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 study 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.
"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, was published in the June 2009 issue of Contraception.
