Withdrawal as Contraception: Why So Skeptical?

To my surprise, my recent article in the journal Contraception on the effectiveness of withdrawal in preventing pregnancy unleashed a mini-storm of commentary in the blogosphere.

To my surprise, my recent article in the journal Contraception
on the effectiveness of withdrawal in preventing pregnancy unleashed
a ministorm of commentary in the blogosphere. On Jezebel alone, an article on the
had (at last
count) 15,000 views and well over 300 comments – more attention than
was garnered by "Slutty Feminists," a popular topic on which Jezebel
also posted around the same time.  

The original article – written
for health care professionals and social scientists who deal with contraception
and family planning – presented data showing that withdrawal, widely
viewed as useless in preventing pregnancy, is only slightly less effective
than condoms.  Used consistently and correctly, condoms and withdrawal
are both very effective; even with typical use rather than perfect use,
both are comparable, at 17% and 18%, respectively. I also noted that
while many women use withdrawal at some point in their lives, often
as a back-up or secondary method (most commonly in alternation or in
conjunction with condoms), there is persistent reluctance among professionals
and individuals alike to consider withdrawal as a viable method of contraception.  

It’s great to see such lively
discussion about withdrawal and intriguing to see the comments, the
most interesting of which fall into three broad categories: personal
accounts of using withdrawal; skepticism, or outright disbelief, that
withdrawal reduces the risk of pregnancy; and claims that withdrawal
places responsibility on the male, who may be less than trustworthy
given the self-control required. 

The many personal accounts
of withdrawal use – in keeping with data showing that 56% of women who
have ever used a contraceptive method report using withdrawal at some
point in their lives – make clear that the method is part of the contraceptive
repertoire for many women, if only occasionally for most. It suggests
that sex education curricula and health care providers should present
withdrawal in its proper context, with both pros and cons, rather than
simply disparaging the method or erroneously presenting it as comparable
to using no method at all.  

This general view of withdrawal
informs another response – sheer disbelief. In my work I’ve grown
used to promoters of abstinence-only-until-marriage programs dismissing
facts about the effectiveness of contraception. However, I’m surprised
to see such disparagement of withdrawal among a crowd that is presumably
younger, more diverse and more open-minded. Perhaps because most of
us have been told for so long that withdrawal doesn’t work, we are
unable or unwilling to embrace scientific evidence that counters what
we "know." 

Most interesting, perhaps,
is the response expressed by many that men can’t be trusted to withdraw
in the heat of the moment. Sometimes it seems men can’t win for losing
when it comes to sexual and reproductive health. We argue that contraception
is a couples’ issue and that women should not be solely responsible,
yet we don’t think men can handle the responsibility. While some women
may not be comfortable depending on their partners to pull out before
ejaculating, and some men may not be able to do it, that does not mean
we should promote a false view of the method’s effectiveness. Withdrawal
may not be appropriate for some couples and individuals, but it is being
used at times by many, so why not ensure they have accurate information
about it?

Withdrawal will not prevent
exposure STIs and is not appropriate for those at high risk of exposure.
But I don’t buy the argument that accurate information about withdrawal
will discourage folks from using condoms and more effective hormonal
methods. The same argument was made about emergency contraception, and
numerous studies have demonstrated that the concern was groundless.
Disparagement of condoms by conservatives has led to more people putting
themselves at risk for STIs, including HIV, because they’ve been told
"condoms don’t work." Although no method can guarantee 100% protection,
condoms are an important option for both STI and pregnancy prevention,
and withdrawal should be considered as an option for preventing pregnancy.

For me, most heartening were
comments like the one offered by Flackette Goes Retro on Jezebel: "I
think the answer here is really just to give people lots and lots of
facts and education on their options. That includes failure rates for
all the various types of BC (pills, IUDs, condoms, withdrawal, NFP,
whatever-all of it, both perfect and "typical" use), information
about the pros and cons, information about protection from STDs (even
if condoms aren’t perfect they are MUCH MUCH better than nothing) and
information about how their bodies work. Then hopefully people will
be able to make informed decisions." Well said.

Than Nothing or Savvy Risk-Reduction Practice? The Importance of Withdrawal,"

by Rachel
K. Jones
of the
Guttmacher Institute, Julie Fennell of Central Connecticut State University,
Jenny A. Higgins of the Office of Population Research at Princeton University,
and Kelly Blanchard of Ibis Reproductive Health, was published in the
June 2009 issue of Contraception.