, 6.2] 

Want later 7.3 [6.0, 8.8] 6.7 [5.7, 7.8] 5.7 [4.7, 7.0] 5.4 [4.6, 6.4] 

Want no more 10.7 [8.9, 12.9] 9.7 [8.4, 11.2] 9.2 [7.9, 10.7] 7.6 [6.8, 8.6] 

Senegal

Want sooner 1.1 [0.6, 2.1] 2.7 [1.9, 3.9] 0.8 [0.5, 1.5] 0.7 [0.3, 1.3] 

Want later 3.0 [2.1, 4.3] 5.6 [4.4, 7.1] 1.5 [1.1, 2.0] 1.0 [0.6, 1.7] 

Want no more 4.4 [3.0, 6.4] 5.9 [4.6, 7.7] 2.6 [1.8, 3.8] 1.6 [0.9, 3.0] 

Tanzania

Want sooner 3.2 [2.2, 4.5] 5.0 [3.3, 7.5] 4.8 [3.2, 7.2] 5.1 [3.6, 7.2] 

Want later 6.4 [5.3, 7.8] 10.8 [8.2, 14.0] 6.8 [5.5, 8.4] 7.5 [6.3, 8.9] 

Want no more 5.2 [4.0, 6.8] 9.6 [7.1, 12.8] 7.3 [5.8, 9.2] 7.9 [6.5, 9.6] 

Zambia

Want sooner 3.0 [2.2, 4.2] 5.9 [4.6, 7.6] 5.1 [3.8, 6.8] 5.8 [4.2, 8.1] 

Want later 7.7 [6.1, 9.6] 14.0 [12.0, 16.4] 11.3 [9.6, 13.2] 8.7 [7.0, 10.9] 

Want no more 8.0 [6.5, 9.8] 14.1 [12.1, 16.3] 8.6 [7.2, 10.2] 8.3 [6.7, 10.3] 

Zimbabwe

Want sooner 3.2 [2.0, 5.2] 1.6 [0.8, 2.9] 1.7 [1.0, 3.1] 1.0 [0.6, 1.9] 

Want later 6.2 [4.9, 7.8] 2.5 [1.5, 4.1] 1.6 [1.1, 2.3] 1.3 [0.8, 2.1] 

Want no more 7.6 [6.1, 9.4] 4.7 [3.6, 6.1] 1.9 [1.4, 2.6] 1.3 [0.9, 2.0] 

1 Survey 1 to Survey 5 refer to the earliest to the most recent DHS data. To match with the survey year, please refer to Table 2.1.
39

4. Case Studies 

In this section, we examine four countries with distinct patterns of change in traditional method use in the 

surveys examined by this report. These countries include one with high and increasing levels of traditional 

method use, Jordan, where traditional use increased from 13% in 1990 to 17% in 2012, mainly from 

increased use of withdrawal; one that has maintained high traditional method use, Peru, where traditional 

use remained stable from 23% in 1996 to 24% in 2012, and where periodic abstinence remains the most 

common method; one that has seen a decrease in traditional methods, Ghana, where traditional use declined 

from 10% in 1993 to 5% in 2014; and one country that has maintained low levels of traditional family 

planning, Indonesia, where traditional use remained stable from 3% in 1994 to 4% in 2012. For each 

country, we focus on the first and most recent survey included in this analysis. The results show changes in 

method mix, and the results of multivariate analyses to determine the changing features of women who use 

traditional methods. In the following regressions, we are interested in the role of age, fertility intentions, 

education, parity, and residence on the likelihood that a woman is using any method of family planning, if 

a woman is using a traditional or modern method, and if a woman employs withdrawal or periodic 

abstinence when using a traditional method. Wealth is not included as a predictor because the wealth index 

for the earlier surveys is not available. 

4.1. Method mix

Table 4.1 presents the distribution of currently married women age 15-49 not using and currently using 

traditional and modern contraceptive methods by DHS survey year for the four countries in the case studies. 

Peru has maintained high levels of traditional method use between the 1996 and 2012 surveys. Periodic 

abstinence remains the most common traditional method (Table 4.1). The use of withdrawal and injectables 

doubled while condom use tripled. The use of longer-term methods has decreased, with prevalence of IUDs 

dropping from 12% to 3%, and female sterilization from 10% to 8%. 

Jordan has high increasing levels of traditional method use, although the distribution of these methods has 

shifted. In the 1990 survey, traditional methods are evenly split between withdrawal (4%), periodic 

abstinence (4%), and prolonged breastfeeding (5%). Prolonged breastfeeding is considered a folk method 

of family planning. In the 2012 survey, prolonged breastfeeding is no longer listed as a method, although 

LAM, a more effective form of prolonged breastfeeding, is included as a modern method. Less than 2% 

report using this method. Another change is the rise of withdrawal (from 4% to 13% of women). Modern 

methods increased as well (especially pills, IUDs, and condoms), and the overall level of modern method 

use has increased from 27% to 42%. 

Ghana has experienced a large decline in the use of traditional methods of family planning between 1993 

and 2014, from 10% to 5%. This decline is seen in users of periodic abstinence and withdrawal. At the same 

time, use of modern methods has more than doubled, from 10% to 22%. The methods that gained the most 

in popularity are injectables and implants. 

Indonesia has a low level of traditional method use, as it has for the previous 20 years. From 1994 to 2012, 

traditional method use rose from 3% to 4%, which was attributed to a small increase in the use of 

withdrawal. Unlike many other surveys, the 1994 Indonesia DHS records specific folk methods, including 

herbs and massage, although in total, less than 1% of women report a folk method. The largest change in 

modern contraceptive popularity is among injectable use, which rose from 15% to 32%. Overall, modern 

method use rose from 52% to 58% between the two surveys. 
40

Table 4.1. Percent distribution of currently married women age 15-49 not using and 

currently using contraceptive methods by DHS survey year

Peru Jordan Indonesia Ghana

Method mix 1996 2012 1990 2012 1994 2012 1993 2014

Traditional 22.9 23.7 13.1 17.3 2.7 4.0 10.1 4.5

Withdrawal 3.2 7.6 4.0 12.8 0.8 2.3 2.1 1.1

Periodic abstinence 18.0 15.0 3.9 4.0 1.1 1.3 7.5 3.2

Prolonged breastfeeding -- -- 5.0 -- -- -- -- --

Folk methods (herbs, massage) -- -- -- -- 0.6 -- -- --

Other 1.6 1.1 0.2 0.5 0.2 0.4 0.5 0.2

Any Modern 41.3 51.8 26.9 42.1 52.2 57.9 10.1 21.9

Pill 6.2 9.4 4.6 8.2 17.1 13.6 3.2 4.7

IUD 12.0 2.8 15.3 22.6 10.3 3.9 0.9 0.8

Injections 8.0 18.2 0.0 0.7 15.2 31.9 1.6 8

Diaphragm 0.7 -- 0.6 -- -- -- 1.2 --

Condom 4.4 12.3 0.8 6.3 0.9 1.8 2.2 1.2

Female sterilization 9.5 8.1 5.6 2.6 3.1 3.2 0.9 1.9

Male sterilization 0.2 0.5 0.0 0.0 0.7 0.2 -- --

Norplant 0.3 -- -- 0.1 4.9 -- -- --

Implants -- -- -- -- -- 3.3 5.2

LAM -- 0.1 -- 1.5 -- -- -- 0.2

Foam or jelly -- 0.4 -- -- -- -- -- --

Female condoms -- -- -- 0.1 -- -- -- --

Emergency contraception -- 0.0 -- -- -- -- -- --

Other modern -- -- -- -- -- -- -- 0.3

Not using 35.8 24.5 60.0 40.7 45.3 38.1 79.7 73.3

-- Not reported.

4.2. Determinants of Contraceptive Use and Choice of Traditional Methods 

In this section, we examine predictors of use of any method (modern or traditional), the use of traditional 

versus modern methods (among contraceptive users), and use of withdrawal versus periodic abstinence 

(among traditional method users) by using binary logistic regression. The sociodemographic characteristics 

of interest include age, parity, education, and residence. Adjusted odds ratios and 95% confidence intervals 

are shown for each country. 

