Abstract
BackgroundDespite its relatively low effectiveness, withdrawal is a common contraceptive practice. In Vietnam, health concerns about hormonal contraception are strong and account for substantial method discontinuation. Given the paucity of evidence on withdrawal, our objective was to identify correlates of using withdrawal among women not desiring pregnancy.MethodsWe conducted a secondary analysis of data from a cross-sectional study of sexually-active adult women attending a public hospital in Hanoi, who did not desire pregnancy. We enrolled a stratified sample of women using the intrauterine device, combination oral contraception, or neither method. Participants completed a questionnaire on demographics and reproductive history and behaviors. We used multinomial logistic regression to evaluate correlates of using a tier 3 contraception method (without withdrawal) and using withdrawal (alone or with a tier 3 method) compared to the referent category of using a tier 1 or 2 method (without withdrawal).ResultsOf the 489 participants in the analysis, 52.3% reported using tier 1 or 2 method (without withdrawal); 19.8% reported tier 3 contraception (without withdrawal) and 27.9% reported using withdrawal (alone or with a tier 3 method). Compared to those using a tier 1 or 2 method, women using withdrawal had lower odds of reporting that avoiding pregnancy was very important or important to them (aOR, 0.4; 95% CI, 0.3–0.7). Women using withdrawal had higher odds of reporting that their husband/partner refuses to give them money for household expenses, even when he has the money (aOR, 2.8; 95% CI, 1.4–5.6).ConclusionsWomen using withdrawal might have less relationship power than nonusers. They also might rely on the practice because they are more ambivalent about pregnancy.
Highlights
Despite its relatively low effectiveness, withdrawal is a common contraceptive practice
Given the lack of research on the practice of withdrawal in Southeast Asia, and Vietnam in particular, and given the exploratory nature of this analysis, we evaluated a broad range of potential correlates in the unadjusted analysis
32 women relied on withdrawal alone; most using withdrawal used another method, most commonly male condoms or rhythm or periodic abstinence
Summary
Despite its relatively low effectiveness, withdrawal is a common contraceptive practice. Some report using withdrawal in place of condoms with established partners whom they perceive to be at low risk of HIV or other sexually transmitted infections (STIs) [5, 7] while others might use withdrawal as a result of misconceptions about the method’s ability to protect against HIV/STI acquisition [8]. Despite the common practice of mixing methods, prevalence estimates often are calculated for the single most effective method used by the participant. These measures, will not account for many withdrawal users
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