Contraceptive withdrawal, or coitus interruptus, is a widespread method in adolescents, but factors affecting usage have not been longitudinally investigated. Study objectives were to examine usage numbers of withdrawal among a group of sexually active adolescent females and to investigate the influence of personal, partner, and family factors on usage patterns.
Subjects (N=387; 14 to 17 years at enrollment; 92% African American) were recruited from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs.
Interventions, Main Outcome Measures
The outcome variable was: withdrawal use during the previous 12 weeks (no/yes); predictor variables included 19 individual, family and partner variables. All models additionally controlled for any current hormonal use (no/yes; any method), current condom use (no/yes) and past withdrawal use (past 30 days; no/yes). Logistic regression, with GEE estimation to adjust for repeated within-subject observations, was performed in SUDAAN, 9.0.
Subjects supplied 1632 quarterly interviews; withdrawal was mentioned in about 25% of the interviews (392/1632). Controlling for primary contraceptive method, withdrawal was mentioned in 13.2% (51/307) of interviews with hormonal methods, in 32.4% (255/787) of the interviews with condoms and in 4.7% (78/1632) of interviews with no method. Current hormonal use was associated with a decreased likelihood of also using withdrawal (OR=0.34), whereas past withdrawal use increased the likelihood of current withdrawal by about 4-fold (OR=4.18). Condom use was not associated with withdrawal use. Current withdrawal use was more likely with a more diverse sexual repertoire (OR=1.65), more sexual partners in the past 3 months (OR=1.46), higher sexual control (OR=1.15), lower perceived STI risk (OR=0.46), higher sexual self-efficacy (OR=1.24), lower sexual coercion (OR=0.56) higher condom negativity (OR=1.16), living with a boyfriend (OR=2.17) and lower family sexual health support (OR=0.88).
Contraceptive withdrawal in adolescents should not be considered ‘rare.’ Careful clinical consideration of usage within the context of other contraceptive behaviors, sexual behaviors/attitudes, and relationship issues could better inform effective contraceptive counseling efforts.
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- Sacred Choices: The Right to Contraception and Abortion in Ten World Religions.Fortress Press, Minneapolis2001
- Contraception and Abortion from the Ancient World to the Renaissance.Harvard University Press, Cambridge, MA1992
- Contraception and Abortion in 19th-Century America.Cornell University Press, Ithaca, NY1994
- On the Pill: A Social History of Oral Contraceptives, 1950-1970.Johns Hopkins University Press, Baltimore1998
- Why withdrawal? Why not withdrawal? Men's perspectives.Reprod Health Matters. 2005; 13: 164
- Coitus-dependent family planning methods: observations from Bangladesh.Stud Fam Plann. 1999; 30: 43
- Challenging the stereotypes: men, withdrawal, and reproductive health in Lebanon.Contraception. 2002; 65: 165
- New Survey Findings: The Reproductive Revolution Continues.Population Reports. 2003; (Chapter 36): 31
- Contraceptive update: withdrawal popular in some cultures.Network. 1996; 17: 1
- Hatcher R.A. Trussel J. Stewart F. Contraceptive Technology. 18th ed., rev. Contraceptive Technology Communications, Inc, New York2004: 311-313
- Contraceptive failure in the first two years of use: differences across socioeconomic subgroups.Fam Plann Perspect. 2001; 33: 19
- Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth.Fam Plann Perspect. 1999; 31: 56
- Use of birth control pills, condoms, and withdrawal among U.S. high school students.J Adolesc Health. 2000; 27: 112
- Delayed application of condoms, withdrawal and negotiation of safer sex among heterosexual young adults.AIDS Care. 2004; 16: 315
- Daily mood, partner support, sexual interest and sexual activity among adolescent women.Health Psychol. 2005; 24: 252
- Incidence and correlates of unwanted sex in relationship of middle and late adolescence.Arch Pediatr Adolesc Med. 2006; 160: 591
- Relationship quality, coital frequency and condom use as predictors of incident Chlamydia trachomatis infections among adolescent women.J Adolesc Health. 2005; 37: 163
Reynolds MA, Herbenick DL, Using computer-assisted self-interview (ACASI) for recall of childhood sexual experiences. In: Sexual Development in Childhood. Edited by J Bancroft. Bloomington Indiana University Press,2003, pp 77-81.
- The timing of changes in girls' sexual cognitions and behaviors in early adolescence: A prospective, cohort study.J Adolesc Health. 2005; 37: 211
- African American and Latina inner-city girls' reports of romantic and sexual development.J Soc Personal Relationships. 2003; 20: 221
- Longitudinal analysis using generalized linear models.Biometrika. 1986; 73: 13
- Version 9.0. Research Triangle Park.RTI International, North Carolina2005
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