Trends and determinants of utilization of traditional contraceptive methods among women of reproductive age (WRA) (15-49 years) in Uganda.

backgroundTraditional contraceptive methods (TCM) use is common in areas with limited access to modern options, or in settings where cultural practices discourage the use of modern methods. TCM, including folk methods, rhythm, withdrawal, and lactational amenorrhea method (LAM) beyond six months postpartum, are less effective than modern contraceptive methods. TCM are entrenched as an initial contraceptive method in many settings. We examined the trends and social-demographic factors associated with TCM use among women of reproductive age (WRA) (15-49 years) in Uganda to gain an in-depth understanding of the method-specific determinants of use, and to inform the development of targeted interventions to improve the use of the modern contraceptive method that are more effective than the TCM, and address unmet need for family planning.

methodsA secondary data analysis was performed on multiple cross-sectional datasets obtained from the nationally representative Performance Monitoring for Action (PMA) Surveys conducted between 2017 and 2024. The surveys were based on a multi-stage cluster design, typically using urban-rural and major regions as the strata. Enumeration areas were sampled to create a representative list of households. Data were collected using PMA Collect based on Open Data Kit (ODK), an open-source application with data collection tools designed, programmed and installed on mobile smartphones. We determined the prevalence of and trends in TCM use across the four surveys. Determinants of use were ascertained using the prevalence ratio (PR)_ as a measure of association. PRs, with corresponding 95% confidence intervals and p-values, were obtained using a "modified" Poisson regression model via a generalized linear model with the family as Poisson and a log link. All analyses were weighted and accounted for a multi-stage cluster design achieved via the survey set (svyset) command in STATA software version 18.

resultsOverall, TCM use has significantly increased over the years, from 3.8% in 2017 to 6.7% in 2024 (p-value < 0.0001), and contributed 11.8% and 16.4% of total contraceptive prevalence in 2017 and 2024, respectively. The increase in TCM use has been highest among women with tertiary education (6.6% to 15.3%), followed by secondary education (4.3% to 7.7%) and lowest in none/primary education (3.2% to 4.7%) between 2017 and 2024. TCM use was significantly higher in women with tertiary adjusted prevalence ratio (adj.PR) = 2.36 [1.74-3.22] or secondary education, adj.PR = 1.63[1.38-1.91] relative to those with primary or no education. Similarly, TCM use was twice as high among young (20-24 years) adj.PR = 2.43[1.79-3.29] and older (25-49 years) women, adj.PR = 2.37[1.67-3.34] compared to the adolescents (15-19 years).

conclusionTraditional contraceptive methods use, and its share to the overall contraceptive use have steadily increased over time. Socio-economic-cultural structure of TCM users is increasingly more urban, higher education, and older women, which may be reflective of empowerment. However, there is a need to assess the impact of the increased TCM use on adverse outcomes such as unintended pregnancies, abortions and maternal mortality.