No Pill? No Prob. Meet the Pullout Generation

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Gather a group of sexually active hetero women, get a few whiskeys in them, and I guarantee that, within an hour, someone will start complaining about how there are no good birth-control options. Sure, there are the IUD evangelists (“No hormones! I barely notice it except for my lighter periods. I canceled my Amazon subscription to tampons!” one friend told me cheerily), and those who have quietly and happily been on the pill or the NuvaRing since their teenage years. But there’s always at least one or two — often many more — who cannot wait to commiserate about their mood swings, depression, or loss of sex drive when they’re on birth control. Condoms are kind of the worst, they all agree, but even some women in long-term monogamous relationships say they’d rather use them than pop a hormone pill every day. This dissatisfaction is exhaustively chronicled in  a new book, Sweetening the Pill, which is dedicated to “every woman who has suffered physically and emotionally as a result of hormonal birth control.”

What the book doesn’t mention — and what some of these women are reluctant to admit, even after a few cocktails — is that some of them have given up on conventional birth control and are relying on the pullout method. Yeah, they know it’s got failure rates to rival condom use at its sloppiest. But these are women who are sick of taking hormones, are in a long-term relationship with a man they trust, and rely on a period-tracker app so they know to use a condom when they’re ovulating. The risk is one they all seem pretty comfortable with.

According to some research, this isn’t as crazy as it sounds. A 2009 study found that, when you compare typical condom use to typical use of the pullout method (rather than the ideal usage of each), the withdrawal method is only slightly more likely than condoms to result in pregnancy. A recent survey conducted by the delightfully named Dr. Annie Dude, a researcher at Duke University, found that almost a third of women between the ages of 15 and 24 have relied on coitus interruptus as a birth-control method. A slew of disappointed articles followed. “Ladies, I implore you: Get on some real birth control,” wrote Janelle Harris at Clutch magazine. Slate’s Amanda Marcotte called the findings “worrisome.” Venerated sexpert Dr. Ruth Westheimer has compared the pullout method to Russian roulette, and clarified that the research mostly proved how often condoms are misused, not how safe withdrawal is.

Every single American woman who’s now in her childbearing years came of age in the era of legal birth control. Many were prescribed the pill before they even started having sex. For years, the pullout method was taboo — seen as non–birth control for ignorant risk-takers. Admitting that you trusted a man — granted, a man who was your monogamous partner, but still — to pull out in time? That was ceding too much control. But I know a dozen women in their late twenties and thirties who, after years of jumping from brand to brand and always feeling crazy or depressed, or after years of nagging health concerns about taking hormones, finally said "enough" and told their partners to put on a condom and deal with it. Though we all want safe and accessible and reliable contraceptive options — thanks, Obamacare? — the pill is no longer synonymous with sexual liberation.

These women describe a deliberate transition from the pill to the pullout. They buy organic kale and all-natural cleaning products, and so can’t quite get down with taking synthetic hormones every day. They are more driven by sexual pleasure — they see orgasms as a right, not a privilege — and hate the feel of condoms. They wouldn’t call themselves porn aficionados or anything, but they don’t think it’s demeaning to have a man come on them. They’re sick of supposedly egalitarian relationships in which they bear the sole responsibility for staying baby-free. They're scared to stick an IUD up there, no matter how many rave reviews the devices get. And despite the fact that non-hormonal contraceptive options remain frustratingly limited, there are new tools at their disposal: With period-tracker apps, charting your menstrual cycle is no longer the domain of hippies and IVF patients. They know when to make him put on a condom. Plus, they can keep a packet of Plan B on hand at all times, ready and waiting should anything go awry. So it makes a certain amount of sense that, for these women, the pullout method is looking more like a legitimate contraception option.

“I've been on the pill for about six years and stopped after a dinner party last month when I realized that all seven women there were not only not on the pill, but had only good things to say about going off,” says a 31-year-old friend of mine, a recent convert to using a cycle-tracking app, plus condoms while she’s ovulating. As another 31-year-old friend recently told me of her choice to use pullout-plus-period-tracker, “I kind of struggled with our method for a while. It seemed kind of embarrassing and definitely felt irresponsible. But after six or so years of this style, we have still never been pregnant.”

But when I talked to women in their early twenties who have relied on withdrawal, I realized their decisions were far less deliberate. Younger women tended to say they had condomless sex with no birth-control backup only when they were too drunk or too in-the-moment or too shy to protest. “I feel like it was used by older men who didn't want to use condoms,” one 24-year-old told me, “and because of my inexperience I didn't advocate for a more reliable method. So I kind of had to trust that they would withdraw in time and it was hella stressful.”

When I asked these women whether they would ever rely on the pullout method, some were appalled. “I and at least one friend of mine ask our boyfriends to pull out in addition to using hormonal birth control,” says Sarah, 22. “I feel like the pullout method is maybe one of the dumbest things a lady could possibly do,” adds Allison, 21. “There's just too much risk, to me — especially if you're that young.”

It’s no coincidence that the pullout advocates I know are women who have been sleeping with the same man for years. More than any other birth-control choice, the pullout method requires women to relinquish control and put a significant amount of trust in their partner. But it also comes with the benefit of sharing the burden of preventing pregnancy. After years of being the ones who had to remember to take a pill or replace the ring, pullout puts the onus on men. A friend of mine, who’s 32, says her current partner has more reservations than she does about using the withdrawal method. “He’s like, ‘I’m nervous. Sometimes I feel like I’m going to fail at my job,’” she says, adding earnestly, “It’s a lot of pressure for them.”

She concedes that the pullout method is risky, but, she continues, “For the longest time I used the pill and condoms because I was terrified of getting pregnant. The older I get, the less scared I am. I’ve had an abortion” — when she was on the pill, actually — “and it's not the end of the world.” These days, she’s more comfortable going condomless than her steady partner is. “The older I get, the more deserving I feel of pleasure,” she says. “When I was younger, men would be like, ‘It’s so much better to have sex without a condom!’ But it’s also more pleasurable for me. The more I connect with my sexual desire, the more I want to have sex without a condom.” And without hormones. And that means pulling out.

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