Contraception as a Rational Choice or Social Practice?

Couples’ fertility control is most often perceived as a rational decision-making process, thereby assuming that people – and women in particular – who want to prevent conception will rely on the most effective method available. Accordingly, it is argued that the introduction of hormonal methods in advanced economies was paralleled by a linear transition from irrational ineffective methods to rational effective ones.

This approach stands in sharp contrast with the abundant empirical research that identifies high rates of unintended pregnancies, contraceptive method switching, and non-use across the US and Europe. Although the key role of efficacy in opting for a specific method definitely cannot be neglected, multiple observations pinpoint to the importance of also looking at contraception as a social practice. For instance, whereas withdrawal is less effective, it may be perceived as a ‘healthy’ and natural alternative for hormonal methods, and even as a more intimate form of contraception. Furthermore, although most female contraceptives are more effective, withdrawal and male condom use enable men to actively participate in contraception. One could also think about the unsolved question whether women would trust their male partner with an equally effective male hormonal pill. Or, researchers have been puzzled for a long time that the prevalence of tubal ligations exceeds that of vasectomies in almost all countries worldwide, despite the fact that both procedures are similarly effective and male sterilization is less physically invasive and less costly.

In an effort to improve our understanding of contraceptive use, we examined the joint importance of structural, ideological, and technological conditions at the individual and regional level for non-use, traditional method use (i.e., withdrawal, and rhythm method), and modern method use (i.e., barrier methods, hormonal methods, and sterilization) (Dereuddre, Van de Velde & Bracke, 2016). We used data from the first wave (collected between 2004 and 2011) of the Generations and Gender Survey (GGS) and selected all countries in which information was gathered for the key variables (Austria, Belgium, Bulgaria, Czech Republic, France, Georgia, Germany, Lithuania, Poland, Romania, and Russian Federation). For our study, the main advantages of the GGS were its cross-national comparability, and the fact that dataset contains data on contraceptive use that are among the most recently available for the Western, Central, and Eastern European countries under investigation.

First, we found that primary individual determinants in predicting traditional over modern contraceptive use are social and cultural expectations (measured as respondents’ response to a range of questions concerning family values, and their religiosity), and socioeconomic status, rather than rational calculations between the costs and benefits of having children (measured in terms of fertility intentions, and the perceived costs of having a/another child within the next three years). Men and women with more traditional family attitudes, and those who are religious, lower educated, and unemployed are more likely to rely on traditional method use compared to modern contraceptive use than those with more egalitarian attitudes, who are not religious, higher educated and employed.

Second, over and above these individual characteristics, contraceptive practice is influenced by the regional context in which people live. Whereas higher levels of gender inequality increase the likelihood of relying on traditional instead of modern methods, both higher levels of gender inequality and religiosity are associated with a higher likelihood of not using contraception.

Interestingly, these results also (partly) capture the ‘East-West’ divide in contraceptive use. Whereas Western European contraceptive users tend to almost universally practice modern methods, the prevalence of traditional methods remains relatively high in the Central and Eastern European region. At the same time, the identified regional indicators related to higher non-use and traditional method use are more clearly present in this latter context. In general, our findings underline the complexity of the dynamics underlying contraceptive usage, and add to the debate that problematizes the perception of contraception as a rational choice. Instead, attention should be shifted towards how contraceptive use fits and is embedded in different cultural contexts.


Dereuddre, R., Van de Putte, B., & Bracke, P. (2016). Ready, willing, and able: Contraceptive use patterns across Europe. European Journal of Population, online first. DOI: 10.1007/s10680-016-9378-0

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