Introduction

Birth rates vary worldwide and are related to economic and social factors as well as contraceptive choice. In parts of Africa the birth rate is high (e.g. in Niger, 48.9 births per 1000 women and a fertility rate of 6.83 children born per woman). In Europe it is dramatically lower (in Germany 8.04 births per 1000 women and a fertility rate of 1.38 children born per woman) (CIA World Factbook, 2004). Although there is such gobal variation there is little cross-cultural evidence about psychological aspect of contraceptive choice and so this chapter will refer to evidence from western societies. In England and Wales, conceptions fell from over 850 000 in 1991 to 190 000 in 2002. In spite of the development of safe and effective contraceptive methods unintended pregnancies are common. In England and Wales, the percentage of conceptions terminated by abortion rose from 19.4% in 1991 to nearly 23% in 2002 with the highest percentages in those aged under 20 or over 40. The Total Fertility Rate (TFR) is the sum of age and specific fertility rates expressed per woman and controls for the changing age distribution over time. In 2002, the TFR in England and Wales was 1.65 per woman, which is similar to the rates between 1920 and 1940, before the widespread use and acceptability of contraception. These observations mean that a simple relationship between knowledge and availability of contraception and its use is unlikely (Office of National Statistics, 2004b, c; http://www.statistics.gov.uk/).