MESSAGES about the use of adequate contraception to protect against pregnancy and sexually transmitted diseases are a dime a dozen worldwide. But for some reason, Jamaicans seem to put a lot of trust in their intimate partners handling contraception, regardless of whether the relationship is committed or casual.
An All Woman online poll posted in the week of March 11 that asked, 'What type of contraception do you and your partner use most often?' showed that of the 2,112 participants, though the majority (670) used the male condom during intercourse, 534 individuals — the second highest number of respondents — said their method of contraception was the withdrawal method.
Ranked among the least reliable methods of birth control, the withdrawal method, or coitus interruptus, involves a man pulling his penis out of his partner's vagina just before he ejaculates.
This method has a failure rate of 15-28 per cent per year, meaning that it is highly unreliable and leads to many unplanned pregnancies. The failure rate is high due to the fact that whilst pulling out just before ejaculation is the target, sperm can still be present in 'pre-cum' which is the fluid a man produces once he is aroused. This fluid is often emitted long before he ejaculates.
So why does the message of adequate contraception not seem to be reaching people?
When All Woman contacted doctors with the results of the poll, they agreed that despite the many family planning and other messages, people don't seem to think of barrier protection as a big deal.
“AIDS is not scary any more. People believe they can use withdrawal effectively. We haven't been pushing the message as we were before and that may contribute,” said Dr Alfred Dawes, general, laparoscopic and bariatric surgeon.
Added obstetrician-gynaecologist Dr Jordan Hardie: “Society is trending towards being more liberal and as it relates to sexuality this appears to be interpreted by many to mean they should not use contraception. It does appear to me that improvements in HIV care has led to less fear.”
Another ObGyn, Dr Daryl Daley, said, “The masses are still unaware of the dangers of sexually transmitted diseases and unwanted pregnancies, as a result, ignorance of sex and its dangers is still high.”
However, he said that while awareness has increased to an extent, there is much work to be done to get people to be proactive in this regard.
Renée Gauntlett, communications and public relations officer at the National Family Planning Board (NFPB), said through the agency's Choose 2 campaign, they encourage dual-method use, that is, using a condom along with another contraceptive method such as the pill, injection, implant or IUD (intrauterine device), for the ultimate protection against unplanned pregnancy and sexually transmitted infections including HIV.
Gauntlett, however, pointed out that the results of the poll are not in the least bit surprising as “perceived risk is very low among young people in Jamaica”.
“Withdrawal might work to prevent pregnancy for some lucky people, but it definitely does not protect against STIs. Young people refuse to believe that an unplanned pregnancy or an STI can happen to them, especially when they are in long-term relationships or have been practising withdrawal for some time,” she said.
Gauntlett added: “Persons have also been known to have unprotected sex with a partner simply because they are very attractive, not thinking that they may have an STI. As a result, they are ignoring the warnings and engaging in risky sexual behaviour.”
Further, Gauntlett said many people choose withdrawal as a method of contraception for various reasons, some being that they do not like using condoms, they believe the rumours that contraceptives are bad for their health, or they just prefer the feel of “skin-to-skin”.
She pointed out though that while withdrawal has been effective for some, approximately one in five women globally who practise withdrawal get pregnant.
“According to the 2008 Reproductive Health Survey, the majority of women who practised withdrawal had two or more children. In order for withdrawal to be more effective, the female must monitor her ovulation cycle correctly and the male should have some serious self-control, and we know that both tasks are not always easy. We also cannot ignore the fact that pre-ejaculation (pre-cum) can actually result in pregnancy as well,” she warned.
Gauntlett maintained that in spite of the difficulties and apart from the Choose 2 media campaign, the NFPB also does outreach and interventions in schools and communities, promoting modern contraceptive use and healthier, more responsible sexual behaviour.
Coming in third in the poll was abstinence with 353 people using that route, while 259 said they used the birth control pill. Seventy-eight people said tubal ligation/vasectomy was their option, 70 voted the rhythm method, 62 said the IUD, 55 said injection/implant, 17 opted for the female condom, 11 said they used the vaginal ring and three people preferred the diaphragm.