Peru 

Table 4.2 presents the profile of users of contraception. The results show that age has been and remains a 

driver of contraceptive use, and that women age 20-44 are statistically more likely to use any method than 

women age 45-49. Among contraceptive users, older users have a higher odds ratio of using a traditional 

method than younger users. When looking at traditional method users, in 1996 younger women had higher 

odds ratio of reporting withdrawal (compared with periodic abstinence) than older women, although in 

2012, there was no significant difference between women under age 35 compared with women over age 45 

(although women age 35-44 have lower odds of use of withdrawal compared with women age 45-49). 
41

Table 4.2. Predictors of current contraceptive use by survey year, adjusted odds 

ratios and 95% confidence interval (CI) from binary logistic regression, Peru

Any Method versus No Method

1996 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 1.13 (0.87, 1.46) 1.21 (0.90, 1.62)

20-24 1.39 *** (1.13, 1.70) 1.78 *** (1.38, 2.29)

25-29 1.94 *** (1.60, 2.35) 1.80 *** (1.44, 2.25)

30-34 2.16 *** (1.81, 2.58) 2.07 *** (1.69, 2.54)

35-39 2.71 *** (2.28, 3.21) 2.20 *** (1.82, 2.65)

40-44 2.41 *** (2.01, 2.87) 2.08 *** (1.72, 2.52)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 2.02 *** (1.75, 2.32) 1.32 ** (1.03, 1.68)

Secondary+ 3.13 *** (2.67, 3.67) 1.51 *** (1.17, 1.94)

Residence

Urban 1.80 *** (1.61, 2.02) 1.15 ** (1.00, 1.31)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 2.05 *** (1.78, 2.35) 2.33 *** (1.94, 2.79)

5+ 1.75 *** (1.45, 2.10) 1.84 *** (1.47, 2.30)

Fertility Intentions

Wants soon 0.44 *** (0.36, 0.54) 0.25 *** (0.20, 0.30)

Wants later Ref. Ref.

Wants no more 0.66 *** (0.58, 0.76) 0.58 *** (0.49, 0.69)

N 17,337 13,757

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

Continued... 
42

Table 4.2 (Peru)—Continued

Traditional versus Modern Method (Among Method Users)

1996 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 0.34 *** (0.23, 0.49) 0.50 *** (0.34, 0.74)

20-24 0.41 *** (0.31, 0.53) 0.66 *** (0.51, 0.85)

25-29 0.44 *** (0.35, 0.56) 0.78 ** (0.61, 0.99)

30-34 0.53 *** (0.42, 0.67) 0.90 (0.73, 1.11)

35-39 0.65 *** (0.52, 0.82) 0.90 (0.74, 1.10)

40-44 0.89 (0.71, 1.12) 1.17 (0.95, 1.42)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 0.75 ** (0.60, 0.94) 1.16 (0.91, 1.48)

Secondary+ 0.55 *** (0.43, 0.70) 0.83 (0.64, 1.08)

Residence

Urban 0.55 *** (0.48, 0.64) 0.62 *** (0.54, 0.72)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 0.77 *** (0.65, 0.92) 0.96 (0.8, 1.14)

5+ 0.60 *** (0.48, 0.76) 1.19 (0.93, 1.51)

Fertility intentions

Wants soon 1.70 *** (1.37, 2.11) 1.94 *** (1.53, 2.47)

Wants later Ref. Ref.

Wants no more 0.90 (0.76, 1.07) 0.76 *** (0.64, 0.89)

N 11,195 10,622

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

Continued... 
43

Table 4.2 (Peru)—Continued

Withdrawal versus Periodic Abstinence (Traditional Users of 

Withdrawal and Periodic Abstinence)

1996 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 2.20 (0.96, 5.04) 1.24 (0.62, 2.48)

20-24 2.69 *** (1.47, 4.91) 1.53 (0.93, 2.53)

25-29 1.78 ** (1.04, 3.05) 1.17 (0.77, 1.79)

30-34 1.17 (0.71, 1.93) 0.81 (0.55, 1.19)

35-39 1.05 (0.64, 1.72) 0.55 *** (0.38, 0.80)

40-44 0.93 (0.56, 1.55) 0.56 *** (0.41, 0.78)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 1.08 (0.67, 1.76) 0.90 (0.56, 1.44)

Secondary+ 1.03 (0.62, 1.72) 0.52 *** (0.32, 0.85)

Residence

Urban 1.50 *** (1.11, 2.02) 1.84 *** (1.45, 2.32)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 1.76 *** (1.20, 2.59) 0.85 (0.62, 1.15)

5+ 2.41 *** (1.45, 3.98) 0.87 (0.56, 1.35)

Fertility Intentions

Wants soon 0.88 (0.55, 1.39) 0.83 (0.55, 1.24)

Wants later Ref. Ref.

Wants no more 0.98 (0.71, 1.33) 1.07 (0.80, 1.44)

N 3,667 3,237

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

In both 1996 and 2012, women who want to have a child soon or want no more children have a lower odds 

ratio of using any method of contraception compared with women who would like to have a child after 2 

years. Of contraceptive users, women who would like a child within 2 years are more likely to use traditional 

methods relative to modern methods compared with women who would like to space their next pregnancy. 

In the most recent survey, women who want no more children have a lower odds ratio of traditional versus 

modern use compared with women who would like to space. 

When examining parity of women during both time periods, women with more children are more likely to 

use a method than women with none or one child. However, in the early survey, among method users, these 

women are less likely to use traditional methods than the low parity women. In the most recent survey, 

there is no distinction by parity for the likelihood of practicing withdrawal compared with periodic 

abstinence—although in 1996, women with more children had a higher odds ratio of practicing withdrawal. 
44

As expected, women with higher levels of education are more likely to use a method of contraception. This 

pattern remains consistent in the two periods. In the earlier survey, odds ratios of traditional use are highest 

among users with no education (among women using a method), although there is no difference in the odds

ratios of traditional method use by educational status in the most recent survey. 

In the 1996 DHS, there is a clear distinction between urban and rural women in the odds ratio of using a 

contraceptive method, although this distinction is not as strong in 2012. Among method users, traditional 

method use is less common in the urban areas in both surveys. In both time periods, among traditional users, 

the odds of withdrawal, compared with periodic abstinence, are more common in urban settings. 

Jordan 

Adjusted odds ratios and 95% confidence intervals from the regression analysis are presented in Table 4.3. 

Results show that in the earlier survey, younger women have approximately the same odds of using any 

method as women age 45-49, while women age 35-44 had a higher odds ratio when controlling for other 

characteristics. In 2012, all age groups are more likely to use contraception than the oldest age group. There 

is a shift in traditional use among contraceptive users by age. In 1990, younger contraceptive users (age 15-

19) had a statistically higher likelihood of using traditional methods versus modern methods, compared 

with women age 45-49. However, in 2012, women age 20-39 have statistically lower odds ratios of 

traditional method use, if they are using any method. Because of the small group of traditional method users 

in the 1990 survey, age groups were combined into women under age 30 and women age 30 and over. In 

both surveys, women age 15-29 are statistically less likely to use withdrawal compared with periodic 

abstinence, compared with women age 30 and older. 

In both the older and more recent surveys, contraceptive use is associated with desired timing of future 

births. Women who want a child within the next 2 years have a lower odds ratio of using any method versus 

no method of contraception, compared with women who want to wait 2 years for a birth. Women who want 

to have no more children have a higher odds ratio compared with these women. While neither time period 

shows a significant difference between women who want be pregnant and give birth soon and those who 

want to wait in terms of traditional versus modern method use, women who want no more children have a 

lower odds ratio of traditional use. 

Women with more children were more likely to use any method of contraception compared with women 

with no or one child. When looking at only contraceptive users, those with more children have lower odds 

ratios of using traditional methods compared with modern methods. These patterns do not change over 

time. The only change over time is among traditional method users. In 1990, women with five or more 

children have statistically higher odds ratios of practicing withdrawal compared with periodic abstinence. 

