Withdrawal and Unintended Pregnancy

Withdrawal is a widely-used contraceptive method — recent study cohorts report an ever-use between 10 and 60 percent. When used correctly, withdrawal has a perfect use rate comparable to male condoms.

Still, more than half of the unintended pregnancies in the U.S. occur while using a contraceptive method. And withdrawal is less effective at preventing pregnancy than other methods of birth control. Since a high proportion of females use withdrawal, this may contribute to the high rates of unintended pregnancies.

A recent study published in the September 2013 issue of Obstetrics and Gynecology examined the prevalence of withdrawal among U.S. females aged 15-24 years and the correlation to unintended pregnancy. The study describes the characteristics of withdrawal users and concludes that they are at a higher risk of unintended pregnancy compared to those who use other forms of contraception. Researchers from the University of Chicago Section of Family Planning and Contraception contributed to the study.

Increased Risk

The study found a high prevalence of withdrawal use and an association with unintended pregnancy.

Using data from the 2006-2008 National Survey of Family Growth, the study found that of the sample (2,640 sexually active females between 15 and 24 years old), 31 percent used withdrawal as a contraceptive method and of these withdrawal users, 21.4 percent experienced an unintended pregnancy. Comparatively, only 13.2 percent of females who only used other contraceptive methods experienced an unintended pregnancy.

Females in this age group who use withdrawal were also more likely to engage in other risk behaviors such as having multiple sex partners. Withdrawal users were 7.5 percent more likely to have used emergency contraception, a marker for risk of undesired pregnancy.

Withdrawal is rarely discussed as a contraceptive option with reproductive health care providers.

Who uses withdrawal?

The survey data pointed to several characteristics associated with withdrawal use and unintended pregnancy. These women were more likely to have been treated for a sexually transmitted infection in the previous year (24.1 percent), cohabitate with their sexual partner, and live below the poverty line. African American females were also more likely to experience an unintended pregnancy while using the withdrawal method.

Most females in this study did not use withdrawal as their only contraceptive method. As previous studies have indicated, many females use withdrawal because they are dissatisfied with hormonal methods or condoms.

Conclusions  

As with any form of contraception, the key to successful withdrawal is using it consistently and correctly. This requires determination and communication by both partners. Given the contextual factors and fertility status of women aged 15 – 24, withdrawal is not the most effective contraceptive method.

Withdrawal is a common contraceptive method, especially for young women. As this puts them at a higher risk for unintended pregnancy, health care providers should consider their need for emergency contraception while encouraging the use of more effective methods of contraception. Clinicians should routinely ask about withdrawal use even if female patients report using barrier or combined hormonal contraceptive methods.

This study echoes our research about the need for improved access to emergency contraception. Because women often use emergency contraception as a backup when their primary method fails, emergency contraception also contributes to preventing unintended pregnancy. Plan B One-Step is available over the counter to women of all ages, but restrictions still exist to other forms of emergency contraception because of cost, the need for a prescription, or because of religious or conscientious refusal of pharmacists.

Dude A, Neustadt A, Martins S, Gilliam M. Use of Withdrawal and Unintended Pregnancy Among Females 15-24 Years of Age. Obstetrics & Gynecology 2013;  122: 595-600

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