WBUR Common Health
Written by Rachel Bloom
Birth Control: Talking ‘Bout The Pullout Generation
When a recent study concluded that nearly 1 in 3 straight, sexually active young women used the withdrawal method for contraception, the media breathlessly coined a neat phrase to characterize these 15- to 24-year-olds: “The Pullout Generation.”
Elite Daily asked: “Gen-Y Or Gen-Pullout? Coitus Interruptus Is The New Form Of Birth Control” and New York Magazine breezily headlined its coverage, “No Pill? No Prob. Meet The Pullout Generation.” The Huffington Post held a forum, asking “Is this an appropriate method of birth control in this day and age?”
The truth is, “pulling out” is old news. Indeed, it’s perhaps the oldest form of contraception (besides abstinence) and has been practiced for millennia. Though clearly not the most effective method of birth control, and offering no protection against STIs, withdrawal is free and when done with skill it can be somewhat effective.
According to Planned Parenthood:
–Of every 100 women whose partners use withdrawal, 4 will become pregnant each year if they always do it correctly.
–Of every 100 women whose partners use withdrawal, 27 will become pregnant each year if they don’t always do it correctly.
–Couples who have great self-control, experience, and trust may use the pull out method more effectively. Men who use the pull out method must be able to know when they are reaching the point in sexual excitement when ejaculation can no longer be stopped or postponed. If you cannot predict this moment accurately, withdrawal will not be as effective.
To find out more, I crowd-sourced the issue on SurveyMonkey and asked why my 20-something peers — savvy, educated — relied on such a frowned-upon form of contraception. I got over 30 responses that fell into five overarching categories:
1. No Access To Contraception
Responses in this bucket ranged from “Didn’t have a condom” or “forgot” to just going for what was most “convenient” in the “heat of the moment.”
2. Personal Preference
These answers were mostly about feeling liberated from other forms of contraception. People said pulling out “feels better” and can be “more pleasurable.”
3. Extra Protection
Some responders said they just wanted a little extra peace of mind. One guy wrote that he pulled out “just to be safe, the pill and condom have failed before,” and another said “there’s always the possibility that a condom could fail so I pull out every time” and even “…my girlfriend’s on the pill. She just gets paranoid and prefers that I pull out to be safer.”
4. Bad Options
Let’s face it, current methods of contraception fall short in many ways. Responses here included, “I don’t like how birth control [pills] negatively affect my sex drive” and “My partner could not stay erect while using a condom.”
These comments took a little more courage, but felt pretty honest:
“I was drunk and wasn’t thinking,” one person wrote. Another said she was “too shy to mention he should use a condom.”
All in all, a wide range of reactions from the field. For an expert perspective, I spoke with Megan Andelloux, founder and director of the Center for Sexual Pleasure and Health in Pawtucket, R.I. She was part of that HuffPo video conference on “The Pullout Generation” so I asked her to unpack the study, published in the journal Obstetrics & Gynecology, and the subsequent public outcry.
According to Andelloux, pulling out isn’t a millennial thing at all. It’s just that these days, women, in particular, are more open and chatty about the type of birth control they use and about sex in general (see, for instance, Lena Dunham’s “Girls”).
“What is different,” Andelloux says, “is that women are feeling more comfortable or in control to say what they’re using. For many people, when they heard about the withdrawal method, it was always couched as a ‘non-effective form of birth control.’”
Andelloux says the withdrawal method should once and for all be viewed as a legitimate form of birth control. “One of the main issues that strikes me about this is we don’t actually talk about how to use withdrawal,” she says. “We get really shocked by the information, because we don’t take the time to explain how to do things correctly. One of the main reasons people get pregnant from this stuff is because guys don’t have ejaculatory control. Premature ejaculation is way more common than erectile dysfunction.”
Andelloux adds that even with all the downsides of pulling out, “it’s better than nothing.”
Here are some more important details of the Obstetrics & Gynecology study that make it more nuanced than some of the headlines suggest:
During the 47-month survey period, 31 percent of female subjects used withdrawal at some point. Of these women, 21.4 percent experienced an unintended pregnancy during the study. That sounds like a pretty high number until we read on: 13.2 percent of the women using only other contraceptive methods (not withdrawal) also became pregnant.
Our Bodies, Our Blog, critiquing the study in a piece called “Headlines About The Pullout Generation Are Premature,” points out that nearly 9 out of 10 women who practiced withdrawal also used other methods of contraception during the study. So whose “Pullout Generation” is this anyway?
An alternative interpretation put forth in New York Magazine suggested that some women are switching from hormonal birth control to a combination of period-tracking and the withdrawal method as a way to reclaim their bodies from artificial cycles of estrogen and progesterone.
All this being said, it’s important to repeat that the withdrawal method, on its own, is far from the most effective form of contraception. “If you were not looking to become pregnant or there is a concern of STI,” says Andelloux, “there are better choices out there.”
Better, but still not good enough, it seems. Yes, my generation will shift to better birth control — when birth control options themselves get better.