The determinants of withdrawal use in Turkey: a husband's imposition or a woman's choice?

This paper seeks to understand why Turkey has one of the highest rates of withdrawal (coitus interruptus) use in the world. Despite a pronounced fertility decline, a marked increase in contraceptive prevalence, and expansion of family planning activities, in 1998 one in four Turkish couples relied on withdrawal, and this fraction has remained stable since 1983. In contrast to previous research that has focused on women's reports, here we use the husbands' module of the 1998 Turkish Demographic and Health Survey to examine user characteristics and attitudes, as well as the determinants of withdrawal use among a representative sample of 1950 currently married men in Turkey. Multivariate methods are employed to estimate these effects and the likelihood of using withdrawal rather than other methods. Among other findings, less egalitarian-minded husbands were more likely to select withdrawal over other contraceptive methods, but measures of male authority had only partial predictive power after controlling for other variables. Although withdrawal use typically reflects husbands' preferences, it is widely practiced as it satisfies user requirements and simplifies women's lives. The results of this study are discussed in a broader historical and cultural context and used to provide insight into how Turkey's family planning and reproductive health programs might be improved. In contrast to neighboring countries, there is little sign of withdrawal being displaced in Turkey anytime soon by modern methods.