By 2012, the distinction is no longer statistically significant. 

In both surveys, women with primary or more education have higher odds ratios of contraceptive use than 

women with no education. In 2012, women with primary, secondary, or more education have much lower 

odds ratios of practicing withdrawal versus periodic abstinence compared with women with no education. 

The differences between urban and rural women do not change between surveys. Urban women are more 

likely to use any method of contraception, and among users of family planning methods, urban women have 

lower odds ratios of using a traditional method. There is no significant difference in the choice of traditional 

method. 
45

Table 4.3. Predictors of current contraceptive use by survey year, adjusted odds 

ratios and 95% confidence interval (CI) from binary logistic regression, Jordan

Any Method versus No Method

1990 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 0.63 (0.39, 1.01) 3.20 *** (1.69, 6.06)

20-24 0.89 (0.65, 1.22) 2.76 *** (1.87, 4.08)

25-29 0.91 (0.69, 1.20) 3.06 *** (2.13, 4.40)

30-34 1.20 (0.92, 1.57) 2.43 *** (1.71, 3.45)

35-39 1.51 *** (1.18, 1.94) 2.36 *** (1.75, 3.19)

40-44 1.80 *** (1.39, 2.33) 2.23 *** (1.65, 3.03)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 1.59 *** (1.29, 1.95) 2.46 *** (1.67, 3.61)

Secondary+ 2.47 *** (1.99, 3.06) 4.29 *** (3.17, 5.80)

Residence

Urban 1.81 *** (1.47, 2.23) 1.25 *** (1.08, 1.44)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 3.81 *** (3.03, 4.79) 5.78 *** (4.49, 7.42)

5+ 4.25 *** (3.17, 5.70) 9.02 *** (6.82, 11.94)

Fertility Intentions

Wants soon 0.49 *** (0.39, 0.62) 0.48 *** (0.39, 0.60)

Wants later Ref. Ref.

Wants no more 1.54 *** (1.30, 1.82) 1.63 *** (1.33, 1.99)

N 5,919 9,512

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

Continued... 
46

Table 4.3 (Jordan)—Continued

Traditional versus Modern Method (Among Method Users)

1990 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 2.31 (0.87, 6.14) 0.42 (0.14, 1.27)

20-24 1.27 (0.77, 2.09) 0.36 *** (0.21, 0.62)

25-29 1.24 (0.78, 1.96) 0.46 *** (0.29, 0.73)

30-34 1.08 (0.72, 1.63) 0.69 (0.45, 1.07)

35-39 1.02 (0.68, 1.52) 0.66 ** (0.44, 0.99)

40-44 1.02 (0.69, 1.51) 0.87 (0.60, 1.26)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 0.74 ** (0.55, 0.99) 1.63 (0.91, 2.91)

Secondary+ 0.80 (0.59, 1.08) 1.31 (0.79, 2.19)

Residence

Urban 0.67 *** (0.50, 0.88) 0.78 *** (0.65, 0.92)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 0.37 *** (0.24, 0.57) 0.37 *** (0.25, 0.55)

5+ 0.41 *** (0.25, 0.66) 0.28 *** (0.17, 0.46)

Fertility intentions

Wants soon 1.30 (0.87, 1.94) 1.09 (0.80, 1.48)

Wants later Ref. Ref.

Wants no more 0.61 *** (0.47, 0.79) 0.73 ** (0.55, 0.98)

N 2,349 5,509

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

Continued... 
47

Table 4.3 (Jordan)—Continued

Withdrawal versus Periodic Abstinence (Traditional Users of 

Withdrawal and Periodic Abstinence)

1990 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age1

15-29 0.50 ** (0.27, 0.93) 0.46 ** (0.22, 0.98)

30-49 Ref.

Education

None Ref. Ref.

Primary 0.96 (0.50, 1.83) 0.12 ** (0.02, 0.67)

Secondary+ 0.60 (0.34, 1.08) 0.06 *** (0.01, 0.26)

Residence

Urban 1.18 (0.69, 1.99) 0.81 (0.55, 1.19)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 1.49 (0.71, 3.13) 2.31 (0.84, 6.34)

5+ 2.72 ** (1.11, 6.63) 1.86 (0.63, 5.47)

Fertility Intentions

Wants soon 0.71 (0.32, 1.54) 0.60 (0.27, 1.29)

Wants later Ref. Ref.

Wants no more 0.83 (0.46, 1.51) 0.43 *** (0.23, 0.79)

N 457 1,655

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

1 Age groups were combined into women under age 30 and women age 30 and over, due to 

small number of traditional method users.

Ghana 

Table 4.4 shows that the age patterns of contraceptive use (controlling for other characteristics) have

changed. In 1993, there is little variation in the odds of using a method of family planning by age. However, 

in 2014, women age 20-44 have significantly higher odds ratios of using contraceptive methods than women 

age 45-49 (there was no significant difference for women age 15-19). 

In addition, among contraceptive users, there is little difference by age in the odds ratio of using traditional 

versus modern methods in 1993. In 2014, however, the odds ratios of traditional use are statistically lower 

for younger women (age 15-29) compared with women age 45-49. Because of the small number of 

traditional users in both surveys, age groups were combined to examine the choice of method among 

traditional users. Results show that there is no significant difference in the type of traditional method used 

by age. 

In 1993, contraceptive use follows the same pattern seen in other countries, with women who want a child 

in the near future having a statistically lower odds ratio of contraceptive use compared with women who 
48

want to space her next birth, and with women who want to avoid future childbearing having a higher odds 

ratio. Among contraceptive users in the earlier survey, the odds ratio of traditional versus modern use is

lower for women who want to limit childbearing, compared with those who wish to space, although no 

significant difference is seen in the later survey. 

While women with more children in both surveys are found to be more likely to use contraception than 

women with no or one child, the odds ratio of using traditional methods compared with modern methods is 

higher for the low parity women in the most recent survey. 

Table 4.4. Predictors of current contraceptive use by survey year, adjusted odds 

ratios and 95% confidence interval (CI) from binary logistic regression, Ghana

Any Method versus No Method

1993 2014

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 0.90 (0.45, 1.79) 0.88 (0.42, 1.84)

20-24 0.97 (0.58, 1.60) 1.71 ** (1.10, 2.65)

25-29 1.12 (0.71, 1.76) 1.80 *** (1.28, 2.53)

30-34 0.97 (0.63, 1.51) 1.44 ** (1.04, 1.99)

35-39 1.26 (0.82, 1.95) 1.36 (0.97, 1.89)

40-44 1.22 (0.77, 1.95) 1.32 (0.95, 1.85)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 3.63 *** (2.83, 4.65) 1.82 *** (1.44, 2.30)

Secondary+ 8.94 *** (6.27, 12.76) 2.03 *** (1.67, 2.48)

Residence

Urban 1.58 *** (1.30, 1.93) 0.85 (0.70, 1.04)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 1.53 *** (1.12, 2.09) 1.19 (0.78, 1.81)

5+ 1.53 ** (1.02, 2.27) 1.23 (0.77, 1.98)

Fertility Intentions

Wants soon 0.55 *** (0.38, 0.78) 0.37 *** (0.28, 0.49)

Wants later Ref. Ref.

Wants no more 1.41 *** (1.11, 1.8) 1.13 (0.93, 1.37)

N 3,085 5,269

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

Continued... 
49

Table 4.42 (Ghana)—Continued

Traditional versus Modern Method (Among Method Users)

1993 2014

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 0.33 (0.09, 1.14) 0.16 (0.02, 1.14)

20-24 0.70 (0.30, 1.61) 0.34 ** (0.12, 0.91)

25-29 (0.28, 1.45) 0.25 *** (0.10, 0.62)

30-34 0.64 (0.31, 1.32) 0.54 (0.23, 1.29)

35-39 0.72 (0.34, 1.55) 0.86 (0.37, 1.99)

40-44 0.92 (0.42, 2.05) 1.10 (0.47, 2.58)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 0.78 (0.51, 1.22) 1.10 (0.48, 2.51)

Secondary+ 0.77 (0.43, 1.37) 3.47 *** (1.71, 7.04)

Residence

Urban 0.91 (0.64, 1.30) 1.80 ** (1.11, 2.92)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 1.01 (0.55, 1.85) 0.36 *** (0.21, 0.63)

5+ 0.89 (0.41, 1.90) 0.25 *** (0.11, 0.57)

Fertility intentions

Wants soon 1.16 (0.66, 2.03) 1.06 (0.57, 1.99)

Wants later Ref. Ref.

