United States Italy
Women age 15-44 using modern contraception 70% 36%
Birth rate per woman 1.8 1.4
What’s Their Secret?
When it comes to birth control Italians have a preference for the “natural” you can trace to the Catholic Church, which long since banished the contraceptive diaphragm and persuaded most people not to use IUDs, Pills, patches, rings, implants, Depo-Provera shots, or sterilization. Condoms, which Italians usually call preservativi – watch out what word you use for jam or you’ll get snickers – are fairly popular. But what most people do to avoid pregnancy is what they call stare attenti or being careful: watching the calendar, and using withdrawal on days they think (rightly or wrongly) that they’re fertile.
Nonetheless, the Italian birth rate hovers between the lowest and the next-to-lowest on the planet. How come? The main explanation is that – contrary to what I was taught in medical school – withdrawal works. It helps that Italy has a surprising culture of shared responsibility between men and women in this particular realm, so guys are more willing to use condoms, and more skilled at pulling out.