Traditional Contraceptive Use among Married Women in Indonesia: A Nationally Representative Analysis of the 2017 Indonesia Demographic and Health Survey

Family planning is a cornerstone of public health, offering women control over their reproductive lives and helping to prevent unintended pregnancies and unsafe medical procedures. In many parts of the world, the focus has long been on ensuring access to modern medical tools like pills, injections, or devices that prevent pregnancy with high reliability. However, a different set of practices persists alongside these modern options. These are traditional methods, such as withdrawing before ejaculation or avoiding sex during specific times of the month. While these techniques have been used for centuries, they generally carry a higher risk of failure if not practiced perfectly. Understanding who uses these older methods and why is crucial for health programs, not just to see if people lack access to modern care, but to understand the full picture of how families make decisions about having children.

In Indonesia, a nation with a vast and diverse population, researchers set out to examine the use of these traditional contraceptive methods among married women. They turned to a massive, nationally representative survey conducted in 2017, which gathered detailed information from nearly fifty thousand women. From this large group, the researchers focused specifically on the more than twenty thousand women who were currently married and actively using some form of contraception. Their goal was to compare the women using traditional methods against those using modern ones, looking for patterns in age, education, wealth, and where they lived. By analyzing this data with careful statistical tools that account for the country's complex geography and population structure, the team sought to identify which characteristics were linked to the choice of traditional methods.

The study revealed that about one in ten contraceptive users in Indonesia relied on a traditional method. Among those who chose these older techniques, the most common approach was withdrawal, followed by periodic abstinence. When the researchers looked deeper into the data, they found that the choice of method was not random; it was strongly linked to specific life circumstances. Women who were older, particularly those between the ages of twenty-five and forty-nine, were more likely to use traditional methods compared to younger women. This pattern held true even after the researchers accounted for other factors, suggesting that as women move through different stages of their reproductive lives, their approach to contraception may shift.

Education emerged as one of the most striking factors in the analysis. Contrary to the assumption that traditional methods are used primarily by those with less education or fewer resources, the data showed the opposite trend. Women with secondary education were twice as likely to use traditional methods as those with no education, and women with higher education were nearly four times as likely. This finding challenges the simple idea that traditional method use is a sign of limited knowledge or access. Instead, it suggests that women with more education are actively making different choices, perhaps based on personal preference, concerns about side effects, or specific family planning goals that they feel are better met by these older techniques.

The place where a woman lived also played a significant role. Women living in cities were more likely to use traditional methods than their counterparts in rural areas. This urban-rural divide persisted even when the researchers adjusted for education and wealth, indicating that the environment itself influences these decisions. In contrast, the researchers found that a woman's wealth did not independently predict her choice of method once education and other factors were taken into account. While wealthier women appeared to use traditional methods more often in a simple count, this difference disappeared when their higher levels of education were considered. This suggests that education, rather than money itself, is the driving force behind the pattern.

The number of children a woman already had also mattered. Those with five or more children were twice as likely to use a traditional method compared to women with fewer children. This points to the idea that family size and reproductive history shape how women approach contraception later in life. Interestingly, the broad geographic regions of Indonesia—whether a woman lived in the western, central, or eastern parts of the country—did not show a significant difference in method choice once individual characteristics like age and education were considered. This implies that the personal circumstances of the woman matter more than the general region she lives in.

The researchers were careful to note that while they could identify these clear patterns, the survey data could not explain the reasons behind them. The study could not determine if a woman chose a traditional method because she preferred it, because she had concerns about modern methods, or because she faced barriers to obtaining them. The data simply showed who was using what, not why. This distinction is vital for health planners, who must recognize that traditional method users are a diverse group ranging from highly educated urban women to those with large families, rather than a single group defined by poverty or lack of access.

Ultimately, this analysis paints a nuanced picture of family planning in Indonesia. It shows that traditional methods remain a relevant part of the landscape, used by a significant minority of women who are often older, better educated, and living in cities. The findings suggest that family planning programs should not assume that traditional method use is solely a result of unmet need or lack of options. Instead, these programs need to engage with a wide range of women, offering balanced information about the effectiveness and limitations of all methods, respecting that the choice to use a traditional method may be an informed decision based on a woman's unique life stage and priorities.