Wants no more 0.57 ** (0.37, 0.89) 1.00 (0.61, 1.62)

N 648 1,411

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

Continued... 
50

Table 4.4 (Ghana)—Continued

Withdrawal versus Periodic Abstinence (Traditional Users of 

Withdrawal and Periodic Abstinence)

1993 2014

Odds Ratio 95% CI Odds Ratio 95% CI

Age1

15-29 0.38 ** (0.18, 0.83) 0.85 (0.18, 3.94)

30-49 Ref.

Education

None Ref. Ref.

Primary 1.96 (0.85, 4.50) 0.07 ** (0.01, 0.76)

Secondary+ 1.33 (0.34, 5.27) 0.28 (0.06, 1.38)

Residence

Urban 0.54 (0.29, 1.04) 0.88 (0.35, 2.21)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 1.03 (0.43, 2.49) 1.15 (0.24, 5.47)

5+ 2.11 (0.58, 7.72) 1.31 (0.16, 11.03)

Fertility Intentions

Wants soon 0.74 (0.24, 2.30) 0.82 (0.24, 2.80)

Wants later Ref. Ref.

Wants no more 0.96 (0.40, 2.30) 0.70 (0.23, 2.17)

N 308 170

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

1 Age groups were combined into women under age 30 and women age 30 and over, due to 

small number of traditional method users.

Indonesia 

The regression analyses showed (Table 4.5) no change in the relationship between age and contraceptive 

use, age and traditional method versus modern method use, or age and type of traditional method used. 

Women under age 45 had a higher odds ratio of using a method than women age 45-49. Among users, 

younger women had a lower odds ratio of traditional method use compared with modern, in reference to 

women age 45-49. 

Similar to the other case studies, women who want a child soon have a lower odds ratio of method use in 

both surveys, and women who want no more children have a higher odds ratio, compared with women who 

are hoping to space their next birth. In 1994, among contraceptive users, women who want to limit had a 

lower odds ratio of traditional versus modern use compared with those who want to space, but in 2012, this 

difference was no longer statistically significant. 

Education shows a different pattern compared with the other three countries in this case study. While overall 

contraceptive use is higher (in both surveys) among women with any education compared with women with 

no education, in both 1994 and 2012, among women who use a method of contraception, more educated 
51

women (those with at least a secondary education) have a higher odds ratio of traditional use (compared 

with modern use), compared with women with no education. 

While there is a significant difference in contraceptive use between urban and rural women in the 1994 

survey, the statistical significance disappears in 2012. Urban women have a higher odds ratio of traditional 

method use (versus modern methods) compared with rural women who use contraception. 

Table 4.5. Predictors of current contraceptive use by survey year, adjusted odds 

ratios and 95% confidence interval (CI) from binary logistic regression,

Indonesia

Any Method versus No Method

1994 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 2.00 *** (1.50, 2.66) 2.85 *** (2.21, 3.67)

20-24 3.31 *** (2.69, 4.07) 4.06 *** (3.40, 4.84)

25-29 3.00 *** (2.51, 3.58) 3.95 *** (3.38, 4.63)

30-34 3.01 *** (2.55, 3.56) 3.30 *** (2.86, 3.81)

35-39 2.77 *** (2.37, 3.23) 3.04 *** (2.66, 3.48)

40-44 2.12 *** (1.79, 2.50) 2.31 *** (2.02, 2.63)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 1.77 *** (1.53, 2.05) 1.75 *** (1.42, 2.15)

Secondary+ 2.40 *** (2.01, 2.88) 1.94 *** (1.57, 2.40)

Residence

Urban 1.16 *** (1.04, 1.30) 0.96 (0.87, 1.05)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 1.81 *** (1.58, 2.08) 2.37 *** (2.11, 2.65)

5+ 1.12 (0.93, 1.35) 1.33 *** (1.13, 1.55)

Fertility Intentions

Wants soon 0.22 *** (0.19, 0.26) 0.13 *** (0.11, 0.14)

Wants later Ref. Ref.

Wants no more 1.37 *** (1.20, 1.55) 1.18 *** (1.06, 1.31)

N 25,797 32,305

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

Continued... 
52

Table 4.5 (Indonesia)—Continued

Traditional versus Modern Method (Among Method Users)

1994 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 0.18 *** (0.05, 0.65) 0.05 *** (0.02, 0.13)

20-24 0.22 *** (0.11, 0.43) 0.14 *** (0.08, 0.24)

25-29 0.25 *** (0.16, 0.39) 0.33 *** (0.22, 0.48)

30-34 0.58 *** (0.40, 0.84) 0.45 *** (0.32, 0.62)

35-39 0.68 ** (0.47, 0.98) 0.71 ** (0.53, 0.95)

40-44 0.88 (0.60, 1.28) 0.85 (0.65, 1.11)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 1.12 (0.74, 1.70) 1.19 (0.59, 2.40)

Secondary+ 2.40 *** (1.54, 3.74) 3.28 *** (1.63, 6.60)

Residence

Urban 1.43 *** (1.11, 1.86) 1.34 *** (1.10, 1.63)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 1.08 (0.72, 1.62) 0.87 (0.66, 1.15)

5+ 1.04 (0.63, 1.70) 1.41 (0.97, 2.05)

Fertility intentions

Wants soon 1.78 *** (1.24, 2.55) 2.64 *** (1.94, 3.60)

Wants later Ref. Ref.

Wants no more 0.68 ** (0.49, 0.94) 0.87 (0.69, 1.10)

N 13,673 19,525

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

Continued... 
53

Table 4.5 (Indonesia)—Continued

Withdrawal versus Periodic Abstinence (Traditional Users of 

Withdrawal and Periodic Abstinence)

1994 2012

Odds Ratio 95% CI Odds Ratio 95% CI

Age

15-19 2.58 (0.14, 47.49) 3.50 (0.83, 14.70)

20-24 3.48 (0.82, 14.73) 6.54 ** (2.38, 18.03)

25-29 1.53 (0.41, 5.73) 4.11 ** (1.78, 9.53)

30-34 1.85 (0.67, 5.14) 2.50 ** (1.31, 4.76)

35-39 1.01 (0.37, 2.77) 2.15 ** (1.21, 3.82)

40-44 0.99 (0.36, 2.74) 1.09 (0.64, 1.84)

45-49 Ref. Ref.

Education

None Ref. Ref.

Primary 0.86 (0.31, 2.41) 0.51 (0.08, 3.34)

Secondary+ 0.37 (0.13, 1.07) 0.17 (0.03, 1.09)

Residence

Urban 0.56 (0.29, 1.08) 0.63 ** (0.43, 0.93)

Rural Ref. Ref.

Parity

0-1 Ref. Ref.

2-4 1.16 (0.52, 2.58) 0.98 (0.57, 1.68)

5+ 1.55 (0.51, 4.76) 1.59 (0.74, 3.42)

Fertility Intentions

Wants soon 0.98 (0.42, 2.28) 0.78 (0.44, 1.40)

Wants later Ref. Ref.

Wants no more 0.56 (0.27, 1.15) 1.41 (0.89, 2.22)

N 613 1,297

Significance level:

** p < .05

*** p < .01

Ref. = Reference category

55

5. Discontinuation and switching 

5.1. Reasons for Discontinuation 

Table 5.1 shows the distribution of the reasons for discontinuation for traditional and any modern 

contraceptive methods (excluding sterilization) separately by country for all episodes of discontinuation 

during the 5 years before the survey. Reasons for discontinuation are grouped into two categories: (1) not 

in need of contraception—wanted to become pregnant, infrequent sex/husband away, marital 

dissolution/separation, and difficulty getting pregnant/menopausal; and (2) in need of contraception—

became pregnant while using (failure), health concerns or side effects, wanted more effective method, 

method inconvenient to use, costs too much/lack of access, husband disapproval, and other reasons/don’t 

know. 

