Nearly a third of women ages 15 to 24 used withdrawal as contraception during a nearly four-year period, with one in five experiencing an unintended pregnancy as a result.
Researchers analyzed the 2006-2008 National Survey of Family Growth, which included more than 2,600 sexually active women, to model the risk of an unintended pregnancy during a 47-month period. Women ages 15 to 24 have the highest risk of experiencing unintended pregnancy and comprise 73% of unintended pregnancies in the United States, leading the authors to study this age group.
Results appeared in Obstetrics & Gynecology.
Nearly one-third (31%) of women used withdrawal, of whom 21.4% had an unintended pregnancy, compared with 13.2% of women who used only other contraceptive methods (adjusted hazard ratio, 1.75, 95% confidence interval [CI], 1.23 to 2.49).
Women who used withdrawal were 7.5% more likely to have used emergency contraception (adjusted odds ratio [OR], 1.57; 95% CI, 1.13 to 2.20). Married women were 14.8% less likely than single ones to use withdrawal (adjusted OR, 0.58; 95% CI, 0.35 to 0.96).
Researchers concluded that health care providers should be aware that many patients may use withdrawal, should consider the need for emergency contraception among these females, and should encourage them to use more effective methods of contraception.
“Given that almost all withdrawal users in our study also used more effective methods of contraception at some point, practitioners might build on their patients’ desire to prevent pregnancy to support their use of more effective contraceptive methods,” the authors wrote.
ACP Internist addressed talking points that physicians can discuss with patients. An expert advises counseling women at the beginning and end of their reproductive life, discussing contraceptives’ typical-use failure rates instead of perfect use failure rates, and matching the contraceptives to a patient’s circumstances.