As women and couples begin rethinking hormonal contraception, old-fashioned methods of birth control are making a comeback. But are they effective? They can be. Here's how.

Withdrawal (otherwise known as the “pull-out method” or “coitus interruptus”) has been getting a lot of attention in the news lately, thanks to an article in New York Magazine by Ann Friedman discussing the use of it by many of her friends. As was highlighted in yesterday morning’s CBC panel on The Current, there are different ways to look at withdrawal depending on who is using it, why, and with what forethought. Friedman was referring to a specific segment of the population – twenty and thirty somethings in committed, monogamous relationships, who are not concerned about the risk of sexually transmitted infections (STI), prefer the intimacy and sensation of sex without a condom, and for a variety of reasons, prefer not to be on the pill (reasons offered were similar to those we hear from our clients – side effects and a growing feeling that hormonal birth control is not congruent with the healthy lifestyle and environmentally-friendly choices these women aspire to).

It didn’t surprise us to hear that this is a common birth control method among a certain sub-set of the population, partly because we have a lot of contact with that subset and partly because we belong to it! I (Amy) have used a combination of Justisse (the fertility awareness method I teach) along with withdrawal, for over seven years. For those of you who may find this shocking, you may be equally shocked to discover that efficacy rates for withdrawal are actually as high as 96% for those who use the method correctly, according to Planned Parenthood. In fact, birth control handouts group withdrawal, in terms of efficacy, with barrier methods such as condoms and cervical caps.

While my job as a fertility awareness educator is to instruct my clients on how to use the method “perfectly” (meaning to its highest efficacy of 99.4% by abstaining from vaginal intercourse on fertile days), many of my clients choose to pair fertility awareness with other birth control practices. As such, it is also my job to educate my clients on to how to use other contraceptive methods effectively. When my clients are interested in using withdrawal as an adjunct to their fertility awareness practice, here is how I help them decide how it best fits in:

1. If you absolutely cannot fathom the idea of getting pregnant. Withdrawal can be used as your “safety cushion” during infertile days of your cycle, either alone or in combination with a barrier method. While sympto-thermal methods of fertility awareness like the Justisse Method I teach are 99.4% effective when used correctly, in practice efficacy rates can be lower because of chart errors, or much lower if a woman hasn’t received proper instruction. Thus, abstaining completely during fertile days, and using a combination of withdrawal and a barrier method on infertile days should get you in the range of pregnancy being virtually impossible.
    

2. If you want to keep the risk of pregnancy, very, very low. For clients who want to engage in vaginal intercourse on fertile days but wish to keep their risk of pregnancy, very, very low, I recommend doubling up on other forms of contraception during fertile days. For some of my clients, this means choosing “the pull-out method” plus condoms or a cervical cap on fertile days. The risk of pregnancy among healthy adults is high on fertile days (about 75%) but if two methods are used, both with efficacy rates in the 85-98 percent range (depending on how well they are used), having both of them fail is quite unlikely and you have got yourself well covered. Withdrawal can be used on it’s own during infertile days if desired to continue to provide a cushion for error.
    

3. If you’re more open to an unplanned pregnancy. If you can handle a risk of 4-26% (meaning of women attempting this approach, 4-26 out of 100 of them will get pregnant in a year), then you can opt to use withdrawal on its own during fertile days. This works well for couples (like myself) who are on the fence about having more children, or about having children at all. You don’t have to commit to getting pregnant, but you are keeping the ‘door’ open, so to speak! ;) In our opinion, this is a totally legitimate choice, assuming both partners know the risk they are taking, and are comfortable with it.

Here is a list of circumstances where we don’t encourage use of the withdrawal method:

1. Whenever there is a risk or concern about sexually transmitted infections. In this case withdrawal should not be relied on unless it is in combination with a condom.

2. When a man is known to have poor ability to anticipate orgasm or react in time.

3. When a couple has not established good communication around birth control and sexual issues. Communication is key to ensuring the method works, and to dealing with it if it doesn’t. (Ideally a male partner should tell his female partner right away if he suspects failure to withdraw in time, so she can opt to take emergency contraception if desired).

4. Whenever a woman does not know her cycle well enough to use the method consciously (as above) in order to give her the highest degree of control possible over her body and her chances of conceiving.

To read more about the Justisse Method of Fertility Management and natural birth control options taught at Red Tent Sisters, check out our Eco-Contraception program or download our free guide to ditching the pill below. 

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Kim & Amy Sedgwick love to discuss sex, periods, and all the other things we’re not supposed to talk about. The co-founders of Red Tent Sisters, they’ve been featured in every major Canadian news outlet and have become a trusted resource for people seeking natural (effective!) birth control, a more joyful sex life, and an empowered journey to motherhood.