In all 16 countries in this study, among reasons for discontinuation of traditional and any modern 

contraceptive methods, the top two reasons reported by women were that they wanted to become pregnant 

and they became pregnant while using a method (contraceptive failure). 

The most common reason reported for discontinuation among currently married women not in need of 

contraception was that the woman wants to become pregnant. For those who used traditional methods, the 

percentage of discontinuations ranged from 17% in Colombia to 45% in Senegal. Similarly, for those who 

used modern methods, the percentage of discontinuations ranged from 13% in Peru to 44% in Tanzania. 

The difference in percentage of discontinuations between traditional and modern methods due to women 

who want to become pregnant, separately by country ranged from around 1% in Jordan, Kenya, and Rwanda 

to 24% in Egypt (19% for traditional and 23% for modern methods). Overall, for women in 11 of the 16 

countries in the study who discontinued a method because they wanted to become pregnant, the difference 

in percentage of discontinuations between traditional and modern methods is less than 5%. 

Among traditional contraceptive users, less than 5% of discontinuations were reported due to difficulty in

becoming pregnant or being menopausal. In Bangladesh, 12% of discontinuation events reported resulted 

from difficulty getting pregnant or being menopausal. In most countries in the study, the proportion of 

discontinuations of modern contraceptive methods due to difficulty getting pregnant or being menopausal 

is less than 1%, except in Bangladesh, where about 3% of discontinuations were reported for this reason. 

Across all countries, discontinuations due to infrequent sex or husband away for traditional methods ranged 

from 0.5% in Zambia to 11% in Zimbabwe. For modern methods, discontinuations due to infrequent sex or 

husband away ranged from 1% in Zambia to 11% in Senegal and Zimbabwe. The share of episodes of 

discontinuation due to marital dissolution and difficulty getting pregnant in both the traditional and modern 

methods was very low in most countries. 

Among currently married women in need of contraception, the most common reasons to discontinue a 

traditional method were that women became pregnant while using the method (contraceptive failure) or the 

women wanted a more effective method. Overall, the percentage of discontinuations due to failure was the 

highest in the Philippines and Rwanda, where about half of episodes of discontinuation were due to 

contraceptive failure (became pregnant while using). The proportion of discontinuations due to method 

failure was also high among traditional methods users in Ghana (48%), Kenya (43%), and Tanzania (41%), 

while the percentage of discontinuations of a traditional method for women who wanted a more effective 

contraceptive method ranged from 3% in Senegal to 30% in Malawi. 
56

Considerations of reasons for discontinuation while in need showed that health concerns or side effects 

were the main reason to discontinue a modern method, whereas method failure was the most common 

reason to discontinue a traditional method. For example, 46% of the discontinuations in Peru, 42% in the 

Philippines, 37% in Rwanda, 35% in Kenya, and 33% in Egypt were due to health concerns or side effects. 

Table 5.1 also shows that in 8 of the 16 countries in the study, currently married women age 15-49 who 

used modern methods attributed about 3% to 7% of discontinuations to a lack of access or higher cost of 

obtaining a contraceptive method. 
57

Table 5.1. Percent distribution of discontinuations of traditional and modern contraceptive methods in the 5 year

main reason stated for discontinuation, most recent DHS with contraceptive calendar data

Survey 

year

Contraceptive 

method

Wanted 

pregnancy

Infrequent 

sex/

Husband 

away

Marital 

dissolution

Difficult 

to get 

pregnant

Failure/

Became 

pregnant

Health 

concern/

Side 

effect

Wanted 

more 

effective 

method

Inconvenient to 

use

Access/

Cost

Countries

Bangladesh 2014

Traditional 29.9 5.8 0.3 12.2 20.4 1.4 17.3 7.7 0.1 

Any Modern 33.4 8.3 0.1 2.8 14.5 28.7 3.9 4.6 1.1 

Indonesia 2012

Traditional 33.4 1.8 0.1 1.0 28.6 5.8 11.8 3.4 0.3 

Any Modern 31.3 5.0 0.8 1.3 6.2 31.0 5.3 3.0 1.8 

The Philippines 2003

Traditional 18.7 3.3 0.2 1.0 50.2 5.8 10.7 3.9 0.2 

Any Modern 16.0 7.3 0.1 0.7 11.2 41.8 5.6 5.4 5.6 

Colombia 2010

Traditional 17.4 5.0 1.0 0.4 35.9 1.6 26.5 4.8 0.5 

Any Modern 19.7 4.3 1.0 0.3 12.1 30.2 13.2 5.5 5.6 

Dominican Republic 2002

Traditional 20.3 2.6 1.1 0.2 27.1 2.2 19.8 6.1 0.9 

Any Modern 23.1 4.6 1.8 0.3 12.3 34.0 4.8 4.7 3.3 

Peru 2012

Traditional 19.4 3.8 0.7 3.2 36.6 1.0 25.6 2.4 0.3 

Any Modern 13.1 4.1 0.7 0.9 6.7 46.4 6.3 7.0 6.1 

Egypt 2014

Traditional 18.8 1.6 0.0 0.3 26.4 2.9 27.7 19.3 0.1 

Any Modern 42.0 8.4 0.2 0.9 10.8 32.9 2.3 1.0 0.3 

Jordan

1 2012

Traditional 40.2 2.7 0.0 1.1 31.1 1.2 20.9 0.7 0.0 

Any Modern 39.2 2.6 0.0 0.5 13.8 25.9 11.2 3.4 0.3 
58

Table 5.1—Continued

Survey 

year

Contraceptive 

Method

Wanted 

pregnancy

Infrequent 

sex/

Husband 

away

Marital 

dissolution

Difficult 

to get 

pregnant

Failure/

Became 

pregnant

Health 

concern/

Side 

effect

Wanted 

more 

effective 

method

Inconvenient to 

use

Access/

Cost

Countries

Ghana 2014

Traditional 38.9 5.4 0.0 0.0 47.5 0.6 5.3 0.0 0.0 

Any Modern 34.8 5.9 0.1 0.2 14.1 32.3 2.2 2.3 3.2 

Kenya 2014

Traditional 31.7 3.0 0.0 0.9 42.6 1.3 17.4 1.4 0.0 

Any Modern 32.8 3.4 0.2 0.6 9.3 34.7 8.8 2.2 1.8 

Malawi

2015/

2016

Traditional 26.0 5.0 1.2 2.0 18.3 2.4 27.5 1.9 0.7 

Any Modern 30.4 6.0 0.7 0.4 3.4 27.9 9.6 3.2 7.2 

Rwanda 2015

Traditional 32.3 0.7 0.0 0.0 50.4 0.0 10.7 3.4 0.0 

Any Modern 31.2 2.7 0.1 0.4 9.4 37.4 11.9 1.5 1.1 

Senegal 2015

Traditional 44.7 2.7 0.0 0.0 37.8 1.0 3.6 0.0 0.0 

Any Modern 33.9 11.3 0.8 0.2 4.4 24.7 6.8 1.1 2.2 

Tanzania

2015/

2016

Traditional 34.2 1.8 0.0 1.2 40.5 0.8 17.2 1.6 0.0 

Any Modern 43.6 2.4 0.2 0.4 6.3 29.7 7.0 0.9 3.5 

Zambia 2014

Traditional 35.9 0.6 0.4 0.2 35.7 0.2 20.8 1.3 0.0 

Any Modern 41.0 1.4 0.4 0.2 11.0 26.0 8.1 2.3 3.8 

Zimbabwe

2015/

2016

Traditional 40.8 10.8 0.0 0.0 23.5 0.5 18.7 0.0 0.0 

Any Modern 43.3 3.5 0.4 0.4 12.2 20.6 8.2 3.3 3.5 

1

In Jordan 2012 DHS, country-specific reasons for discontinuation, such as “Ramadan” and “contraceptive expired” were excluded from 
59

5.2. Rates of discontinuation, failure, and switching 

Table 5.2 presents the cumulative 1-year (12-month) contraceptive discontinuation and switching rates for 

women age 15-49. Discontinuation rates due to failure and stopping are presented separately. To examine 

trends, discontinuation rates for each country were calculated for two DHS surveys conducted 

approximately 10 years apart. Two countries—Senegal and Rwanda—have calendar data that are 5 years 

apart and four countries (the Philippines, Dominican Republic, Ghana, and Zambia) have data from only 

one survey. 

