Withdrawal attitudes and experiences: a qualitative perspective among young urban adults.

CONTEXT: Withdrawal is a widely used pregnancy prevention practice, but is popularly regarded as ineffective. An in-depth study of withdrawal behaviors would improve understanding of its role in reproductive health care.
METHODS: Ninety-five ethnically diverse males and females aged 18-25, recruited through family planning clinics and community outreach in a large U.S. city, participated in semistructured, open-ended interviews in 2006 and 2007. Interviews examined up to six heterosexual relationships and focused on contraceptive attitudes, norms and experiences. Transcripts were reviewed and coded, and key themes related to withdrawal were identified.
RESULTS: Withdrawal was a popular contraceptive technique, but opinions on its effectiveness were mixed. Some participants (especially women) expressed anxiety concerning pregnancy risk due to perceived ineffectiveness of withdrawal, and women were concerned about their partner's capacity to consistently withdraw prior to ejaculation. Others described confidence and skill in using withdrawal, and considered it effective. Reasons for use of withdrawal included convenience and dissatisfaction with hormonal contraceptives and condoms. Withdrawal was described as an expected alternative to condoms in both casual and long-term relationships, and as a secondary, or backup, method with use of hormonal contraceptives or condoms. Participants had rarely discussed withdrawal with health care providers; knowledge about the method had generally come from less reliable sources, including peers.
CONCLUSIONS: Health care provider discussions with patients about withdrawal could give greater insight into risk behaviors. More informed prevention counseling messages would be helped by better effectiveness estimates and understanding of factors most likely to result in withdrawal failure.