Withdrawal As Pregnancy Prevention: College Men’s Perspectives

Condom use on U.S. college campuses has been in decline over the past few decades, resulting in substantial increases in sexually transmitted infections (STIs) and unintended pregnancies among college students. Despite this, most research on sexual health and contraceptive decision-making focuses on women without taking men’s perspectives into account. This is problematic given the ample evidence that contraceptive dynamics in sexual encounters are influenced by both partners. Therefore, in this paper, we examine men’s narratives surrounding withdrawal use in sexual encounters with women, drawing on in-depth contraceptive life history interview data from 44 men attending a university in the western United States. In doing so, we highlight men’s narratives surrounding withdrawal use and their strategies for avoiding pregnancy. Findings show that men frequently relied on withdrawal as a method of pregnancy prevention even though they were aware of the risks of doing so. Indeed, despite the risk of STIs following condomless sex, and the awareness that both partners should be responsible for pregnancy prevention, the college men in our sample largely prioritized their own sexual pleasure during sex (via condomless sex), while encouraging their partners to use emergency contraception afterwards. Thus, withdrawal was seen as an important part of a contraceptive strategy that facilitated men’s sexual pleasure while avoiding pregnancy, but also left both partners at risk of STI transmission. Further, this common strategy reinforced gender inequality in romantic relationships as women faced the mental and physical burdens of taking emergency contraception after sex to avoid unwanted pregnancy. Our findings underscore the importance of expanding access to the full range of birth control methods – including emergency contraception – on college campuses and developing interventions aimed at improving contraceptive communication between college men and women to enhance the sexual and reproductive health and autonomy of both partners.