Results in Table 5.2 show that in all countries, failure rates are higher for traditional methods compared 

with modern contraceptive methods. Failure rates for traditional methods range between 4% and 21% in 

the earlier and most recent surveys. In the earlier surveys, Bangladesh has the lowest failure rate, while 

Peru, Senegal, Jordan, and Colombia have the highest (about 15%). In contrast, stopping rates are higher 

for modern methods in 14 of the 16 countries in this report (except Egypt and Zimbabwe). In Senegal, data 

from the 2010 DHS showed that 48% of the 12-month discontinuations were due to stopping contraceptive 

method. 

Examination of trends shows that in 5 of the 16 countries, stopping rates for traditional methods declined 

in Bangladesh, Egypt, Colombia, Senegal, and Tanzania. The rate did not change over time in Kenya, but 

increased in the remaining six countries. 

One-year switching rates by broad categories of contraceptive methods were calculated for currently 

married women who switched to another method if she used a different method in the month after 

discontinuation or if she gave “wanted a more effective method” as the reason for discontinuation and 

started another method within 1 month of discontinuation. The rates are a subset of the discontinued 

episodes included in the discontinuation rate. 

Fewer than 10% of switching events were reported in the first year during both time points in Indonesia, 

Kenya, Rwanda, Senegal, and Tanzania by women who used traditional methods. In contrast, among 

modern contraceptive users, switching rates were less than 10% in Malawi, Senegal, Tanzania, and 

Zimbabwe. 

The examination of trends in the 1-year switching rate for countries with two time points in Table 5.2 shows 

that for traditional method users in Bangladesh, the percentage of switching events decreased from 24% to 

10% between 2004 and 2014. A similar pattern is observed for Egypt, Colombia, Senegal, and Tanzania. 

Switching rates rose in Indonesia, Jordan, Peru, Kenya, Malawi, Rwanda, and Zimbabwe. For women who 

used any modern contraceptive methods, the largest change was a decrease from 25% in 2004 to 12% in 

2014 in Bangladesh. In contrast, the largest increase in switching rate was in Jordan, where the rate rose 

from 17% in 2002 to 28% in 2012. 
60

Table 5.2. One-year contraceptive stopping, failure, all reasons for discontinuation, and switching rates by 

country, among currently married women age 15-49

Country

Survey 

year Stopping

1 Failure

Discontinuation for 

any reason Switching

2 N

Traditional Modern Traditional Modern Traditional Modern Traditional Modern

Bangladesh 2014 15.5 28.2 3.7 3.6 19.2 31.8 9.7 12.3 

2004 37.9 46.4 9.9 3.5 47.8 49.9 23.5 25.0 

Indonesia 2012 15.8 26.3 5.2 1.3 21.0 27.5 7.2 13.7 

2002/03 14.0 19.0 4.8 2.0 18.8 21.0 5.0 9.4 

The Philippines

3 2003 23.2 38.4 15.3 3.6 38.5 42.0 10.0 16.6 

Jordan 2012 36.9 40.6 14.9 5.2 51.8 45.8 17.6 28.2 

2002 29.6 32.8 20.5 6.4 50.0 39.1 10.5 17.1 

Egypt 2014 29.5 25.7 11.0 3.9 40.5 29.6 18.8 7.7 

2005 36.3 28.0 6.8 2.9 43.2 30.9 43.2 30.9 

Colombia 2010 30.1 40.1 14.9 4.8 45.0 45.0 16.6 20.8 

2000 39.7 42.7 20.8 6.5 60.5 49.2 28.1 27.4 

Dominican Republic

3 2002 46.5 47.3 14.5 5.9 61.0 53.2 25.8 13.9 

Peru 2012 27.0 46.9 15.8 3.2 42.8 50.1 17.9 31.4 

2004/06 25.8 47.7 15.5 3.0 41.2 50.7 16.6 33.4 

Ghana

4 2014 11.4 22.2 11.2 3.2 22.6 25.4 2.5 2.3 

Kenya 2014 18.3 27.3 11.2 2.7 29.6 29.9 7.5 12.2 

2003 18.1 34.2 15.7 2.5 33.8 36.7 3.7 9.4 

Malawi 2015 45.4 36.9 5.6 0.8 51.0 37.6 14.7 5.7 

2004/05 27.8 34.4 11.1 2.2 38.9 36.6 5.6 3.8 

Rwanda 2015 14.8 24.2 13.2 2.8 28.0 27.0 7.6 11.1 

2010/11 13.5 23.7 13.3 2.3 26.8 26.0 6.4 11.4 
61

Table 5.2—Continued

Country

Survey 

year Stopping

1 Failure

Discontinuation for 

any reason Switching

2 N

Traditional Modern Traditional Modern Traditional Modern Traditional Modern

Senegal 2015 12.0 34.8 15.6 1.6 27.6 36.4 1.9 7.0 

2010 33.6 47.9 7.7 3.2 41.4 51.2 4.0 5.7 

Tanzania 2015/16 13.9 25.9 10.4 1.4 24.3 27.4 8.3 6.4 

2004/05 26.7 36.9 9.1 2.3 35.8 39.2 9.2 9.8 

Zambia

4 2014 20.3 24.8 9.1 2.5 29.4 27.4 11.7 7.3 

Zimbabwe 2006 18.0 15.4 5.0 2.1 23.0 17.5 4.5 4.6 

2015/16 21.1 18.4 5.1 2.3 26.2 20.7 8.9 6.7 

Note: Figures are based on life table calculations using information on episodes of use that began 3-62 months before the survey

1

Includes all reasons except becoming pregnant (failure).

2 The episodes of use included in this column are a subset of the discontinued episodes included in the discontinuation rate. A wo

to have switched to another method if she used a different method in the month following discontinuation or if she gave "wanted a 

method" as the reason for discontinuation and started another method within 12 months of discontinuation.

3 The recent DHS survey did not include the calendar module.

4 Of the five DHS surveys included in this study, only one survey collected reproductive calendar data.
62

5.3. Events prior to starting a family planning method 

Tables 5.3 and 5.4 present the percentage distribution of prior events before the destination family planning 

method, and all episodes among currently married women that began in the past 5 years, by method type. 

The proportion of most preferred destination method for women who were non-users or started use after 

birth/termination for each specific method (modern and traditional) is included separately for each country. 

Table 5.3 shows the proportion of prior events before switching to the destination traditional methods. In 

most of the countries, similar to modern destination methods, the prior events before starting a traditional 

method are episodes of non-use, except in Egypt (77%) and Zimbabwe (53%), where births or terminations 

contributed to the starting of a traditional method. The most preferred traditional method in many countries 

in this study was withdrawal (9 out of the 16). Periodic abstinence was the preferred method in Bangladesh, 

Peru, Ghana, Kenya, Senegal, and Tanzania. In Egypt, prolonged breastfeeding was the preferred method 

for episodes of non-use and birth/termination. In the case of the event immediately after a birth, the uptake 

of contraceptives is not in the month immediately after the birth. A woman may use a traditional method 2 

or 3 months after birth, especially if she is practicing postpartum abstinence. 

