Saving $$$ on Family Planning

[Yankuba]

For those in committed relationships, this article suggests that you can give your condoms to a teenager and use the withdrawal method instead - saving you big bucks!

https://broadly.vice.com/en_us/article/pulling-out-is-as-effective-as-using-condoms?utm_source=broadlytwitterus

[ChaseJuggler]

Why not both?

[countdown]

My niece exists due to the withdrawal method. Vasectomy through Kaiser was a whopping $15 copay.

[forummm]

Are you kidding me? The withdrawal method when done correctly EACH time has a 22% typical use failure rate over the course of a year. That means 22% of people will get pregnant in the average year. If you still want to have kids later get an IUD or implant and be safe. Plus you can enjoy sex more. And IUDs and implants are free with most health plans now because of the ACA.

http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/Family-Planning-Methods-2014.pdf

[Yankuba]

Are you kidding me? The withdrawal method when done correctly EACH time has a 22% typical use failure rate over the course of a year. That means 22% of people will get pregnant in the average year. If you still want to have kids later get an IUD or implant and be safe. Plus you can enjoy sex more. And IUDs and implants are free with most health plans now because of the ACA.

http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/Family-Planning-Methods-2014.pdf

That's a cool chart. But it looks like male/female condoms are only a tiny bit more effective than withdrawal, which I suppose was the point of the Vice article. The pill was also surprisingly vulnerable at 9%.

[Erica/NWEdible]

Are you kidding me? The withdrawal method when done correctly EACH time has a 22% typical use failure rate over the course of a year. That means 22% of people will get pregnant in the average year. If you still want to have kids later get an IUD or implant and be safe. Plus you can enjoy sex more. And IUDs and implants are free with most health plans now because of the ACA.

http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/Family-Planning-Methods-2014.pdf

Total agreement. There are places to NOT cheap out - and preventing the conception of a child if you do not want a(nother) child is one of those places.

[Katsplaying]

Reminds me of what they call Catholic women who used the rhythm method: MOTHERS

OMFSM this is one place where cheaping out is potentially disastrous. MMM talks about waiting til you're FIRE to get a fucking DOG, which could be re-homed if worse comes to worst, but an unplanned pregnancy derails everything, FOREVER.

Again for those who missed it:

UNPLANNED PREGNANCY DERAILS EVERYTHING FOREVER

[sheepstache]

To be fair, you can take Plan B the next day if pulling out fails.

[calimom]

Are you kidding me? The withdrawal method when done correctly EACH time has a 22% typical use failure rate over the course of a year. That means 22% of people will get pregnant in the average year. If you still want to have kids later get an IUD or implant and be safe. Plus you can enjoy sex more. And IUDs and implants are free with most health plans now because of the ACA.

http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/Family-Planning-Methods-2014.pdf

Total agreement. There are places to NOT cheap out - and preventing the conception of a child if you do not want a(nother) child is one of those places.

X2

Just pick up some condoms at a free site, like your groovy local high school's health office.  It's insane to think the rhythm method is effective as birth control.

[soccerluvof4]

This is a case in point where trying to be cheap can cost you an arm and a leg. Just get the condoms and move on.

[MsPeacock]

Hmmmm, well I would say that the answer to "condoms aren't any more effective than withdrawal" - is use something more effective. E.g. condoms plus spermicide, the pill, IUD, etc.

Agree w/ pp that not using condom in order to "save money" is cheap rather than frugal. And an unwanted pregnancy is just not something to mess around w/ in terms of risk.

[wordnerd]

To be fair, you can take Plan B the next day if pulling out fails.

Plan B is not terribly effective and pretty expensive.

[lbmustache]

To be fair, you can take Plan B the next day if pulling out fails.

Plan B is not terribly effective and pretty expensive.

Plan B depends on a ton of factors: how fast it's used, time of your cycle, individual body chemistry, weight.

