[6] Societies in the ancient civilizations of Greece and Rome preferred small families and are known to have practiced a variety of birth control methods.
[8] However, these societies viewed birth control as a woman's responsibility, and the only well-documented contraception methods were female-controlled devices (both possibly effective, such as pessaries, and ineffective, such as amulets).
[10] An analysis of Demographic and Health Surveys in 43 developing countries between 1990 and 2013 found a median 12-month failure rate across subregions of 13.4%, with a range of 7.8–17.1%.
[11] A large scale study of women in England and Scotland during 1968–1974 to determine the efficacy of various contraceptive methods found a failure rate of 6.7 per 100 woman-years of use.
[16] It has been suggested that the pre-ejaculate ("Cowper's fluid") emitted by the penis prior to ejaculation may contain spermatozoa (sperm cells), which would compromise the effectiveness of the method.
While no large conclusive studies have been done, it is believed by some that the cause of method (correct-use) failure is the pre-ejaculate fluid picking up sperm from a previous ejaculation.
A contrary, yet non-generalizable study that found mixed evidence, including individual cases of a high sperm concentration, was published in March 2011.
That is, looking for motile sperm in small amounts of pre-ejaculate via microscope after two minutes – when the sample has most likely dried – makes examination and evaluation "extremely difficult".
Some people prefer it so they can avoid possible adverse effects of hormonal contraceptives or so that they can have a full experience and be able to "feel" their partner.
[30] Other reasons for the popularity of this method are its anecdotal increase in male sexual deftness, it has no direct monetary cost, requires no artificial devices, has no physical side effects, can be practiced without a prescription or medical consultation, and provides no barriers to stimulation.
However, a reduction in the volume of bodily fluids exchanged during intercourse may reduce the likelihood of disease transmission compared to using no method due to the smaller number of pathogens present.
[22] Based on data from surveys conducted during the late 1990s, 3% of women of childbearing age worldwide rely on withdrawal as their primary method of contraception.
[32] In the United States, according to the National Survey of Family Growth (NSFG) in 2014, 8.1% of reproductive-aged women reported using withdrawal as a primary contraceptive method.