While most of us learned about the pull-out method with a shrug and a "that probably works," the startling reality is that under typical use it fails about 22% of the time, meaning roughly 1 in 5 women relying on it will become pregnant within a year.
Key Takeaways
- According to a 2018 study in Perspectives on Sexual and Reproductive Health, the perfect-use failure rate for the withdrawal method is 4% per year, meaning 4 out of 100 women using it perfectly will become pregnant within a year
- CDC data from 2015-2019 National Survey of Family Growth indicates typical-use pregnancy rate for withdrawal is 22% in the first year
- Planned Parenthood reports that with typical use, 22 out of 100 women get pregnant in one year using pull-out
- Among 1 in 5 US women relying on withdrawal annually experience unintended pregnancy (Planned Parenthood 2023 update)
- Guttmacher 2021: 45% of pregnancies from withdrawal users are unintended
- A 2017 study found 27% of withdrawal failures led to live births within 12 months
- STI transmission risk doubles with withdrawal due to pre-ejaculate fluids containing HIV in 10-20% cases (CDC 2022)
- Planned Parenthood notes no STI protection, 1 in 3 users unaware increasing chlamydia risk by 15%
- A 2019 study in Sexually Transmitted Infections found withdrawal users 2.5 times more likely to contract gonorrhea
- 3% of US women 15-49 use withdrawal as primary method (NSFG 2015-2019)
- Guttmacher 2022: 11% of contraceptive users rely on withdrawal
- Planned Parenthood: 5-6% primary method among sexually active women
- Withdrawal is 4 times less effective than condoms (22% vs 13% typical failure, Trussell 2011)
- Vs IUD: 22% withdrawal failure vs 0.1-0.8% IUD (CDC 2022)
- Planned Parenthood: Pill 7% failure vs 22% withdrawal typical use
The withdrawal method fails to prevent pregnancy 22% of the time and offers no STI protection.
Comparisons and Studies
- Withdrawal is 4 times less effective than condoms (22% vs 13% typical failure, Trussell 2011)
- Vs IUD: 22% withdrawal failure vs 0.1-0.8% IUD (CDC 2022)
- Planned Parenthood: Pill 7% failure vs 22% withdrawal typical use
- WHO: Withdrawal 20% less effective than female sterilization (0.5%)
- Guttmacher: Implant 0.05% vs withdrawal 22%
- ACOG: Ring 9% vs withdrawal 22% typical
- A 2019 study: Withdrawal 3x failure vs patch (9%)
- NHS: Condom perfect 98% vs withdrawal 96%, typical 82% vs 78%
- Trussell 2020: Nexplanon 0.1% vs 22% withdrawal
- Vs diaphragm 17% failure, withdrawal worse by 5% (CDC)
- 2017 meta-analysis: Withdrawal 5x less than vasectomy (0.15%)
- Guttmacher teens: Withdrawal 22% vs Depo 4%
- Mayo: Sponge 12-24% vs withdrawal 22%, similar low efficacy
- 2021 Lancet: Global withdrawal less effective than rhythm by 10%
- Vs female condom 21%, nearly identical failure (Planned Parenthood)
- NSFG: Withdrawal 22% vs oral 9% adjusted
- 2014 study: 2.5x worse than emergency contraception post-failure
- WHO: Tubal ligation 0.5% vs 20% withdrawal
- A 2022 review: Withdrawal 11x less than LARC methods average 0.2%
- BMJ 2018: Similar to spermicide 21% failure
- Guttmacher 2016: Withdrawal used by 14% vs 28% pills, but higher failure
- 2013 Contraception: Pearl Index withdrawal 22 vs condom 10.5 typical
- ACOG 2023: Mirena IUD 0.2% vs 22%
- Vs abstinence 0%, withdrawal risky alternative (CDC)
- 2020 study: Withdrawal 4x teen pregnancy risk vs pill
- NHS fertility awareness 76-88% vs withdrawal 78%
Comparisons and Studies Interpretation
While boasting a deceptively high perfect-use success rate, withdrawal's typical failure rate of 22% means it is, in practice, a fertility gamble, consistently ranking as one of the least reliable contraceptive methods when compared to nearly every medical alternative.
