A few days ago, Miriam at Feministing suggested we take another look at withdrawal as a contraceptive method. Up to a point, she’s right that “it might be a useful method in low-resource situations.” If, that is, we’re talking about the sort of grinding poverty where the partners can’t even afford condoms.
Overall, though, I’m really troubled by this idea. I think it’s setting women up for more unwanted pregnancies than they already experience. (I’m leaving aside the STI issue, not because it’s trivial, but because it’s self-evident that condoms are vastly superior.)
Right off the bat, I’m suspicious of the figures Miriam cites (which come from a Guttmacher Institute report) that portray withdrawal as statistically equivalent to condoms (18% of women became pregnant with “typical” use of withdrawal versus 17% with “typical” use of condoms over the course of a year). First, other sources show a much bigger gap. Planned Parenthood says 15% of women will become pregnant with typical use of condoms over a year, versus 27% with typical use of withdrawal. (Scarleteen cites two other sources that agree on this statistic for withdrawal. Ditto for condoms. Bear in mind that the Guttmacher report is based on a single study, which ought to give us pause right there.)
Now let’s compare the ideal conditions. Even with “perfect” use, the figures are 2% for condoms, 4% for withdrawal. (Both Guttmacher and PP agree on this.) So, for those of us who’re downright obsessive about avoiding pregnancy, that means withdrawal would be twice as risky! I don’t see that as trivial.
Secondly, if we’re talking about truly low resource conditions, it makes no sense to compare condoms and withdrawal. Instead, we should be asking how withdrawal stacks up against other free methods. The various rhythm methods – which Planned Parenthood calls “fertility-based awareness methods” – fail 12 to 25% of women per year. The proposal is to educate people on withdrawal, but honestly, how much needs to be said aside from “it only works if you do it on time, every time”? Where people are too poor to afford condoms, wouldn’t it make better sense to educate women to the point where they could use a fertility-based awareness method and approach that 12% figure? Where poverty is less absolute, condoms could be used on days when conception was more likely. Or scarce resources could be allocated toward fitting women for diaphragms, cervical caps, or IUDs, which don’t require major ongoing expenditures.
But the killer argument against withdrawal, to my mind, is how dependent it makes women on their partners. Much more than condoms, it puts a woman’s reproductive fate totally at the whim of her partner at a moment when he’s not clear-headed. This may not be a big deal in a long-term relationship devoid of abuse, where both partners trust each other, know their bodies, and wouldn’t experience a pregnancy as catastrophic. These, however, are mostly not the couples who need help and education on contraception.
Think about the fifteen-year-old with a twenty-year-old partner. Can she trust him with her future? What about the thirty-year-old mother of five in sub-Saharan Africa whose husband won’t wear a condom – can she hope he’ll more willingly commit to withdrawal? How about any hookup situation, never mind where or with whom?
Even for couples where the power differential is small and the trust is great, using withdrawal effectively requires much more than “good communication.” Miriam at Feministing writes:
But I think we can all agree that we want to promote communication around safer sex.
Yes, and the key word is “around.” By all means, talk about birth control before and after sex. Communicate your desires during sex. Negotiating contraceptive decisions or timing during sex is asking for trouble, however. I wouldn’t want to stake my reproductive future on complete and reliable communication at a moment when my partner (and maybe I) are both muddled with passion.
Can we even hold men wholly culpable when they promise to pull out but don’t? Is anyone fully compos mentis when they’re about ready to come? If you’re doing sex right, the guy shouldn’t exhibit Olympian detachment at the moment of climax. Myself, I wouldn’t want to be with a partner who was having to pull back erotically (and maybe emotionally too) in order to pull out. Condoms, at least, can be donned earlier, before arousal is at its peak, when both partners are still more sensible.
Any method that collides with people’s lived experience is bound to fail, over and again. Sex isn’t a game of Tiddlywinks in which you can change the rules and expect embodied experience – and thus behavior – to follow. Apart from those folks (men, mostly) who’ve internalized porn’s money shot fetish, doesn’t orgasm feel better for most men when they’re inside their partner? Don’t their female partners sometimes feel a loss, too, if detachment has to trump connection at a moment that should be about ecstasy, not calculation? Or if the lovely friction comes to a screeching halt right when she’s verging on orgasm, herself? Can the female partner really relax and enjoy if she’s wondering whether he’ll pull out soon enough? I’ve never relied on withdrawal, personally, but I’m certain I’d find it much, much more intrusive than using condoms.
Of course, withdrawal is a time-honored method. It was the method of choice for many couples in the early twentieth century, prior to the pill. It was quite effective when used with another time-honored backup method: abortion. In Germany during the 1920s, withdrawal was the primary method. Various dodgy douches held second place; all you really need to know about them is that whatever didn’t wash out got forced up into the cervix. So withdrawal was superior to douching. It was also clearly better than nothing. But the abortion rate was estimated at half a million per year – and this in a country of 60-odd million – despite abortion being illegal and often unsafe.
There’s a moment in the film The Abortion Diaries where one of the women telling her story says, “He said he’d pull out. And then he didn’t.” She’s retelling this because it’s the moment that led to her pregnancy. Her words are clipped and bitter. This, too, is a disadvantage to withdrawal: when it fails, someone is very clearly to blame. I have no idea how many other relationships have failed as a result, but the number can’t be trivial.
So I’ve got nothing against discussing withdrawal. And perhaps the Guttmacher authors are right in saying it has a place in providing extra insurance when used with other methods. (Even there, I can’t imagine compliance would be high: if you’re on the pill, will you really feel a need for you partner to pull out, too? If a guy is already putting up with the decreased sensation of a condom, will he be motivated to finish up outside his partner?) Still, there’s no reason to be “sanguine” about withdrawal. And there’s really no good basis for recommending it as a sole method, unless the alternative truly is no method at all.
Update, 5-21-09: This study continues to draw attention from the feminist blogs: Rachel at Feministe is skeptical, while Lynn Harris at Broadsheet gives it a more sympathetic reading. I’d like to repeat that this is just a single study and its findings differ from the existing literature. That doesn’t mean it’s wrong, but it means the discrepancy requires further explanation and can’t just be asserted as the new “truth.” According to the original study by Rachel Jones et al (.pdf), most of the couples using withdrawal were also using other methods (see Nat’s comments below, as she describes the kinds of strategies the researchers also found). It’s not clear to me that you can chart withdrawal on “safe” days against condom use on “less-safe” days and produce a meaningful comparison. These are apples and oranges! I’m having trouble linking the original study (it’s a .pdf) but you can get to it from the Guttmacher summary report. Its strong point, in my view, is its phenomenologically fascinating interview material, in which people talk frankly about how they use this method, how it feels, and how it fits into their lives.