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But We *Still* Need To Take Withdrawal Into Account

Tue, 2009-05-26 20:55 — figleaf

That said, I’d like to comment on the widely, widely pulled… but also widely misinterpreted pull quote from the introductory paragraph of “Better than nothing or savvy risk-reduction practice? The importance of withdrawal“ (pdf) by researchers Rachel K. Jones, Julie Fennell, Jenny A. Higgins and Kelly Blanchard of the Guttmacher Institute published in Contraception magazine.

Having now read the darn thing I think Jones might still be a bit more sanguine than I or, say, Scarleteen might be about the feasibility of withdrawal as a viable form of primary birth control if your really don’t want to get pregnant her paper indicates it’s still an important consideration.

Jones makes the point that because withdrawal isn’t considered a viable form of contraception it’s often not mentioned at all in surveys of contraceptive use, with results-fuzzying results

  1. It’s often not mentioned in questions by researchers because they don’t consider it a valid method
  2. It’s often not volunteered by respondents because they don’t consider it a valid method either, even though
  1. An evidently large, but largely undetermined, number of people still do it at least occasionally

The result is the extent of its use, or effectiveness, isn’t as well understood as it could be.

But there’s another consequence that Jones unearths: there’s considerable evidence that couples use withdrawal in combination with other methods more often than researchers take into account. With the result that the actual effectiveness of other methods may show up looking better than they really are.

For instance if very many users of the newly-re-reintroduced Today contraceptive sponge (made famous in the 90s in a Seinfeld episode) also used withdrawal its already pretty-awful failure rate (a not at all “spongeworthy” 16-36% likelihood of pregnancy each year!) might look even worse that it seems.

But is it? Do they? Should we? The message from Jones is it’s hard to say because we don’t really know.

Thus the first affirmative result from Jones’ paper her admonition that withdrawal needs to be better studied and better understood is dead on.

Tue, 2009-05-26 22:24 — 2969 (not verified) #permalink

I agree that it’s good to know how effective it is, but at the same time… I don’t really want this to get much press if it’s just kinda effective, because I don’t want “c’mon, I won’t come in ya” to be any more popular an excuse for not using condoms than it already is.

Tue, 2009-05-26 23:45 — 2969 (not verified) #permalink

Huh. That never would have occurred to me. I mean, the birth control methods I’ve used are pretty reliable so it’s hard to see the benefit of making them twice as effective at three times the annoyance factor!

Wed, 2009-05-27 08:08 — 2969 (not verified) #permalink

Figleaf, I’m glad you’re looking at this in a more nuanced way. I don’t see anything wrong with people using withdrawal even in the “risky” way it’s typically understood if they would be okay with an unplanned pregnancy, either because they were already planning to have children (but not quite yet) or because an early abortion would be an acceptable option for them. And by all means, it’s good to understand how people actually use (and don’t use) contraceptive strategies, as opposed to how they’re “supposed” to use them.

My concern is much more that the press release-style report on the Guttmacher website (more so than the actual article) really plays up the idea that failure rates for withdrawal are virtually equivalent to the condom. However, the evidence for that in “typical use” is pretty thin – a single study that Jones et al. cite in a footnote. Maybe that study is so excellent that it supersedes all the research that came before – but if so, why haven’t Planned Parenthood or Scarleteen adopted its 18% failure rate?

Even if you look at “ideal” use, condoms have a 2% failure rate versus 4% for withdrawal. That means condoms are (ideally) twice as effective. Used correctly and every time condoms are actually pretty good. (They worked 100% for me over a period of several years, but by then I was also in a committed relationship with another hyper-diligent person). Condom failures are mainly due to a very simple reason: The condom stayed in its package. Actual breakage is much less likely (especially if you use lube, which I suspect many people don’t).

And I’m with Plymouth – I’m just astounded that a substantial number of people are on hormonal contraception, yet are so worried about pregnancy that they pull out, too. At what point does risk awareness make sex all about danger at the expense of pleasure?

Wed, 2009-05-27 09:51 — 2969 (not verified) #permalink

Oh, I’m sorry if my first sentence comes across as patronizing. It sure wasn’t meant that way, but I can see it could be read in a know-it-all tone. And while that may still be one of my character flaws, I just meant to say I really appreciated this post and the preceding one; I think they’re insightful and fruitful. Hope that clarifies. :-)

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