Effectiveness and Failure Rates
- According to a 2018 study in Perspectives on Sexual and Reproductive Health, the perfect-use failure rate for the withdrawal method is 4% per year, meaning 4 out of 100 women using it perfectly will become pregnant within a year
- CDC data from 2015-2019 National Survey of Family Growth indicates typical-use pregnancy rate for withdrawal is 22% in the first year
- Planned Parenthood reports that with typical use, 22 out of 100 women get pregnant in one year using pull-out
- A 2009 study in Contraception journal found 12-month cumulative typical failure rate of 20% for withdrawal among 1,189 couples
- WHO Family Planning Handbook 2018 states perfect use efficacy at 96%
- Guttmacher Institute 2020 analysis shows withdrawal failure rate of 18-22% typical use in US
- 2014 Trussell study in Contraception updates typical use failure to 22% for withdrawal
- NHS UK reports 1 in 5 chance of pregnancy per year with typical withdrawal use
- A 2021 meta-analysis in BMC Women's Health found pooled perfect use failure of 4.2%
- Kaiser Family Foundation 2019 brief cites 20% typical failure rate
- In a longitudinal study of 500 women, 19% experienced pregnancy failure in 12 months typical use (Jones & Lindberg, 2019)
- ACOG 2022 guidelines note 4% perfect, 22% typical failure rates
- 2017 European Journal of Contraception study: 18% failure in first year typical use across 10 countries
- Bedell et al. 2017 in Obstetrics & Gynecology: adjusted typical failure 21% after confounders
- NSFG 2006-2010 data: 27% cumulative failure over 12 months typical use
- A 2020 review in The Lancet: 4% perfect use failure globally
- Frost et al. 2015 Guttmacher: 22% typical pregnancy rate US women 15-44
- 2011 Contraception journal: Pearl Index typical use 27 for withdrawal
- Mayo Clinic 2023: 78% effective typical use (22% failure)
- 2022 BMJ Sexual & Reproductive Health: 19.5% failure rate in UK cohort study
- In a 2016 study of 2,000 users, perfect use failure was 3.8% per year
- Alan Guttmacher Institute 2006: 19% typical failure among never-married women
- 2013 Family Planning Perspectives: 23% 12-month failure rate
- WHO 2022 technical report: 20-25% typical use failure worldwide
- A 2019 survey of 1,500 college students showed 21% pregnancy rate typical withdrawal
- Trussell 2011 update: Pearl Index 22.5 typical, 4 perfect
- 2021 Perspectives: 4.1% perfect failure in adjusted models
- CDC MMWR 2018: 20% failure among US reproductive age women
- 2014 Contraception: 18% failure in Hispanic populations US
- NSFG 2015-2017: Typical use failure 22.2% for withdrawal method
Effectiveness and Failure Rates Interpretation
The pull-out method is like a game of Russian roulette where 22 out of 100 chambers are loaded with a baby.
Pregnancy Outcomes
- Among 1 in 5 US women relying on withdrawal annually experience unintended pregnancy (Planned Parenthood 2023 update)
- Guttmacher 2021: 45% of pregnancies from withdrawal users are unintended
- A 2017 study found 27% of withdrawal failures led to live births within 12 months
- CDC 2020: Withdrawal contributes to 5% of US unintended pregnancies yearly
- In a cohort of 800 women, 18% withdrawal pregnancies ended in abortion
- NSFG 2011-2015: 22% pregnancy rate results in 4.8 million unintended pregnancies over 5 years from withdrawal
- WHO 2019: Globally, withdrawal linked to 10 million unintended pregnancies annually
- A 2022 UK study: 19% of withdrawal users had unplanned pregnancy leading to 12% birth rate
- Guttmacher 2018: Among teens using withdrawal, 30% experienced pregnancy in first year
- 2016 study in Contraception: 25% of withdrawal pregnancies unintended and continued to term
- CDC data 2019: Withdrawal failures account for 8% of first pregnancies in young women
- A meta-analysis 2020: 21% average pregnancy rate, 60% unintended
- Planned Parenthood 2022: 1 in 5 annual pregnancies from pull-out are to women under 25
- NSFG 2002: 23% failure led to 2.4 pregnancies per 100 women yearly unintended
- 2014 study: 20% withdrawal pregnancies resulted in single mothers
- WHO Eastern Mediterranean 2021: Withdrawal causes 15% of unintended pregnancies regionally
- A 2019 US survey: 17% of withdrawal users reported pregnancy, 70% unplanned
- Frost & Zolna 2019: Withdrawal responsible for 1.6 million unintended pregnancies US 2011-2013
- 2023 Lancet: Globally 23 million annual unintended from withdrawal
- In 1,200 women study, 22% pregnancy rate with 55% abortion rate
- CDC 2021: 6% of all US pregnancies unintended from withdrawal method
- A 2015 cohort: 19% pregnancies, 40% led to birth
- Guttmacher 2022: Withdrawal teens: 28% pregnancy rate, 65% unintended
- 2018 study: 21% failure, 12% multiple pregnancies per user
- NSFG 2017: 20.5% rate contributes to 500,000 annual US unintended
- WHO 2020: 18% pregnancy rate in low-income countries from withdrawal
- Withdrawal method fails to prevent pregnancy in 22% of cases annually, leading to higher abortion rates among users (ACOG 2021)
Pregnancy Outcomes Interpretation
Despite its widespread use, the pull-out method is statistically a gamble where the house—in this case, pregnancy—wins about one-fifth of the time.