Table 5.3. Percentage distribution of prior events before starting traditional method and most popular 

destination traditional method, currently married women age 15-49

Survey 

year No use

Any 

modern Traditional

Birth/TerminationNumber of 

episodes Most popular

Bangladesh 2014 68.9 23.2 0.5 7.5 823 Periodic Abstinence (52.7%)

Indonesia 2012 46.7 27.6 0.6 25.1 1,209 Withdrawal (42.3%)

The Philippines 2003 56.5 12.3 3.4 27.8 1,948 Withdrawal (53%)

Colombia 2010 53.1 32.5 1.7 12.7 2,313 Withdrawal (38.2%)

Dominican Republic 2002 33.1 24.1 5.0 37.9 1,733 Withdrawal (22.9%)

Peru 2012 48.7 31.8 5.7 13.8 4,553 Periodic Abstinence (32.3%)

Egypt 2014 19.5 2.9 0.1 77.6 794 Prolonged Breastfeeding (83.7%)

Jordan 2012 47.3 35.3 3.5 13.9 4,871 Withdrawal (50.7%)

Ghana 2014 68.4 4.2 27.4 314 Periodic Abstinence (71.1%)

Kenya 2014 56.8 18.3 0.7 24.1 565 Periodic Abstinence (64.1%)

Malawi 2015 73.9 11.2 15.0 424 Withdrawal (52.5%)

Rwanda 2015 61.5 17.9 0.0 20.5 553 Withdrawal (45.3%)

Senegal 2015 68.5 11.9 0.4 19.3 222 Periodic Abstinence (60.0%)

Tanzania 2015/16 74.3 9.1 0.5 16.1 866 Periodic Abstinence (46.2)

Zambia 2014 83.8 6.4 0.3 9.5 985 Withdrawal (77.0%)

Zimbabwe 2015/16 35.7 10.0 54.3 111 Withdrawal (85.7%)

In Table 5.4, for most countries, women who were non-users contributed to the largest share of switching 

to modern methods followed by those who were prior users of other modern methods. For example, in 

Egypt and Ghana, 84% and 85% of prior events of non-use, respectively, switched to a modern method. 

However, in Zimbabwe, birth/termination events contributed to nearly 50% of those who started a modern 

method. In 10 of the 16 countries in this study, an injectable was the preferred destination method, followed 

by the pill. The IUD was the most preferred destination method in Jordan. 
63

Table 5.4. Percentage distribution of prior events before starting any modern contraceptive method 

and most popular destination modern method, currently married women age 15-49

Survey 

year No use

Any 

modern Traditional

Birth/TerminationNumber of 

episodes Most popular

Bangladesh 2014 73.4 18.3 1.6 6.8 8,835 Pill (49.0%)

Indonesia 2012 61.1 21.2 0.7 17.0 19,045 Injection (55.1%)

The Philippines 2003 61.0 12.7 5.6 20.8 3,099 Pill (54.0%)

Colombia 2010 53.1 23.8 4.0 19.2 13,745 Injection (27.8%)

Dominican Republic 2002 60.9 11.9 6.0 21.2 6,987 Pill (55.5%)

Peru 2012 34.0 34.7 9.2 22.1 10,967 Injection (30.7%)

Egypt 2014 81.2 10.7 1.3 6.9 14,776 Pill (37.2%)

Jordan 2012 46.2 13.4 8.9 31.5 9,028 IUD (21.7%)

Ghana 2014 85.3 2.7 0.3 11.7 1,478 Injection (45.3%)

Kenya 2014 65.4 17.1 1.1 16.4 6,116 Injection (48.9%)

Malawi 2015 79.7 5.7 0.5 14.1 13,173 Injection (66.0%)

Rwanda 2015 72.4 15.4 0.8 11.4 5,359 Injection (50.1%)

Senegal 2015 74.8 6.0 0.3 18.9 2,031 Injection (42.3%)

Tanzania 2015/16 79.9 9.5 2.8 7.9 4,201 Injection (44.6%)

Zambia 2014 74.8 10.1 2.1 13.1 7,553 Injection (38.0%)

Zimbabwe 2015/16 39.6 11.5 0.3 48.7 6,148 Pill (63.2%)

65

6. Summary and policy implications 

With a global decline in desired family size (Westoff 2010), women have a need for family planning. Much 

of this need is being met with modern methods, although gaps remain. Global use of traditional methods of 

contraception has declined from 11% in 1970 to 5% today, and from 31% of all methods used to just 8% 

(United Nations 2016). In developing countries, the rate has risen, from 4% to 5% over the same time, 

although in the future, the rate is expected to decrease. 

In this report we have examined levels and trends in the use of traditional methods, multiple traditional 

methods and simultaneous modern and traditional method use; discontinuation and switching; and case 

studies that focused on four countries with unique patterns in traditional methods use over time. For the 

four countries, we looked at determinants of contraceptive use, method choice (traditional vs. modern), and 

choice of traditional method (withdrawal vs. periodic abstinence) by using binary logistic regressions. 

While traditional method users are considered to be a shrinking group, findings from this study indicate 

that traditional methods still have a role in the global family planning method mix and that use has actually 

increased in some countries. While the study included less effective traditional methods (prolonged 

breastfeeding) and ineffective folkloric methods such as herbs and massage, findings from the case study 

show that these methods represent a negligible fraction of traditional method use.

We find that overall, use of traditional methods is most popular among women over age 35. With respect 

to parity, currently married women with five or more children (high parity) tend to have a higher use of 

traditional methods compared with women with low parity or no children. This pattern remains the same 

over time for most countries in this study. 

Results from an analysis of multiple traditional method use and simultaneous modern and traditional 

method use indicate that the vast majority of traditional method use reported in the composite method use 

variable reflects a single traditional method. In addition, the findings show that a sizeable minority of 

women were using a combination of periodic abstinence and withdrawal only in two countries (the 

Philippines and Malawi). 

Traditional method use is higher among the most educated women than among women with no education. 

This may be driven by more educated women’s greater use of contraception in general, as shown in the 

case studies. In some countries, this pattern reverses over time. Results of the relationship between 

residence and traditional method use show that urban women tend to have a higher percentage of traditional 

method use compared with rural residents. Examining traditional method use by wealth quintile indicates 

two distinct patterns: in some countries, traditional method use is more common among richer women, and 

in others, women in the low quintiles (poorer) are more likely to use traditional methods. Higher use among 

urban, educated, and wealthy women runs counter to conventional wisdom that traditional methods are 

preferred by uneducated and rural women and women who may lack access to modern methods. Such 

higher levels of use may reflect greater motivation to use contraception overall or a distinct preference for 

these methods among urban educated women as recorded in qualitative and mixed methods surveys in 

Cameroon and Ghana (Johnson-Hanks 2002; Staveteig 2017). 

Findings from the multivariate analyses for the four countries in the case studies indicate that regardless of 

whether traditional method use is increasing, decreasing, or remaining stable, shifts occurred in the 

popularity of individual methods. In Peru, which maintained high levels of traditional methods use, results 

from the regression analysis indicate a change in who was using traditional compared with modern methods 

over time. The significant difference in traditional use by age declined between the 1996 and 2012 surveys, 

while the distinction by education disappeared. In Jordan, which experienced an increase in traditional 

method use, we see in the earlier survey little difference in use by age group, although in the more recent 
66

survey there were much lower odds ratios of use among younger women. In Ghana, the country with a large 

decline in traditional use, we see the greatest change among parity groups. In 1993, there were no significant 

differences by parity, although by 2014, there are significantly lower odds ratios of use among women with 

more than two children and much higher reliance among these women on modern methods. In Indonesia, 

which has maintained a low level of traditional method use, we see little change in predictors of traditional 

use among contraceptive users. 

The contrast between traditional and modern methods is more apparent when considering women who 

stopped using the method because of health concerns or side effects. In 15 of the 16 countries, over 25% of 

women report discontinuing a modern method because of health concerns or side effects, while in 12 

countries, less than 2% of women who discontinued traditional methods give this reason. In addition, with 

proper knowledge, traditional methods (excluding folkloric methods such as herbs) are easily available and 

free. Traditional method users in the majority of countries in this study have lower discontinuation and 

switching rates compared with modern method users. Traditional methods can also be a popular choice for 

postpartum women—who may want to avoid hormonal contraceptive use while breastfeeding. Over half of 

women who begin using a traditional method in Egypt and Zimbabwe start after giving birth. 

