Contraceptives ideal for family planning, not withdrawal method, say experts

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Many women in Nigeria want to space their children but are reluctant to adopt modern contraceptive methods due to widespread myths and misconceptions. Cultural beliefs and spousal disapproval also hinder uptake, even as economic hardship and hunger worsen.

These misconceptions have pushed some women toward traditional family planning methods such as periodic abstinence, withdrawal, and lactational amenorrhoea which experts who spoke with PUNCH Healthwise described as unreliable, with failure rates exceeding 50 per cent.

Nigeria’s rapidly growing population, combined with economic struggles driven by inflation, signals a potential rise in poverty unless population growth is better managed.

Unmet need for family planning also remains a major public health concern.

Evidence shows that the unmet need for family planning in Nigeria has remained high over the past 15 years despite numerous policies and programmes aimed at generating demand. Experts describe contraception as the scientific means of preventing unplanned pregnancies by spacing or limiting births.

The World Health Organisation defines family planning as the ability of individuals and couples to have their desired number of children, including the spacing and timing of births, and a woman’s right to decide whether she wants children at all.

Access to contraception reduces unplanned pregnancies and lowers the risk of unsafe abortions—one of the leading causes of maternal death. Studies suggest that increased contraceptive use could prevent up to 33 per cent of maternal deaths globally.

An Associate Professor and Consultant Obstetrician and Gynaecologist at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State, Dr Uche Agu, cautioned women against relying on the withdrawal method for birth control, describing it as unreliable and prone to failure.

He noted that the withdrawal method,popularly known as “pull-out” has a high failure rate and should not be relied upon for family planning.

According to the Nigeria Demographic and Health Survey (2023–2024), the contraceptive prevalence rate is 20 per cent among currently married women and 50 per cent among sexually active unmarried women. Only 15 per cent of married women and 38 per cent of sexually active unmarried women use a modern contraceptive method.

Among married women, implants (6 per cent) and injectables (4 per cent) are the most commonly used modern methods, while among sexually active unmarried women, male condoms (26 per cent) and withdrawal (9 per cent) are most used.

Agu said that although withdrawal works for a few people, it is fundamentally flawed.

He explained that the goal of withdrawal is to prevent sperm from entering the vagina. However, the method fails frequently; one in five couples who use it consistently for a year will become pregnant.

Agu stressed that many men lose control at the point of orgasm and ejaculate inside the vagina before pulling out. Even where they succeed in withdrawing, sperm cells may already be present in pre-ejaculatory fluid.

According to the National Bureau of Statistics, only 12 per cent of women in Nigeria used modern contraceptive methods as of 2021, while over 83 per cent were not using any method in 2018.

Explaining further, Agu said, “Withdrawal is a traditional family planning method used by people who do not want to use standard methods such as condoms, injectables, intrauterine devices, or implants.

“In the withdrawal method, the man believes he can pull out before orgasm. But it is not very effective because, at the climax of the feeling, he may forget himself and ejaculate inside the vagina before pulling out. Even the first secretions before ejaculation contain sperm cells, and these can cause pregnancy.

“The method only works for some people, but it is flawed by inconsistencies and failures. It has a high failure rate.”

WHO data from 2020 shows that even with perfect use, four per cent of people relying on withdrawal will become pregnant. Condoms, by comparison, have a two per cent pregnancy rate under perfect use.

WHO lists contraceptive methods such as pills, implants, injectables, patches, vaginal rings and IUDs as safe, effective, and rigorously tested. Long-acting methods like implants, IUDs, and sterilisation are highly effective and durable; pills, injections, patches, and rings work well when used correctly. Condoms prevent pregnancy and also protect against sexually transmitted infections, including HIV.

Agu emphasised that withdrawal requires exceptional discipline on the part of the man.

“Using the withdrawal method involves a lot of discipline and commitment because many men lose control and ejaculate inside the vagina. Even those with some control may release sperm cells in the initial secretions before pulling out. That is why it fails,” he said.

He urged women to embrace modern contraceptives to prevent unintended pregnancies and stressed the need to improve access to accurate information about modern family planning methods.

A Public Health Physician with more than 25 years’ experience, Dr Salma Ibrahim-Anas, said family planning and fertility education are critical to achieving sustainable development and national security.

Ibrahim-Anas, the Special Adviser on Health to the President, said the lack of family planning and poor access to fertility education contribute to insecurity.

She explained that proper spacing of children helps parents instil morals, provide good nutrition and education, improve child survival, and reduce pressure on health facilities.

“Lack of family planning is a great contributor to insecurity in the country because it helps you decide how many children you want, when to have them, and the family size you can adequately cater for.

“If you have too many children, you may not be able to cater to them. Without proper upbringing and access to quality education, children may become vulnerable and resort to unhealthy means of survival, contributing to insecurity,” she said.

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