I've used ELLA (not available OTC), it was free through Kaiser (thanks Obama!)... and I'm not pregnant. But in general, yes "Plan B" is a last resort, plus depending in how you react, dumping a ton of hormones into your body at once isn't the best.

For those wanting to cheap out, there are TONS of places to get free condoms. The reason the article is saying that pulling out isn't as effective as condoms is because people don't use condoms correctly. When used correctly condoms are more effective than pulling out.

[wordnerd]

To be fair, you can take Plan B the next day if pulling out fails.

Plan B is not terribly effective and pretty expensive.

Plan B depends on a ton of factors: how fast it's used, time of your cycle, individual body chemistry, weight.

I've used ELLA (not available OTC), it was free through Kaiser (thanks Obama!)... and I'm not pregnant. But in general, yes "Plan B" is a last resort, plus depending in how you react, dumping a ton of hormones into your body at once isn't the best.

For those wanting to cheap out, there are TONS of places to get free condoms. The reason the article is saying that pulling out isn't as effective as condoms is because people don't use condoms correctly. When used correctly condoms are more effective than pulling out.

Agree. I'm glad Plan B exists (I've used it and did not get pregnant), and the effectiveness is much higher the sooner you take it (overall effectiveness is somewhere around 80%, I think). My point was just that saying, "meh pulling out is a fine plan because there's always Plan B" seems...short-sighted.

[lbmustache]

To be fair, you can take Plan B the next day if pulling out fails.

Plan B is not terribly effective and pretty expensive.

Plan B depends on a ton of factors: how fast it's used, time of your cycle, individual body chemistry, weight.

I've used ELLA (not available OTC), it was free through Kaiser (thanks Obama!)... and I'm not pregnant. But in general, yes "Plan B" is a last resort, plus depending in how you react, dumping a ton of hormones into your body at once isn't the best.

For those wanting to cheap out, there are TONS of places to get free condoms. The reason the article is saying that pulling out isn't as effective as condoms is because people don't use condoms correctly. When used correctly condoms are more effective than pulling out.

Agree. I'm glad Plan B exists (I've used it and did not get pregnant), and the effectiveness is much higher the sooner you take it (overall effectiveness is somewhere around 80%, I think). My point was just that saying, "meh pulling out is a fine plan because there's always Plan B" seems...short-sighted.

Oh ok - I definitely agree.

[sheepstache]

To be fair, you can take Plan B the next day if pulling out fails.

Plan B is not terribly effective and pretty expensive.

Plan B depends on a ton of factors: how fast it's used, time of your cycle, individual body chemistry, weight.

I've used ELLA (not available OTC), it was free through Kaiser (thanks Obama!)... and I'm not pregnant. But in general, yes "Plan B" is a last resort, plus depending in how you react, dumping a ton of hormones into your body at once isn't the best.

For those wanting to cheap out, there are TONS of places to get free condoms. The reason the article is saying that pulling out isn't as effective as condoms is because people don't use condoms correctly. When used correctly condoms are more effective than pulling out.

Agree. I'm glad Plan B exists (I've used it and did not get pregnant), and the effectiveness is much higher the sooner you take it (overall effectiveness is somewhere around 80%, I think). My point was just that saying, "meh pulling out is a fine plan because there's always Plan B" seems...short-sighted.

I pointed out Plan B because people tend to respond as though if something goes wrong and pull out doesn't happen that it's the end of the world and I'm saying you still have another option in that case.

Yeah, if pull out failure is happening too often, then maybe the method just isn't right for that couple. But they might decide that the occasional hassle and cost of Plan B is a better option than constantly using condoms (which don't feel as good) or BC (which is changing your hormone levels most of the time). It's sort of like the mustachianism of having a high-deductible health insurance plan.

I was also thinking that they might chart. There are some parts of the woman's cycle where pregnancy definitely can't happen. So if they're charting then they'd only use Plan B if there's a pull out failure near the fertile period.

[Gin1984]

The study they site is a survey study which does not state what they say it does.

