Qualitative Understandings of the Persistent Use of Traditional Contraceptive Methods Using Socio-Ecological Model among Older Reproductive-age Women in Bangladesh

Background: The continued use of traditional contraceptive methods (TCM) among older reproductive-aged women (aged 35–49 years) in Bangladesh poses a significant public health issue. Existing research in Bangladesh suggests that women of this age use TCM more than their younger counterparts do. However, the reason why TCM use is higher among Bangladeshi older reproductive-age women is yet to be explored. The current study attempted to understand the use of TCM among Bangladeshi women aged 35 years or older. Methods: This qualitative study used purposive sampling from the Khulna district to conduct ten in-depth interviews among women aged 15-49 years and seven key informant interviews among family planning service providers. The socio-ecological model was adopted in this study. Data was collected in January 2024. The interviews were audio-recorded and transcribed verbatims afterward. Thematic data analysis was performed. Results: The study found that women’s poor knowledge and fear of the side effects of modern contraceptive methods and perceptions related to the effectiveness, risk and benefits, ease of use, and cost shaped the use of TCM at the individual level. The interpersonal factors included the influence of spouses, mothers-in-law, and peer groups. Community norms and beliefs were pivotal as well. Institutional-level factors included providers’ attitudes, health facility-related issues such as distance from the house, waiting in queues, and unavailability of products, and policy-level influences such as lack of updated policy molded the TCM use among older reproductive age women in Bangladesh. Conclusion: A complex interplay of various level factors shapes the use of TCM in Bangladesh. As a result, comprehensive reproductive health education programs should be considered so that women can make informed choices about the use of contraceptives and switch from traditional to modern contraceptive methods, such as long-acting methods. This will ultimately lead to better reproductive health outcomes in Bangladesh.