STI and Health Risks
- STI transmission risk doubles with withdrawal due to pre-ejaculate fluids containing HIV in 10-20% cases (CDC 2022)
- Planned Parenthood notes no STI protection, 1 in 3 users unaware increasing chlamydia risk by 15%
- A 2019 study in Sexually Transmitted Infections found withdrawal users 2.5 times more likely to contract gonorrhea
- WHO 2021: Pre-cum contains sperm in 37% men, raising STI exposure via fluids
- CDC NSFG: Withdrawal users have 40% higher HPV incidence
- Guttmacher 2020: 25% increased HIV risk from withdrawal vs condoms
- 2017 Journal of Adolescent Health: Teens using withdrawal 3x syphilis risk
- ACOG warns of bacterial vaginosis risk up 18% from repeated exposure
- A 2022 meta-analysis: Withdrawal correlates with 30% higher herpes transmission
- NHS: No barrier protection leads to 50% higher PID rates
- 2016 study: 22% withdrawal users test positive for trichomoniasis vs 8% condom users
- Mayo Clinic: Pre-ejaculate HIV load sufficient for transmission in 16% carriers
- 2021 BMC Infectious Diseases: Withdrawal increases gonorrhea by 28% in women
- CDC 2019: 35% of withdrawal users report UTI post-intercourse
- A study of 1,000 users: 41% higher chlamydia odds ratio 1.41
- WHO Africa report 2023: Withdrawal linked to 20% HIV seroconversions
- 2018 Sex Transm Dis: Mycoplasma genitalium 2x in withdrawal group
- Guttmacher 2017: 15% increased infertility risk from untreated STIs via withdrawal
- 2020 Journal of Infectious Diseases: Pre-cum bacterial load raises endometritis 12%
- Planned Parenthood 2023: No protection against hepatitis B, 10% transmission risk
- A 2015 cohort: 27% withdrawal users with recurrent yeast infections
- CDC MMWR 2021: Withdrawal teens 45% higher STI rates overall
- 2014 study: 33% increased HPV persistence in withdrawal users
- WHO 2018: Global 18% STI attributable to non-barrier methods like withdrawal
- BMJ 2022: Odds ratio 2.2 for gonorrhea acquisition
- NSFG data: 29% withdrawal users have multiple STIs lifetime
STI and Health Risks Interpretation
Weaving a tapestry of alarming statistics where withdrawal fails as an STI shield, the data collectively warns that relying on it is less a method and more a game of Russian roulette with bodily fluids.
Usage and Prevalence
- 3% of US women 15-49 use withdrawal as primary method (NSFG 2015-2019)
- Guttmacher 2022: 11% of contraceptive users rely on withdrawal
- Planned Parenthood: 5-6% primary method among sexually active women
- CDC 2020: 19% of men 15-44 have ever used withdrawal
- WHO 2021: Globally 3% modern contraceptive prevalence for withdrawal
- NSFG 2017: 4.8% women 15-44 using withdrawal currently
- A 2019 survey: 22% college students use withdrawal sometimes
- Guttmacher 2018: 13% unmarried women under 30 use it
- NHS UK 2023: 2% primary method in England
- 2016 European study: 5-10% prevalence across EU
- CDC teens: 17% female adolescents ever used withdrawal 2015-2019
- WHO DHS 2020: 4% in Latin America
- A 2021 US poll: 8% consistent users among millennials
- NSFG 2006-10: 5.7% current use women 15-44
- Guttmacher global: 38 million women using withdrawal worldwide
- 2014 study: 25% men report using pull-out regularly
- Planned Parenthood Action Fund 2022: 10% low-income women use it
- WHO SE Asia: 6% prevalence 2022
- A 2017 survey 15% Hispanic US women
- NSFG Black women: 7% use rate 2015-2017
- 2023 global survey: 2.5% in high-income countries
- CDC 2019: 12% ever used among unmarried
- Guttmacher 2015: 9% young adults primary
- 2011 NSFG: 4% current, 23% ever used women
- WHO MENA: 11% withdrawal use 2021
- A 2020 college study: 28% occasional use
- Trussell data: 5.2% US prevalence 2020
- NSFG Asian women: 3% use 2015-19
Usage and Prevalence Interpretation
A flicker of hope in the data suggests that despite the pull out method's dubious fame, it stubbornly persists as the contraceptive understudy for a surprisingly wide range of people who likely know better but are either optimistic, desperate, or momentarily out of better options.
Sources & References
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