Uncovering withdrawal use among sexually active US adolescents: high prevalence rates suggest the need for a sexual health harm reduction approach

ABSTRACT

This paper explores the use of withdrawal as a harm reduction approach to adolescent pregnancy prevention and its association with condom use. Data come from a baseline survey of a randomised controlled trial to test the effectiveness of FLASH, a sexual health education curriculum. Study participants completed electronic self-report surveys in health classes in their first or second year of high school (age range 14.1–17.9, mean 15.3 years). One-hundred and ninety-one students (12% of full sample) reported engaging in vaginal intercourse in the 3 months prior to the survey; of these, 66.0% reported using withdrawal as a birth control method, without significant differences by race, gender, region or birth control beliefs. Withdrawal was often used in combination with condoms (55.5%), periodic abstinence (40.0%) and birth control pills (13.4%). The effectiveness of withdrawal and its prevalence suggest an opportunity to reflect on how withdrawal is taught – moving from avoiding its use to a harm reduction approach to help sexually active youth avoid risk, reduce risk and reduce potential harm associated with sexual behaviours. Rather than focusing on withdrawal as risky, youth-serving professionals should acknowledge young people’s efforts to prevent pregnancy and recognise the social and relational contexts of contraceptive choices.

KEYWORDS:

• Adolescents
• pregnancy prevention
• withdrawal
• harm reduction
• USA

Disclosure statement

No potential conflict of interest reported by the authors.

Notes

1. The response option is ‘had sex during the safe time of the month.’ This may also be referred to as periodic abstinence, where couples avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.

Additional information

Funding

This work was supported by Grant Number TP2AH000031 from the HHS Office of Population Affairs. The contents of this paper are solely the responsibility of the authors and do not represent the official views of the Department of Health and Human Services or the Office of Population Affairs.