Sevgi Özsoy and Hilmiye Aksu*
Nursing Department, Faculty of Nursing Obstetrics and Gynecology, Adnan Menderes University, Aydın, Turkey
Received Date: March 14, 2018; Accepted Date: March 21, 2018; Published Date: March 28, 2018
Citation: Özsoy S, Aksu H (2018) An Old and Widespread Method: Withdrawal J Healthc Commun 3:24. doi: 10.4172/2472-1654.100134
Since humans discovered that conception occurs through transmission of sperms, withdrawal or coitus interruptus has been used periodically or preservatives have been utilized for contraceptive purposes. There has been a decrease in the use of this method with the introduction of more effective modern contraceptive methods in the 20th century. However, it is still used as a contraceptive by one every six couples in the world and it is especially common among couples in Southern Europe and some countries in Western Asia . Withdrawal is practiced by more than one fifth of the couples in Albania (46.5%), Serbia (31.0%), Azerbaijani (30.1%), Macedonia (29.4%), Bosnia Herzegovina (27.7%), Turkey (25.8%), Armenia (25.1%), Montenegro (23.0%) and Greece (21.7%) . There have been no changes in rates of withdrawal use in some countries in the last 20 years. Many studies have shown that it is frequently practiced by couples in some stage of their lives and is used most commonly and for the longest period of time [2-8]. It is stated in some articles that participants might not have mentioned it since they do not consider it as a contraceptive method . This suggests that available evidence may not reflect the reality and that it may be used more commonly than reported.
Instead of withdrawal, a temporary and less effective method, effective modern contraceptives are offered to couples in many countries. Although these services are widespread, free of charge or inexpensive, it is surprising that many couples still practice withdrawal, having weak contraceptive effects, and other natural methods. In fact, it does not have side-effects or require presenting to a health center, purchasing anything or using any tools or drugs. In addition, it is always available and free of charge. Therefore, it seems that it fulfills all expectations from an ideal contraceptive. However, despite all above positive sides, it causes a high risk of pregnancy and is not protective against sexually transmitted diseases. Withdrawal, utilized by one fourth of couples in Turkey, is responsible for one third of unwanted pregnancies .
Researchers have reported that couples prefer withdrawal since they find it easy and safe to use, take account of health status of their spouses and take responsibility for contraception and since it does not have health risks, does not require medical follow-up and is inexpensive and monogamic [4-6,8,11]. In addition, it has been shown that some couples insist on using it even after an unwanted pregnancy or even though they are aware of the risk of pregnancy [5,7,8].
According to all the above-mentioned evidence, health professionals must accept that withdrawal is a contraceptive method and is more effective than using nothing although it is not as effective as other contraceptive methods. Willingness of males to take responsibility for protection of reproductive health is desirable behavior. One must respect the couples who prefer withdrawal despite availability of many contraceptive methods. The method deserves more attention and support since it seems to play an important part in contraception thanks to its superiority to other current contraceptives .
There are couples who use withdrawal for years but never experience an unwanted pregnancy. Whatever method a couple use, that method is the best if they have not had an unwanted pregnancy. Therefore, it is reasonable to accept the preference of the couples who use withdrawal successfully. Accepting and offering this method as a contraceptive alternative may allow identifying real users. A qualitative study with nurses offering counseling for family planning in Turkey revealed that individuals do not talk about withdrawal comfortably and ask questions to nurses about it and that nurses do not mention it if they are not asked questions about it . Initiation of a talk about withdrawal without waiting for a question can help to reveal things remaining hidden and not discussed and to talk about its risks.
To sum up, individuals provided with family planning services especially in countries where withdrawal is commonly used should be asked questions about this method, it should be offered as a contraceptive, those selecting or using this method should be respected and informed about its risks. Its only risk is unwanted pregnancies in monogamic couples. Therefore, determining differences in its use between couples successfully utilizing it for years and those experiencing unwanted pregnancies can fill an important gap. Knowledge to be obtained can help individuals to use it more effectively.
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