Reading the new report published by the Guttmacher Institute (PDF) on the withdrawal method of contraception -- better known by laymen as "pull and pray" -- you get the strong impression that the authors are simply contributing new data to the discussion about this method in public health circles.  Researchers cobbled together the shockingly small amount of research on withdrawal as a method of contraception to suggest that the preliminary findings - 4 percent failure rate for perfect use/18 percent for typical use - could possibly indicate that it's not as bad a pregnancy prevention method as usually assumed, but, of course, more research is needed.  But in the meantime, the authors suggest there's nothing wrong with teaching it to couples with low STI risk as a way to mitigate risk of unintended pregnancy if you're using no method of contraception, or as a back-up to pills or condoms, particularly if you have a history of using those methods improperly.

What they intended was a sober-minded discussion of risk mitigation, with a particular focus on withdrawal as a back-up method.  What they got was an extremely emotional and divisive reaction.  The mainstream media's take was to have a sexist chuckle over how women weren't going to like this, ha ha ha.  Jezebel defensively argued that this should mean women who use it as their primary method of birth control should get a pass on being judged by others, even falsely claiming that it's not the "worst" method, even though with an 18% typical use failure rate, it might actually be, if you're using it as a primary method. Feminist blogger Lindsay Beyerstein pushed back, pointing out that the paper is not an actual extensive study, and shouldn't be treated with the same weight as thorough research.  In an article by Dana Goldstein, Heather Corinna got to the heart of why this subject raises so many hackles, when she pointed out that withdrawal is associated with pushy young men who exhibit disregard for women's health or wishes.

The problem with much of the reaction is that it's based on the assumption that the papers' authors were advocating withdrawal as a method on par with hormonal or barrier methods.  When asked about it in email, study author Rachel Jones responded: 

I can't say I'm surprised, but I'm still disappointed, that folks are interpreting the commentary and the subsequent coverage it has generated to mean that we are advocating that they use withdrawal. The point of the article was to inform, or remind, folks that withdrawal substantially reduces the risk of pregnancy; those of us who work in the field of sexual health do everyone a disservice by unilaterally dismissing it as ineffective..... Alternately, talking about it as a secondary or back up method-for example, when the condom breaks, when the woman forgets to take her pill, or "doubling up" so as to be extra sure that the woman doesn't get pregnant-might result in fewer unintended pregnancies.

Indeed, the paper itself mostly focuses on the use of withdrawal as a back-up method employed along other methods, or as something to fall back on for couples that don't have anything else on hand, but aren't letting that deter them from having sex.  Which happens, even if it makes many of us uncomfortable discussing it.

What Guttmacher researchers tripped over in this discussion about risk mitigation was the almost-startling revelation that the public at large has strong stereotypes and opinions about withdrawal, and the people who use it.  As the defensive post at Jezebel demonstrated, it's widely believed that women who use withdrawal are rolling over for some man who has openly demonstrated his contempt for her well-being by refusing to wear a condom.  Candidly, that's what first comes to mind for me, as well--and let's face it, I thought, if a guy cares for you so little he uses the "we don't need a condom, I'll pull out" line, then odds ratchet up dramatically that he won't keep that promise.  Because he's already shown that he doesn't care. 

Using the utterly unscientific method of asking people on Twitter and Facebook what they thought of when they thought about withdrawal, I found that many others didn't immediately think of sexist men pushing doormat women around, as I did.  Instead, they thought of people who are so prudish and afraid of dealing honestly with sexuality that they find themselves having sex without even trying to obtain contraception ahead of time.  People associated it with drunken sex, with abstinence-only education, being under-educated, and having a fear of sexuality drilled into your head by religion.  A few people agreed with these stereotypes, but actually said it worked for them when they were in the position of being too uneducated or scared to use more effective methods.  More often, people made cracks about how people who use it call themselves parents, and disdained the idea that perfect use could even work, because it's much easier to slip up than it is with condoms. Some people suggested that it was okay if you were okay with having a baby, or keeping emergency contraception on hand.  Interestingly, no one suggested that abortion was an appropriate backup.

With an emotionally laden topic like this, therefore, it really isn't surprising that the Guttmacher paper got the reaction that it did.  For people who feel ashamed of relying on withdrawal, either as a primary or more commonly as a back-up method, there was an over-eagerness to embrace the paper as vindication, much like when people mistakenly believe that "no saturated fat" means the same things as "no calories,", or that chocolate or wine is actually good for you, because they think they read in the paper that both had health benefits.  For people who associate withdrawal with everything from lack of education to the abuse of women, reading the paper from Guttmacher was frustrating, and even alarming, as it was seen as potentially giving people "permission" to avoid more reliable methods.

In reality, it's neither.  The wishful thinkers would do well to reread the paper and realize that the sample sizes are small, the questionnaires are inexact, the method mostly crops up as a back-up (making it hard to measure), and mostly the topic is ignored on surveys.  In fact, one of the aims of the paper is to call for more rigorous study of the topic.  Those of us with negative gut reactions would do well to remember that the authors weren't saying that withdrawal should be promoted as an acceptable primary method, especially for teenagers or non-monogamous people, but more as a back-up, with the knowledge that people are often not so great at using their primary methods and could benefit from using two methods at once. But above all, we need more research, both in the method's effectiveness and on social attitudes about withdrawal that might make it harder to incorporate in a risk reduction strategy than it might seem on its surface.