Why Young Women are Still Using the ‘Withdrawal’ Method to Prevent Pregnancy

About one-third of young women are relying on the “withdrawal” method — trusting their male partner to pull out before ejaculation — in order to avoid pregnancy, according to new research that will be published in an upcoming issue of the Obstetrics & Gynocology journal. Those women are opting to use that old-fashioned method even though it’s much less reliable than other forms of birth control.

Researchers at the Duke University Medical Center analyzed data from 2,220 participants in between the ages of 15 and 24, and found that 31 percent of those women had used withdrawal as a form of birth control at least once. Twenty one percent of the women who had used the “pull out” method experienced an unintended pregnancy, compared to only 13 percent of the women using modern forms of contraception. Women relying on withdrawal were 7.5 percent more likely to have used a form of emergency contraception, like Plan B.

Of course, family planning experts aren’t surprised the new study has confirmed that the withdrawal method isn’t very effective. They’ve known that for a long time — and they suspect doctors don’t even think to address “pulling out” with their patients because it’s such an antiquated form of birth control.

So why are so many young women still relying on it, when there are so many more effective contraceptive options available? It may be easy to assume that young people are simply being irresponsible with their sexual health, but that’s not exactly the whole story.

Women’s health experts suspect there are still several barriers to contraception for young women, particularly since the United States still uses the outdated policy of tying oral birth control pills to a prescription. “Many contraceptives are short-acting and require a lot of action on the part of a woman,” Dr. Kari Braaten, an obstetrician-gynecologist at Brigham and Women’s Hospital who wasn’t involved with the study, pointed out. “Using a condom, having a condom, going to the store or pharmacy to get one. Refilling the pill, taking it every day, getting a prescription refilled. Travel and moving. So many issues make these contraceptive methods difficult to use or to be consistent about.”

Aside from the logistics, stigma remains an issue for many women, particularly those who live in more rural areas. Not everyone is comfortable with walking into their local pharmacy and picking up condoms or a birth control prescription.

And more generally, problematic cultural attitudes about birth control still influence Americans’ decisions about whether to use it. Not every woman may feel comfortable convincing their male partner to wear a condom if he’s resistant to the idea — and many young people may not see the point of using modern contraceptives at all, if they’ve sat through abstinence-only education courses that have taught them they aren’t actually effective at preventing pregnancy. The persistent emphasis on women and birth control — rather than including men in discussions about effectively preventing pregnancy — is part of the problem, too.

Cost can also be prohibitive for young people who want to avoid pregnancy. Modern forms of birth control are expensive, and research conducted in 2012 found that nearly half of young women said they hadn’t used their preferred method of birth control as directed in order to cut down on costs. A recent study also found that birth control can actually be more expensive in low-income areas, which likely suppresses its use among poorer women.

There is some hope. Obamacare helps improve women’s access to birth control by requiring employer-based insurance plans to cover modern contraception without charging a co-pay, and an estimated 27 million women are currently accessing no-cost preventative care under that provision. Researchers may eventually find different results once they’re able to survey women who have benefited from the health reform law, since the data used in this new study was gathered between 2006 and 2008.

In addition to the progress under Obamacare, doctors emphasize that encouraging more women to use long-lasting forms of birth control could also lower the number of partners opting for withdrawal. “One of the things we need to do is improve access to long-acting methods like IUDs and implants, so we minimize these experiences and encounters where women find themselves needing to rely on an ‘emergency’ form of contraception like withdrawal or Plan B when they’re otherwise unprepared,” Braaten explained. Although parents largely remain resistant to this sexual health resource, the American College of Obstetrics and Gynecology encourages doctors to recommend IUDs to their teen patients.

Photo Credit: Thinkstock


Jim V
Jim Ven4 months ago

thanks for sharing.

Kathy Perez
Kathy Johnson4 years ago

I got pregnant while on the pill :o but this go 'round we didn't really try to NOT get pregnant. It can be very expensive to get bc every month. Mine was $60 a month, and the new perscription after I had my son was $120 a month. for a single mom? that was a lot. Mine wasn't even really for pregnancy prevention but for regulation of very crazy cycles (I had to go to the hospital many times bc I bled for 22 days, 35 days ect and lost too much blood)

Phillipa W.
Phillipa W4 years ago

unbelievable. I don't think inconvenience is the issue when it comes to contraception being prescription-only, I think it's more to do with the cost of seeing a doctor.

Manuela C.
Manuela C4 years ago

I don't even trust a man to put on a condom... I would never trust that a guy would pull it out before ejaculating (and, of course, some semen can make its way out before that)!

Pia M.
Pia M4 years ago

Sorry, it seems my previous comment was too long. I'll continue it here:
- - and if everything seems to go smoothly, a "permanent permission" to acquire hormonal contraception over the counter? However, I consider the annual checkups and bi-annual Pap smears essential to reproductive health, and I don't quite understand why they're described as "antiquated practices" in articles (via ThinkProgress and Mother Jones). They make it sound like a patriarchal scheme against women's lib - personally, I'm only happy that I have the opportunity to PREVENT health problems or get them fixed at the earliest possible stage.

Pia M.
Pia M4 years ago

I disagree with the view that "tying birth control pills to a prescription is an outdated policy". The links from the article to another one and to another one don't give information on countries where birth control pills can be purchased over the counter, but "Higher income countries — western Europe, Australia, Japan and North America — generally require a prescription". Gee, maybe because in higher income countries consumer safety is taken more seriously than in e.g. China and India? Hormonal contraception can cause serious side effects, and a visit to a doctor should be required before choosing a hormonal method to find out whether there are certain risk factors (or contraindications) and to inform about possible drug interactions. I don't know about the practices in other countries, but in my country you need to take a liver function test after the first 2-3 months of using contraceptive pills to see if they suit your body or not. I've never had any side effects from contraceptive pills, but one of my friends had to ditch them because of elevated liver enzymes. I strongly support reproductive rights and an easy access to affordable, safe and effective birth control, but I think that offering hormonal contraceptives over the counter carries too many health risks. Perhaps some sort of a compromise - an initial checkup with health risk assessment etc., followed by a liver enzyme test a couple of months later - and if everything seems to go smoothly, a "permanent p

Glenda L.
Glenda L4 years ago

Give me a break, it's not that difficult to get and use a condom!!

Sonali G.
Sonali G4 years ago

There is so much choice these days so why are so many women using this method?? Even I was told many years ago that it is potentially completely ineffective. Condoms and pill. Belt and braces.

Mark Botermuc
Mark p.muc4 years ago

o g. ... ty ...

Alice Mullen
Alice Mullen4 years ago

Shocking that people can be so irresponsible. There are so many options for contraception. USE THEM