Although 40% of the global population relies on traditional biomass use, mainly firewood and charcoal, for cooking, traditional biomass has received very little attention in the current biomass debate, because of its considered primitive and unsustainable nature. In this review, we discuss how the sustainability of household cooking in developing countries can be improved.Indoor air pollution due to incomplete combustion of traditional biomass causes the death of 1.45 million people every year, mainly of women and children, who also carry the heavy burden of fuelwood collection. In addition, charcoal production and combustion is responsible for very high greenhouse gas emissions per unit of energy. On the other hand, fuelwood production and trade is of vital importance for local economies and serves as safety net for the poorest people. Moreover, fuelwood collection is not a driver of deforestation and global fuelwood shortage will not occur, despite local problems of fuelwood provision.There are two distinct policy alternatives to increase the sustainability of cooking in developing countries. The first option is to climb the energy ladder and to switch from solid fuels to fossil fuels (LPG or kerosene), biogas or electricity. As this largely avoids the severe health damages of traditional biomass use, this option is considered the most desirable by numerous countries and by international organizations. However, as most developing countries are far away from meeting the necessary requirements, related to infrastructure, economics and local culture, expecting a large-scale switch to liquid fuels or electricity is unrealistic.In that case, the second policy option, increasing the sustainability of the current traditional biomass system, must be considered. This can be realized by an integrated approach, in which national and regional fuelwood policies are adapted, improved systems for charcoal production are implied and improved stoves, in combination with chimneys, are distributed.