Every minute 250 babies are born around the world. In many instances it is a time of great celebration and joy. In some it can be a time of trouble, sorrow, and difficulty. The differences surrounding childbirth can be striking, even in contexts that appear similar.

Evidence shows that in the majority of European countries declining fertility rates are not due to a lack of desire for children. The contributing factors are rather delayed childbearing due to educational attainment, lack of a ‘suitable’ partner, older age at onset of childbearing, limited family friendly services, as well as financial issues - all factors affecting family size.

Throughout Europe we are also witnessing an increasing medicalization of birth – for example, lack of choice on where and how to deliver, increasing rates of cesarean section – which tend to make childbirth an overly technical procedure rather than an emotional, joyous experience. While we of course want specialized medical care and adequate interventions available to ensure appropriate care and positive outcomes for high risk and complex pregnancies and births, there is a danger - and an economic loss - in applying practices that are required for complex pregnancies and birth when it is not medically necessary. Luckily many European countries are working to negate this trend by promoting midwifery lead care, mother friendly hospitals with room for family and the breastfeeding friendly hospital initiative.

This edition of Entre Nous looks at how women are able to access care, who is able to provide the care for them, the quality of the care they receive and the varying cultural or religious practices that influence the process of childbirth, with a focus on choice. It is a human right of women and couples to be able to choose if and how many children they want and when they want them. Often the best childbirths are those where women and their families have choices to have the kind of birth they want.

Entre Nous is funded by the United Nations Population Fund (UNFPA), Regional Office for Eastern Europe and Central Asia, with the assistance of the World Health Organization Regional Office for Europe, Copenhagen, Denmark. Entre Nous is distributed primarily via the web. A limited number of copies are distributed in print (500 Russian and 500 English).