Despite its ubiquity,
withdrawal is understudied as a family planning method. We investigated the
context of and decision making around withdrawal use, drawing on in-depth,
qualitative interviews with 38 Black and Latina women (ages 18 to 24).
We
examined contraceptive use histories to understand when and why participants
used withdrawal. The majority of participants (n = 29; 76%) had used
withdrawal in their lifetimes, though two-thirds of users mentioned withdrawal
in their contraceptive histories only after interviewer prompts.
Withdrawal was
primarily used during transitions between contraceptive methods and when other
methods were not desired. Relationship context was also an important factor, as
many used withdrawal to increase intimacy with their partners; because they
felt condoms were no longer necessary due to monogamy; or to fulfill their
partners' preferences to increase sexual pleasure. Our findings indicate that
decision making around withdrawal is embedded in situational and relational
contexts.
Future research should explore how health care providers and sex
educators can engage young women in discussions of withdrawal's benefits and
constraints.
A harm reduction framework, which recognizes that optimal use of
withdrawal is preferable to not using a pregnancy prevention method at all, may
inform the ways that withdrawal can be addressed in clinical and educational
settings.
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1a Department of Maternal and Child Health , School of
Public Health, University of California , Berkeley.
2b School of Social Welfare , University of California
, Berkeley.
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