Hail Mary or Russian Roulette: Provider Knowledge and Attitudes Toward the Withdrawal Method of Contraception [02B

Abstract

INTRODUCTION: Withdrawal is often perceived as an ineffective contraceptive method that is infrequently discussed by clinicians, despite frequent use and an efficacy level similar to condoms. It is also one of the few methods available to men. To address this discrepancy, we surveyed the knowledge and attitudes of women's healthcare providers about withdrawal. METHODS: In this IRB-approved, exempt study, surveys were distributed at four contraceptive health conferences across the United States. As part of a 16-item survey with open and close-ended questions, providers were asked about the effectiveness of withdrawal for pregnancy prevention and if and how they discussed withdrawal with their patients. Qualitative data were coded with 80% interrater reliability. Distribution frequencies and associations via chi-square tests are presented. RESULTS: Overall, 17.7% and 2% of respondents correctly identified typical and perfect use failure rates for withdrawal. Asked how they would respond if their patient reported withdrawal for contraception, half (55.3%) provided responses suggesting open-mindedness. Compared to other healthcare providers (such as physician assistants and nurses), physicians were more likely to endorse negative attitudes about using withdrawal (P<.01). Half (51.1%) of providers do not list withdrawal as a method choice on reproductive history intake forms; only one-third routinely ask about this method. CONCLUSION: Better education about withdrawal and its efficacy as a contraceptive method are needed for practitioners to recognize the importance of its inclusion in their counseling, as well as to provide their patients with the data needed to make informed contraceptive choices.