[obstinate]

Pronbably the worst advice I've seen on this forum. Family planning is already very inexpensive considering its wealth building properties.

[sunday]

Condoms are 10 cents. Abortions are 500 dollars. Condoms are cheap insurance. Financially and emotionally.

[ketchup]

Condoms now.  Vasectomy later.  No kids ever.

[iamlittlehedgehog]

I can't speak for gentlemen (other than wrap it before you tap it) but an IUD has been a God send for women like me who cannot take hormonal birth control. They are super cheap now thanks to ACA and have multiple options. I'm glad to see more women are using them as their primary form of birth control. Kids are expensive (and loud, and sticky).

[Sibley]

Just to make sure people understand one of the problems with the pullout method... some gentlemen will have a bit of release that they're not aware of. Meaning, even if you do pull out, it may not matter.

[EricP]

Are you kidding me? The withdrawal method when done correctly EACH time has a 22% typical use failure rate over the course of a year.

This sentence isn't correct.  22% is the typical use failure rate.  That means that it includes the times when withdrawal method isn't used correctly.  If used correctly every time then it would have a lower failure rate.  That's why the numbers are all relatively high because they are accounting for when people don't use the birth control correctly.

Although I still wouldn't recommend the pull and pray because you're going to screw it up.  If you don't want kids use multiple birth control methods.

[RangerOne]

The withdrawal method is reasonably easy to screw up... Especially given the fact the men while having sex have severely compromised cognition. Climax is probably the last moment you want a person making a rational decision to perform the proper pull out method.

[La Bibliotecaria Feroz]

If you really want to save money on condoms, it would seem to make more sense to use them in conjunction with natural family planning. If you keep good charts and know when you ovulate, then once that's a few days behind you, you don't need condoms again until after your next period.

That said... it's tricky to let yourself think that "we don't always need condoms."

This may or may not be why we have a second child.

[Mississippi Mudstache]

LOL at everybody confirming precisely the ignorant attitude that is specifically addressed in the article. My wife and I have used pulling out successfully as our primary contraceptive method for the entirety of our 5-year marriage plus 2-year courtship. We had to resort to Plan B exactly once, early on when a condom failed. And just for giggles, I'll add that my wife was an "oops", conceived while her mom was on birth control.

Now that we are finished making babies, I plan to get snipped shortly after our son is born in December.

[NumberCruncher]

Are you kidding me? The withdrawal method when done correctly EACH time has a 22% typical use failure rate over the course of a year.

This sentence isn't correct.  22% is the typical use failure rate.  That means that it includes the times when withdrawal method isn't used correctly.  If used correctly every time then it would have a lower failure rate.  That's why the numbers are all relatively high because they are accounting for when people don't use the birth control correctly.

Although I still wouldn't recommend the pull and pray because you're going to screw it up.  If you don't want kids use multiple birth control methods.

Where is everyone getting their numbers? Planned Parenthood has 4% as the PERFECT USE failure rate for the withdrawal method, and 27% as the TYPICAL USE failure rate (http://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method).

To compare, the failure rate for condoms is 2% for PERFECT USE and 18% for TYPICAL USE (http://www.plannedparenthood.org/learn/birth-control/condom).


Perfect use of the withdrawal method results in twice as many unplanned pregnancies as perfect use of condoms in a year.

Now...if we look at the chance of having any unplanned pregnancy, we can do some fuzzy math...assuming each year the failure rates are the same, the chance of NOT getting pregnant is 98% each year for perfect use of the withdrawal method and 96% each year for perfect use of condoms. If we further assume each year is independent, we can calculate a 66% chance of NOT having an unplanned pregnancy using the withdrawal method PERFECTLY over ten years, and a 82% chance of NOT having an unplanned pregnancy over ten years using condoms PERFECTLY. These numbers get very small if we look at typical use... O.o

[Gin1984]

Are you kidding me? The withdrawal method when done correctly EACH time has a 22% typical use failure rate over the course of a year.

