Use of withdrawal (coitus interruptus) for both pregnancy and HIV prevention among young adults in Rakai, Uganda

Declining yet persistent use of traditional contraceptive methods in low- and middle-income countries

Traditional contraceptive methods are used by 55 million women in developing countries. This study analysed over 80 national surveys to compare traditional with modern method users, by type, region, socio-demographic characteristics, strength of family planning programmes and discontinuation rates. The advance of modern methods has greatly reduced the share held by traditional methods, but the actual prevalence of their use has declined little. Young, sexually active unmarried women use traditional contraception much more than their married counterparts. Discontinuation rates are somewhat lower for traditional methods than for the resupply methods of the pill, injectable and condom; among users of all of these methods, more than a quarter stop use in the first year to switch to alternative methods. Traditional method use is firmly entrenched in many countries, as the initial method tried, a bridge method to modern contraception and even the primary method where other methods are not easily available.

Contraceptive values and preferences of adolescents and young adults: A systematic review

OBJECTIVE

We sought to systematically review the literature on values and preferences for contraception among adolescents and young adults globally.

STUDY DESIGN

We searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding end-users' values and preferences for contraception. We included studies that report specifically on people up to 25 years old.

RESULTS

Fifty-five studies out of 7,846 met our inclusion criteria. These studies included participants aged 10-25 years and were conducted in 16 countries. Through open coding, we identified 18 content areas. The five most commonly discussed content areas were: (1) general preferences regarding contraception, (2) contraceptive method benefits, (3) contraceptive method drawbacks, (4) the influence of the social context, and (5) the influence of myths and misconceptions, including safety and side effects, on contraceptive choice. Privacy and autonomy were important overarching themes, along with safety of the method. These considerations affected participants' access to and use of contraception.

CONCLUSION

Various social, cultural, and method-specific factors influence a young person's values and preferences around contraceptive methods. Understanding their values and preferences can help providers and programs improve contraceptive care for young people.

Pre-ejaculate fluid in the context of sexual assault: A review of the literature from a clinical forensic medicine perspective

Much has been written about the presence or absence of spermatozoa in pre-ejaculate fluid (PEF). Published studies only have a small number of participants; their results are conflicting, may be inaccurate and findings have not reached statistical significance. There are potential methodical issues. However, upon review, the possibility exists that PEF may sometimes contain viable spermatozoa. Additional forensic science differentiation may be required to determine whether or not any spermatozoa found on a swab/stain originate from PEF or ejaculate. This may have implications for sexual assault cases.

"Is That A Method of Birth Control?" A Qualitative Exploration of Young Women's Use of Withdrawal

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.

Which young adults are most likely to use withdrawal? The importance of pregnancy attitudes and sexual pleasure

OBJECTIVES

Use of withdrawal (coitus interruptus) has consequences for reproductive health, but few nationally representative studies exist. We (1) examined patterns of withdrawal among 15- to 24-year-old women and men, and (2) explored withdrawal's associations with sociodemographic, psychological, and sexual factors.

STUDY DESIGN

Using data from the 2006-2010 National Survey of Family Growth, we assessed reports of any and only withdrawal use at last sexual episode in the last month from 3517 sexually active 15 to 24 year-old women and men at risk of unintended pregnancy. Logistic regression documented associations with withdrawal.

RESULTS

Fourteen percent of young women and 17% of young men reported any use of withdrawal at last sex; 7% and 6%, respectively, reported only use of withdrawal. Though associated with few sociodemographic factors, withdrawal was significantly linked with pregnancy- and condom attitudes. In regression models, compared to those who said they would be upset if they discovered they were pregnant, young women who said they would be pleased about a pregnancy were 2.2-2.6 times as likely to have used any/only withdrawal (p<.01). For both women and men, those who felt that condoms were likely to diminish sexual pleasure were more likely to have used any/only withdrawal (odds ratio=1.8-2.6, p<.05).

CONCLUSIONS

At their last sexual episode, a greater proportion of young adults used withdrawal in conjunction with other methods than by itself. The psychological and sexual variables of orientation toward pregnancy and attitudes about condoms and pleasure were more strongly linked with withdrawal practices than most sociodemographic variables.

IMPLICATIONS STATEMENT

Since a substantial minority of young adults use withdrawal, providers may wish to speak directly to contraceptive clients about this method, though they should distinguish between only versus any withdrawal use. Practitioners may also be well served by assessing and responding to pregnancy orientation and pleasure attitudes in contraceptive counseling.

Understanding Condom Use Decision Making Among Homeless Youth Using Event-Level Data

This is one of the first qualitative event-based studies to understand the various mechanisms through which multiple factors influence condom use decision making among homeless youth. Event-level interviews that explore characteristics of the environment surrounding sexual events were conducted with 29 youth who were asked to describe two recent sexual encounters. In thematic analyses of data across events, reasons that youth gave for engaging in unprotected sex included the expectation of having sex and use of alternative methods of protection against pregnancy. Other nonevent factors that influenced condom use decision making were related to attributes of the partnership (e.g., testing, trust and love, and assessments of risk) and attributes of the youth (e.g., perceptions of diseases, concerns over pregnancy, and discomfort using condoms). Additional event analyses conducted within the same individuals found that decision making was influenced by multiple interacting factors, with different pathways operating for event and nonevent factors. Future interventions should consider taking a multilevel and individualized approach that focuses on event-based determinants of risky sex in this population.

Pull and pray or extra protection? Contraceptive strategies involving withdrawal among US adult women

OBJECTIVE

Research assessing contraceptive use often focuses on the most effective method used and suggests that very few women rely on withdrawal. We adopted a new measurement strategy in an attempt to measure contraceptive practices and withdrawal in particular.

STUDY DESIGN

We collected data from a national sample of 4634 US women aged 18-39; the survey was administered online in November and December 2012. We obtained information about recent use of hormonal methods and coital methods using two separate items, and we placed withdrawal first on the list of coital methods. The analysis examines several measures of withdrawal use in the last 30 days: most effective method used, any use, use with other methods and withdrawal "method mix."

RESULTS

Among women at risk of unintended pregnancy, 13% reported that withdrawal was the most effective method used in the last 30 days, but 33% had used withdrawal at least once. Most women who used withdrawal had also used a hormonal or long-acting method (13% of the sample) or condoms (11%) in the last 30 days, and a minority reported using only withdrawal (12%). Younger women, women in dating relationships and women strongly motivated to avoid pregnancy had some of the highest levels of "dual" use of withdrawal with condoms or highly effective methods.

CONCLUSION

Many women and couples in our sample used withdrawal in combination, or rotation, with condoms and highly effective methods. Findings suggest that some people who use withdrawal may be more versus less vigilant about pregnancy prevention.

IMPLICATIONS

Health care providers who discuss contraception should include withdrawal in these conversations. A substantial minority of individuals has used it recently, and many appear to be using it as a backup or secondary method. If dual use were more widespread, it could help reduce the incidence of unintended pregnancy.