A new Guttmacher Institute report, published in Contraception, treats the withdrawal method (aka “pulling out” or coitus interruptus) like a serious method of birth control. This is creating a few ripples in the women’s issues blogosphere.
I was not surprised at all when this article was written, since other sources have long included withdrawal in the discussion. I have always included withdrawal when comparing methods of birth control with poor success rates. The sponge and the cervical cap, especially in parous women (women who have already had a child), spring to mind. Neither offer much STI protection, and the sponge may have side effects such as local irritation. I was surprised, years ago, when I saw a comparison of success rates, and the much derided non pharmaceutical methods such as withdrawal and the fertility awareness (aka symptothermal method, natural family planning, rhythm method) had moderate success rates and fit firmly in the sorta crappy second tier of birth control.
This is the tier my two sons come from. My older, condom son and my younger, vaginal contraceptive film son. I would have never considered withdrawal or fertility awareness. I was in long term monogamous relationships both times and knew that STIs were not a problem. Both would have been good options for me. I cannot use hormonal methods, since I get migraines. Many women don’t want to use hormones or get significant side effects from hormonal methods. I am not saying they don’t work remarkably well for many women, and may even have some therapeutic applications. Different women with different health issues have different needs.
I have known women who have used the withdrawal method intentionally. No, not drunken teenagers, but a woman with a master’s degree in a long term relationship and a midwife(!) who knew the odds and decided it worked for her and her partner. At least one of the sites I linked to above says it shouldn’t be ignored but it shouldn’t be encouraged (and one questioned the ability of teenagers to use the information wisely, which I think is the problem with abstinence only education).
I don’t think any method of birth control should be encouraged. I think every method should be presented without bias, either bias from the sex-is-bad-don’t-encourage-it camp or the must-be-a-pill-or-a-medical-device-or-it-doesn’t-count camp. I thank the medical science gods (ha!) every day for my copper IUD. If it wasn’t refused to me (with bias and non-scientific information from an ob/gyn) I wouldn’t have a contraceptive film child. If I didn’t succumb to “I don’t care what the failure rates say, if it’s a pharmaceutical method, it must be better than our other options” bias in my own head, I wouldn’t have a contraceptive film child. Don’t get me wrong, I love Z and without being refused my IUD the first time and having him, I wouldn’t be the MomTFH I am today, since I ended up training as a midwife at the birth center.
But, I love my IUD now. It is the ideal option for me. It doesn’t protect against STIs. It has a fantastic pregnancy prevention rate. It’s ideal use rate is almost identical to its real use rate, which is what I need. Less room for human error. When I talk about my IUD, I try to present it as honestly as possible. Mutual masturbation is a very viable option that is enjoyed by teenagers extensively. That may not have been ideal for my marriage in my twenties, but at 16 it was a fine option. I know women who are passionately dedicated and successful (to different degrees) with the symptothermal method. I know women who love their pill, hate their pill, and swear they have gotten pregnant on the pill. Hell, IUDs are the top of the top tier of pregnancy prevention, and at the recent ACM some medical students were joking about how their reproductive endocrinologist professor got his wife, their maternal fetal medicine professor, pregnant with twins even while she had an IUD in!
Let’s talk about it all. My ideal teen sex education program would talk about withdrawal and mention how it is dependent on the male being able to control himself, be trustworthy, be sober, and will not prevent STIs. Then I would present the failure rate. I would also talk about sex toys, masturbation, homosexuality, abstinence, anal sex, oral sex, abortion and other topics.
My (almost) ideal sex ed program may be coming to teenagers soon, actually. But it’s not going to be in schools. Rumor has it the Midwest Teen Sex Show is coming to Comedy Central. I hope it does to abstinence only education what the Daily Show has done to cable news.