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Withdrawing Denial, Dealing With Withdrawal

Mon, 2009-05-18 17:07 — figleaf

Megan of Jezebel passes along some kind of cool, kind of ominous information about the effectiveness of the old-fashioned “withdrawal” method of birth control. Quoting Rachel K. Jones in the magazine Contraception she says

[Withdrawal] is not as ineffective at preventing pregnancy as we might think.

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.

So, if it’s just pregnancy we’re concerned with avoiding, it’s actually not the worst choice.

Read the quote in context here.

I’m reminded of the line we were given when I was a teen peer councilor at a sex information hotline back when pregnancy was the biggest concern because all common STIs were still curable with antibiotics: “Condoms… they’re better than nothing… barely.”

Jones mentions using withdrawal in conjunction with other forms of birth control, which is actually always a good idea anyway. Score one for the evident ongoing migration of the unfortunate “money shot” phenomenon from porn to real life.

But Megan passes along Jones’s main point: it’s time to stop stigmatizing women (I’d say women and men since, now that I think about it, it’s an actual third way men can contribute actively to contraception besides condoms and vasectomies) and…

start talking about it in a scientific fashion with their patients, and that they stop telling women who use it that they might as well use nothing at all — which is both inaccurate and unhelpful.

If people are going to keep using it — and statistics suggest a heck of a lot of people do — then yeah, might as well give it a good, hard look and make sure you know what you’re talking about when you talk about it. We don’t have to like it, but especially if it’s in the ballpark with other common alternatives then dealing with is a whole lot more effective than denial.

Mon, 2009-05-18 20:42 — 2952 (not verified) #permalink

Uh-huh. My first child was conceived using the oh so awesome withdrawal method. let us NOT encourage ppl! pleeze!

[Hi Lisa. For the record I still think it’s insane to trust just condoms so believe me when I say I’m the last person on the planet to believe anyone should trust a method that’s even less effective than that. (Though, in practice, only 1% less.) But looking at the numbers it looks like it gets resorted to way too often to whistle past. To be honest what appeals to me would be using it in combination with other less than 99% reliable methods. (Obviously you want to wear condoms for reasons other than contraception as wel… but if pregnancy is also a risk it’s better to ejaculate somewhere where a broken or slipped-off condom isn’t going to result in pregnancy.) But one way or another, the better it’s understood by researchers and educators, and the better that information (including the insanely risky downsides) is communicated to users… well… the better. Thanks. —fl]

Mon, 2009-05-18 21:31 — 2952 (not verified) #permalink

That’s only a valid comparison if doing the withdrawal method “perfectly” is at least equally easy to using a condom “perfectly”.

Tue, 2009-05-19 11:05 — 2952 (not verified) #permalink

That’s actually a lower figure for typical use of condoms than is usually stated near anywhere else: they are generally stated, by credible sources, to be 85% effective with typical use, while withdrawal is given around a 73% typical use figure (Contraceptive Technology is still consistent with those figures, and that’s basically the bible for this info). The perfect use figure is nothing new: we’ve had that for a long time.

So, I’d want to see a citation for the figures she’s using, which I don’t with the article.

I’d also factor in that it’s important to bear in mind age groups when we talk about withdrawal. how fertile women are makes a BIG difference, so we’re going to see larger failure rates for younger women — who typically are left out of studies — than older ones. And the same goes for men when it comes to typical or perfect use: for younger men, who’ve less control over and familiarity with ejaculation, it’s more likely to fail.

But yes, by all means, no need to talk about this method differently than we talk about others. However, working in repro health, I’ve generally found it already is.

Tue, 2009-05-19 12:52 — 2952 (not verified) #permalink

FYI, I just dug into the paper, and I’d personally not be comfortable, based on what was cited, saying that the typical use rates for withdrawal have changed that drastically/are that different from the other studies we have.

It’s clearly noted that the sample size of women using withdrawal alone was very small, and this isn’t about lab-controlled studies, but self-reporting. It’s also primarily based on but one 2002 census of contraception use.

So, me? I’m not changing our figures on this yet: I’d want more study and better study first, and for a couple different studies to find the same results.

[Hi Heather! Dang it all, I just realized I’ve mentioned this in multiple posts now without ever getting around to clarifying that when I think of “withdrawal” I’m not thinking so much about “get to the edge and pull out in the nick of time.” And certainly not as a primary form of contraception(!!!) Which may or may not be what Jones is talking about either. Instead I’m thinking more along the lines of just getting away from the whole idea of ejaculating inside someone. Or getting close. And preferably I’m thinking in terms of using a condom and still not ejaculating inside one’s partner. Or at least while talking in terms of contraception inside one’s partner’s vagina. Thanks. —fl]

Sat, 2009-05-23 10:17 — 2952 (not verified) #permalink

Thing is, that’s not, to my knowledge, how withdrawal is usually defined or practiced. I’ve listened to a lot of people talk about withdrawal during my years doing the work I do, and it usually is a wait-til-the-last-minute affair in common practice.

And if you’re taking efficacy stats like she was in the piece, and NOT showing combined rates (for using it with something else), then you are talking about it as a sole method. The rates she posited were for it as a sole method, even though, again, it was stated the sample size for those reporting using it that way was very small.

FYI? I got asked about this last week by three different press folks, and the conclusion I have come to is that a) I really loathe this piece, and b) I don’t understand why it is people are SO quickly affixing to ONE new piece of data from one study that wasn’t even on withdrawal specifically, especially when it’s so different from all the other information we have. I can’t think of another single piece on contraception where I saw so many people immediately shout out that something was more effective than we thought so confidently, and it strikes me as really irresponsible, particularly given how flawed a study this is on this. Honestly, I am flummoxed.

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