There are two negatives with traditional methods. First, in the case of the two most popular traditional 

methods—withdrawal and periodic abstinence—husbands must be cooperative for correct method use. 

They must understand their bodies in order to withdraw prior to ejaculation, and/or abstain from intercourse 

during a woman’s fertile period. Second, traditional methods have lower effectiveness in preventing 

pregnancy than modern methods. Traditional method users are much more likely than modern method users 

to discontinue a method due to pregnancy. The literature has shown that proper counseling and knowledge 

of traditional methods can increase their effectiveness (Che et al. 2004). 

Traditional method users, while overlooked in most contemporary literature on family planning, are an 

important user demographic. Hence, even among policymakers interested in promoting modern method 

use, traditional method use is an important part of the global landscape of family planning. Users of 

traditional methods, almost by definition, practice their contraceptive method outside of the modern medical 

sector. However, they may be reachable through other medical services such as vaccinations or antenatal 

care, or at times when they switch to and from modern methods. Broad-scale community outreach is another 

way to reach traditional users. To the extent that women and couples who use traditional methods are 

motivated to use contraception, they may be an important demographic for modern method programs that 

are interested in increasing their user base. In particular, the Standard Days Method is a formal 

implementation of a traditional practice (periodic abstinence). Users of periodic abstinence may be 

empowered by trying a more effective implementation of their existing contraceptive approach. Similarly, 

the Lactational Amenorrhea Method is a formal implementation of prolonged breastfeeding practices and 

may be taught to women during antenatal care or at the time of delivery. 
67

This report has shown that although traditional methods have become a smaller part of the contraceptive 

mix for women in developing countries, they continue to play a role in the lives of millions of women.

Qualitative studies find that traditional method users may be well aware of and able to access modern 

methods but find that the advantages of traditional methods outweigh the disadvantages (Johnson-Hanks 

2002; Staveteig 2017). Our quantitative data confirm the persistence of traditional method use even among 

urban, educated, wealthy women in the study countries. We recommend a two-pronged strategy. First, 

consistent with a rights-based approach to family planning that empowers women and couples to make 

independent and informed decisions about contraceptive methods and provides respectful services, 

traditional methods should not be completely excluded from family planning programs. Instead, programs 

should educate users who prefer these methods about their correct and consistent use. Users of folkloric 

methods should be informed about these methods’ lack of effectiveness. It is worth emphasizing the 

importance of non-coercive approaches to communicating this information. Second, programs should 

continue to ensure that traditional method users are aware of modern approaches such as the Standard Days 

Method and other even more effective modern methods that can be used covertly and do not interrupt 

pleasure so that they are empowered to make fully informed decisions about the most suitable method. 

69

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Appendix 

Appendix A.1. Percent of married women 15-49 using any modern method, periodic 

abstinence, withdrawal, folkloric methods, and not using a method of family 

planning

Country

DHS 

Survey 

year Not using

Using a method of family planning

Any 

modern

Periodic 

Abstinence Withdrawal Folkloric

Bangladesh

1999/2000 46.2 43.5 5.4 4.1 0.9

2004 41.9 47.3 6.5 3.6 0.6

2007 44.2 47.5 4.9 2.9 0.6

2011 38.8 52.1 6.9 1.9 0.4

2014 37.6 54.1 6.2 1.9 0.3

Indonesia

1994 45.3 52.1 1.1 0.8 0.8

1997 42.6 54.7 1.1 0.8 0.8

2002/03 39.7 56.7 1.6 1.5 0.5

2007 38.6 57.4 1.5 2.1 0.4

2012 38.1 57.9 1.3 2.3 0.4

Philippines

1993 60.0 24.9 7.3 7.4 0.4

1998 52.2 28.2 8.7 8.9 2.1

2003 51.1 33.4 6.7 8.2 0.6

2008 49.3 34.1 6.4 9.8 0.4

2013 44.9 37.6 5.1 12.1 0.3

Jordan

1990 60.1 26.9 3.9 4.0 5.2

1997 47.4 37.7 4.9 7.6 2.4

2002 44.2 41.2 5.2 9.3 0.1

2007 43.0 42.1 4.1 10.8 0.0

2012 38.8 42.3 3.5 14.3 1.0

Egypt

1995 52.1 45.5 0.8 0.5 1.1

2000 43.9 53.9 0.6 0.2 1.3

2005 40.8 56.5 0.7 0.3 1.7

2008 39.7 57.6 0.5 0.2 2.0

2014 44.6 53.6 0.4 0.3 1.1

Colombia

1990 33.9 54.6 6.1 4.9 0.5

1995 27.8 59.3 5.2 5.8 1.8

2000 23.1 64.0 6.0 6.3 0.7

2005 21.9 68.1 3.8 5.7 0.6

2010 21.0 72.9 2.3 3.5 0.3

Continued...
74

Appendix A.1—Continued

Dominican Republic

1991 43.6 51.7 2.0 2.2 0.5

1996 36.3 59.5 1.8 1.9 0.5

2002 30.2 65.8 1.4 1.7 0.9

2007 27.1 70.0 1.3 1.5 0.1

2013 28.2 68.6 1.2 1.8 0.2

Peru

1996 35.8 41.4 18.0 3.3 1.6

2000 31.1 50.4 14.4 3.2 0.9

2004/06 28.6 47.4 18.3 4.1 1.5

2009 26.8 50.0 15.6 6.6 1.1

2012 24.5 51.8 15.1 7.6 1.1

Ghana

1993 79.7 10.1 7.5 2.1 0.5

1998 78.0 13.3 6.6 1.5 0.6

2003 74.8 18.7 5.1 0.8 0.6

2008 76.5 16.6 4.7 1.4 0.8

2014 73.3 22.2 3.2 1.1 0.2

Kenya

1993 67.3 27.3 4.4 0.4 0.6

1998 61.0 31.5 6.1 0.6 0.8

2003 60.7 31.5 6.3 0.7 0.8

2008/09 54.5 39.4 4.7 0.7 0.7

2014 42.0 53.2 3.8 0.7 0.3

Malawi

1992 87.0 7.4 2.2 1.5 2.0

2000 69.4 26.1 0.9 1.5 2.1

2004/05 67.5 28.2 0.5 2.1 1.7

2010 53.9 42.2 0.8 1.8 1.2

2015/16 40.8 58.1 0.3 0.5 0.3

Rwanda

1992 78.8 12.9 5.1 3.1 0.1

2000 86.8 5.7 4.7 2.9 0.1

2005 82.6 10.3 4.2 3.0 0.0

2010/11 48.4 45.2 2.9 3.5 0.1

2014/15 46.8 47.5 2.7 3.1 0.0

Senegal

1992/93 92.5 4.8 0.8 0.1 1.8

1997 87.1 8.1 1.1 0.2 3.6

2005 88.2 10.3 0.6 0.1 0.8

2010/11 86.9 12.1 0.4 0.2 0.5

2015 76.7 21.2 0.9 0.3 0.9

Tanzania

1996 81.6 13.3 2.0 2.6 0.5

1999 74.6 18.7 2.2 3.5 0.9

2004/05 73.6 20.0 2.0 3.0 1.3

2010/11 65.7 27.4 3.2 2.9 0.9

2015/16 61.6 32.0 3.7 2.0 0.6

Continued...
75

Appendix A.1—Continued

Zambia

1992 85.0 8.9 0.9 3.0 2.2

1996 74.1 14.4 4.4 4.5 2.7

2001/02 65.8 25.3 1.1 5.1 2.7

2007 59.2 32.7 1.2 5.6 1.3

2013/14 51.0 44.8 0.7 3.2 0.4

Zimbabwe

1994 51.9 42.2 0.1 4.2 1.7

1999 46.5 50.4 0.2 2.6 0.4

2005/06 39.8 58.4 0.2 1.2 0.4

2010/11 41.5 57.3 0.1 1.0 0.2

2015 33.2 65.8 0.1 0.9 0.0