This sentence isn't correct.  22% is the typical use failure rate.  That means that it includes the times when withdrawal method isn't used correctly.  If used correctly every time then it would have a lower failure rate.  That's why the numbers are all relatively high because they are accounting for when people don't use the birth control correctly.

Although I still wouldn't recommend the pull and pray because you're going to screw it up.  If you don't want kids use multiple birth control methods.

Where is everyone getting their numbers? Planned Parenthood has 4% as the PERFECT USE failure rate for the withdrawal method, and 27% as the TYPICAL USE failure rate (http://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method).

To compare, the failure rate for condoms is 2% for PERFECT USE and 18% for TYPICAL USE (http://www.plannedparenthood.org/learn/birth-control/condom).


Perfect use of the withdrawal method results in twice as many unplanned pregnancies as perfect use of condoms in a year.

Now...if we look at the chance of having any unplanned pregnancy, we can do some fuzzy math...assuming each year the failure rates are the same, the chance of NOT getting pregnant is 98% each year for perfect use of the withdrawal method and 96% each year for perfect use of condoms. If we further assume each year is independent, we can calculate a 66% chance of NOT having an unplanned pregnancy using the withdrawal method PERFECTLY over ten years, and a 82% chance of NOT having an unplanned pregnancy over ten years using condoms PERFECTLY. These numbers get very small if we look at typical use... O.o

Also, keep in mind perfect use with a condom is easier to do that perfect use with pulling out.

[EricP]

@NumberCruncher, from the CDC link that forummm gave above.

[Merrie]

I think it also depends on how much you want to avoid a child. The rate of unintended pregnancy among people who would like to wait a bit longer to get pregnant is really alarmingly high sometimes.

[obstinate]

Yeah I would have to suspect that there is a lot more skewness in the use distribution of pull-out vs. condoms. As in, there's like four couples in the entire country that do pull-out with perfect use. OTOH there are a fairly large number of people that use condoms perfectly, since it's really not very hard to do. You . . . wait for it . . . put it on. Every time.

But really, why not get an IUD. It costs like $100 and lasts for three years.

[Flyingkea]

And for those saying the withdrawal method works because of your anecdote, I offer my own to counter it. I bowed to pressure and used withdrawl. I was pregnant within 2 weeks.
Now I have an IUD.

[heitzrun]

Is this the right approach.  Is it morally acceptable?

[DINK]

I've never really understood using "pull and pray" as a method for birth control. It seems like it would make it a lot less fun for the man. My husband and I were condoms when we first started dating then I started taking BC once we had been together a few months. Now that I we are mid-30's though and know we don't ever want to have children I just went ahead and got sterilized. $2,000 out of pocket for a bi-lateral salpinectomy and I couldn't be happier knowing that I am never going to have any kind of an "oops" pregnancy.

[EllieStan]

I will never consider the P&P method as a form of ''birth control''. At least not for people who truly don't want to have kids (I suspect those who practice P&P are actually okay with the possibility of a pregrancy, or they'll just ''deal with it'' if it happens and claim they're super fertile).

SO and I are childfree by choice, so there's no way in hell we would risk a pregnancy (plus having to deal with an abortion, which I'm sure would be a traumatic experience for me, physically and emotionally). My health and overall peace of mind are far more important than saving a few bucks.

I have an IUD ($80) and when its 5 year time span is over, SO gets a vasectomy ($150).

[beberly37]

I have been an advocate of pull-out for years.  Between the time my wife and I used it and my previous girlfriend did, I have over six years of non-failure with PO, which at 78% success rate each year, is .78^6 or 22% chance of having six successive years of using pullout without a failure.  (for those who want to use PO as a long term method, ten years of 78% success rate is 8.3% success rate per decade, not good)

I will note that when my wife and I decided to "stop avoiding getting pregnant"  (which is the same thing as trying to get pregnant from a practical perspective) she was knocked up after her first ovulation, so there wasn't any infertility at play in my six years of pull-out.

