Does Withdrawal Deserve Another Look?

New Review of the Evidence Suggests <br />It Is More Effective Than Widely Assumed

A new commentary, "Better Than Nothing or Savvy Risk-Reduction Practice? The Importance of Withdrawal," by Rachel K. Jones et al., published in the June 2009 issue of Contraception, highlights that withdrawal is only slightly less effective than the male condom at preventing pregnancy. Yet there is a general reluctance among health care providers and individuals alike to consider withdrawal as a viable method of contraception—even as a backup to more effective methods or as an alternative to not using contraceptives at all—which likely stems from misconceptions about its effectiveness at preventing unintended pregnancy. The article examines why this lack of enthusiasm persists despite the method’s relative effectiveness, as well as the consequences of the method’s lack of popularity.

The best available estimates indicate that with "perfect use," 4% of couples relying on withdrawal will become pregnant within a year, compared with 2% of couples relying on the male condom. More realistic estimates suggest that with "typical use," 18% of couples relying on withdrawal will become pregnant within a year, compared with 17% of those using the male condom. In other words, with either method, more than eight in 10 avoid pregnancy.

A majority of sexually experienced women rely on withdrawal at some point in their life—56%, according to the 2002 National Survey of Family Growth. (By comparison, 82% have ever used the pill, and 90% the male condom.) However, only 5% of women at risk of unintended pregnancy currently use the method (11% when those who use it in conjunction with another method are included). A smaller study, the Women’s Well-Being and Sexuality Study, found that 21% of younger and more educated women were using withdrawal.

Withdrawal does not protect against sexually transmitted infections and, therefore, is not an appropriate method for a number of individuals. However, it can substantially reduce the risk of pregnancy for those who have difficulties using other contraceptive methods, including women who have trouble taking pills regularly and couples who prefer not to use condoms, and for those who have unplanned sex and have no other method available to them in the moment. In addition, it is free and requires no planning.

"Hormonal and long-acting contraceptive methods, such as the IUD, are the most effective means of preventing pregnancy," says lead author Rachel Jones of the Guttmacher Institute. "However, these methods are not suitable for or available to all women. Also, we’re hearing anecdotally that because of the current economy, fewer women are able to afford these more effective methods, yet many cannot afford to have another child right now. For these couples, withdrawal may be a good backup option when used in conjunction with condoms. Withdrawal can provide ‘extra insurance’ against pregnancy for all couples, even those using hormonal methods. And withdrawal is far more effective at preventing pregnancy than use of no method at all."

The authors also found that many individuals participating in related qualitative studies did not mention withdrawal when asked what they thought of when they heard the terms "birth control" and "contraception," because they did not consider withdrawal a contraceptive method or thought it was ineffective at preventing pregnancy. They suggest that if people realized that correct and consistent use of withdrawal substantially reduces the risk of pregnancy, they might consider it—and use it more effectively. Health care providers and health educators should discuss withdrawal as a legitimate, if imperfect, method when counseling individuals about their contraceptive options.

Click here for "Better 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, published in the June 2009 issue of Contraception.

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