Constructing Natural Fertility: The Use of Western Contraceptive Technologies in Rural Gambia

In 1992 in 41 villages in the North Bank region of rural Gambia researchers interviewed 2979 15-54 year old women to examine the means by which this population maintains natural fertility birth intervals. Only 3.3% had ever had formal schooling. The total fertility rate was 7.5. Criteria the women used in their decision making process about contraception included effectiveness confidentiality speed with which fecundity returns after the practice ends and risk of long-term fertility impairment. Women practice postpartum abstinence for 5-7 months. Birth intervals were around 33 months. Just 5.4% of all married women with at least 1 child used Western contraceptive methods (i.e. oral contraceptives the condom or Depo-Provera). Most of the use of Western contraceptives (55%) occurred within 18 months postpartum especially 12-17 months the time when most womens fecundity returns. Few women used them for more than a few months however. After 30 months they stopped using all forms of preventing pregnancy (Western local and abstinence) suggesting that they do not intend to reduce fertility but to control its timing. Most contraceptors (69%) who had had sex in the last month used a Western contraceptive compared to just 33% of those who were not sexually active. Women were most likely to use any contraception once they begin to supplement breast milk with other foods and least likely once they wean the child indicating that they are planning for another pregnancy. Even though younger women of higher parity (5-6) were more likely to use any contraception than older women of even higher parity (9-10) they were more likely to use abstinence or traditional means to assure a return to fertility. Among older high-parity women Depo-Provera was the most common method surpassing traditional methods. These findings show that women actively find means to use Western methods to achieve a 2 year minimum birth interval which essentially does not change birth intervals and total fertility.