However, I will add two big caveats to this anecdote:
Successful PO has a lot to do with the individual.  Maybe I'm really good a knowing when to pullout, maybe there is absolutely zero sperm in my pre-ejaculate.  But not everyone will have such characteristics.  It would be nice to have a way to test if you are good at it that didn't have major consequences. 

Also, my wife and I were using PO in conjunction with basal temperature rhythm method which is basically tracking vaginal body temperature as a means of predicting ovulation, not a perfect science and we ignored the it most of the time (she was doing it as a body awareness exercise).

I will also note that after our first was born and before we were ready for #2, we used condoms. While pullout was successful for so long, at the time, having a kid would not have been the end of the world, but in no way did we want 2 under 2. 

Vasectomy was free with insurance and I have a week until I test for effectiveness.  Hopefully we're a week away from free, zero-waste sex. 

Also, our biggest reason for not using an IUD between #1 and #2, was the terrible, yet rare consequences if there is a pregnancy while using one, which scared my wife away immediately. 

---------------------------------------------------------------------
An after thought, I'm not sure the capital and operating expenses involved, but there is a device that people having trouble conceiving use to pinpoint ovulation (which uses hormone levels in urine).  These can theorectically be used to avoid the 3-4 days per cycle when pregnancy can occur.  Amortizing the cost of the device over it's lifetime as well as the cost of consumables and comparing that to the cost of condoms, it might be a low cost method.  Though the average number of times one has sex per week/month/year will directly impact the economics.  If you're a birthdays and anniversaries couple, condoms are pretty cheap; if you're everyday and twice on Saturdays, condoms would be pricey. 

[MrsPete]

Where is everyone getting their numbers? Planned Parenthood has 4% as the PERFECT USE failure rate for the withdrawal method, and 27% as the TYPICAL USE failure rate

Regardless of your sources, I'm inclined to believe that all methods (except surgical sterilization) would be radically different in terms of "perfect use" vs. "typical use".  I work with teenagers every day, and they really do buy into things like giving a friend your pill because you won't be using it this weekend ... or not understanding that antibiotics counteract pills ... or somehow thinking that they're not capable of getting pregnant because they once had a UTI.  Mostly they just don't take the time to read and understand this very important subject. 

I'm sure I've read articles that say that younger, less educated women are more likely to experience a "birth control failure" -- which makes no sense unless you add in the variable of "perfect use" vs. "typical use".  An older woman who takes the time to understand HOW her birth control works is obviously less likely to experience a failure. 

[powskier]

Semen is frequently present in pre ejaculate, so if you wait until ejaculation before withdrawl you may have already sent out some strong swimmers and defeated the purpose.
Other perspectives : why deny your companion the penis swelling and throbbing that occurs at ejaculation? wear a thin condom, be nice to your partner, explore thousands of other ways of enjoying each other.
Sure "pull and pray" works for some but the risk/reward ratio ( risk/punishment in this case since prevention is goal) is IMO not worth it.
Sidenote: I cannot believe the ridiculously low level of sex education in the USA. I was fully informed at age 10 in Europe as were all my classmates.

[La Bibliotecaria Feroz]

Semen is frequently present in pre ejaculate, so if you wait until ejaculation before withdrawl

Well, yes. That's why even with perfect use, there is a certain failure rate.

How about this assessment: It is perhaps a niche birth control for couples in committed relationships. Many, if not most, people will either hate it or find that their risk tolerance is insufficient. And should definitely never be practiced by teenagers. My sister put her daughter on the Pill when she was 15 and had a boyfriend--better safe than sorry, no? (IUDs are coming into favor for young girls because they are known to forget things, but Sis and I both have had bad experiences with IUDs, both ending up with minor surgery.)

[TVRodriguez]

And for those saying the withdrawal method works because of your anecdote, I offer my own to counter it. I bowed to pressure and used withdrawl. I was pregnant within 2 weeks.
Now I have an IUD.

