A global perspective on contemporary trends in the use of withdrawal and periodic abstinence for pregnancy prevention

Abstract

Periodic abstinence and withdrawal (the dominant methods in the “traditional methods” category) have been used for preventing pregnancies in both historical and contemporary contexts and, in some countries, continue to be used despite the increase in availability and use of modern methods. Yet research on family planning programs and contraceptive methods often focuses solely on the use of modern contraceptive methods, thereby overlooking the trends and patterns of traditional method use. In this study, we analyze population-level survey data from 1990 to 2020 and find a global decline in the share of overall contraceptive use that is made up of these traditional methods (e.g., withdrawal and periodic abstinence), a slight decline in traditional method prevalence rates, and an overall increasing absolute number of users of these traditional methods. We then examine geographical and temporal variation in levels and patterns of use of withdrawal and periodic abstinence methods. Last, we identify countries that reached low levels of fertility since 1970 with higher levels of withdrawal or periodic abstinence use or where these methods account for a substantial portion of overall contraceptive use. We find that while reported use of withdrawal and periodic abstinence is low in many settings, it remains an important tool used in pregnancy prevention in a number of countries.