+1  THIS

Plus, under my insurance at the time I paid a whopping $40 co-pay for the IUD.  My son, priceless as he is, requires way more out of pocket.

[waffle]

Nothing really to add on the subject, but I did notice some misconceptions about how statistics and probability work here. If the success rate of something is 80% then that means that it is 80% every time. Not 80% effective the first time and then less effective the next.

If you are flipping a coin you have a 50% chance of getting heads. If you flip that coin 10 times and all were tails are you more likely to get heads on the next flip? No it is still 50/50.

I have been an advocate of pull-out for years.  Between the time my wife and I used it and my previous girlfriend did, I have over six years of non-failure with PO, which at 78% success rate each year, is .78^6 or 22% chance of having six successive years of using pullout without a failure.  (for those who want to use PO as a long term method, ten years of 78% success rate is 8.3% success rate per decade, not good)
 

[Lis]

No. No no no no no no nonononononoooooooo.

I'm doing a good job keeping my cats alive and well. Sometimes I don't even know how to take care of myself. Adding a baby to the mix anytime soon is an absolute no go.

When I was doing the deed on the regular, I was on the pill and boyfriend used the rubbers. I just switched to an IUD (and no longer have a BF), but the next guy I'm with will also use a condom. Various forms of birth control until future hubby and I sit down and decided together we're ready for a baby.

(Side note, another +1 for the IUD, at least as cost savings. My visit to get it inserted cost me $25 and my follow up is covered. My pill cost me $50 a month, this is costing me $0.96.)

[TomTX]

That's a cool chart. But it looks like male/female condoms are only a tiny bit more effective than withdrawal, which I suppose was the point of the Vice article. The pill was also surprisingly vulnerable at 9%.

That pill stat has to be user error. We used the pill (only) as birth control for 20 years. No kids.

Ah ha! Fertility issues!

Nope.

Once we discontinued the pill, she was pregnant within a few months - which coincided with the first time I was home at the right time of the month instead of on a trip for work. Didn't do anything special except having sex when we wanted to.

[Pigeon]

This may be the stupidest advice I have ever read.

[beberly37]

Nothing really to add on the subject, but I did notice some misconceptions about how statistics and probability work here. If the success rate of something is 80% then that means that it is 80% every time. Not 80% effective the first time and then less effective the next.

If you are flipping a coin you have a 50% chance of getting heads. If you flip that coin 10 times and all were tails are you more likely to get heads on the next flip? No it is still 50/50.

I have been an advocate of pull-out for years.  Between the time my wife and I used it and my previous girlfriend did, I have over six years of non-failure with PO, which at 78% success rate each year, is .78^6 or 22% chance of having six successive years of using pullout without a failure.  (for those who want to use PO as a long term method, ten years of 78% success rate is 8.3% success rate per decade, not good)
 

Now, I'm not a medical doctor or a statistician, but I'm fairly certain that the effectiveness rates given for birth control are on an annual basis.  Meaning that if its 80% effective, out of 100 couples using a given method for a year, 20 of them will get pregnant.  Its not base on 100 couples using a method for eternity and 20 of them get pregnant or 100 couple use a method right now, once, and 20 of them end up pregnant. 

As for each 10 coin tosses; all tails, the eleventh one still has 50/50 chance, but the odds of getting  10 in a row is .5^10 (which is just shy of 0.1%).  When it comes to planning (ie family planning) you have to look at hte cumulative odds of all events, not just each individual decision.  One might be inclined to bet on the outcome of one coin toss, but would you bet on the total outcome of 10?  {the answer is not unless a $1 bet won you >$1000}

Which is why they give birth control on an annual basis.  Using condoms as an example (i thinks it 97%).  If that were a 3% failure rate per instance, and you planned on having sex once per week for a year, your success rate (success being defined as not getting pregnant) would be .97^52 or 20%.  Single time success rate of a condom is more then 97%, to calculate it, we would have to know the average instances of sex per couple per year, but being pessimistic at 52/year, its the 52nd root of .97 or 99.94%