This well-researched and erudite book is also a thoroughly engaging read. As part of a series entitled Medicine and Biomedical Sciences in Modern History it will appeal to social, cultural and demographic historians as well as medical professionals. In recent years there has been a growing number of voices calling for the reassessment of our understanding of the fertility transition, citing a need for a greater understanding of fertility limitation and the attitudes of, and practices adopted by, individuals and couples who wanted to avoid conception. Hionidou's work is an impressive response to this plea.

Abortion and Contraception sets out with two main objectives: to re-evaluate the timing of the fertility transition in Greece and to understand the processes contributing to the decline in fertility. The first of these is dealt with in a single chapter considering Greek fertility trends between 1870 and 1967. Hionidou notes the debate over the Princeton European Fertility Project's estimate that the county's fertility transition had begun in the 1890s, before arguing persuasively that even as late as 1931 the country's age-specific fertility curves were still characteristic of a natural fertility regime. Rates of fertility had been low over the previous three decades but this was ‘not because couples were intentionally controlling their fertility but because of the turbulent history of the country in those years and its effects on the lives of the population’ (p. 39). Couples had not been using parity-specific family limitation but, possibly unintentionally, had been spacing their children, creating a ‘natural’ fertility profile.

The much more complex question of how Greek couples may have reduced their fertility takes up the remainder of the book. Hionidou pulls together cultural, medical, societal and economic factors to show that the use of ‘birth control’ evolved over a relatively long period, with changes in attitude and new innovations creating occasional, but not necessarily immediate, ‘step changes’ in practice. She takes pains to highlight the role of doctors in fertility control in Greece during her period, and is careful to describe how very similar practices can have very different meanings to different generations. Her arguments are enhanced by extracts drawn from two sets of interviews she conducted on Mykonos and Hios during the 1990s. Many of her elderly respondents had been married in or around the 1930s, just as the fertility transition gained momentum. A further set of interviews, undertaken in 2011 with a small number of physicians who had graduated between 1950 and 1974, provides an additional dimension to the discussion.

Perhaps surprisingly in a book dealing with methods of avoiding fertility, Hionidou begins by looking at childlessness. In Greek culture this condition was a source of considerable stigma and regret amongst married couples, and a great many means were deployed to encourage fertility. One of these was the use of emmenagogues. In the nineteenth century irregular menstruation was seen as a sign of ill health. Emmenagogues were prescribed to bring on a ‘delayed’ period; to regulate menstruation and therefore improve fertility. If the emmenagogue was successful and the woman happened to be pregnant, the result was in effect an abortion; but, Hionidou argues, it was for reasons of ‘reproductive health’ that a great many Greek women resorted to them until at least the middle of the twentieth century, often under the care of a physician. By the end of the nineteenth century doctors were also practicing curettage (the removal of the lining of the womb) ‘as a treatment of female ailments and ultimately sterility’ (p. 145). By the mid-1920s, however, this surgical technique was being widely used as a means of abortion early in pregnancy, particularly in urban areas, even though this was technically illegal. Curettage, it is suggested, helped to depress Greece's already low illegitimacy rate even further. The fact that ‘abortions’, rather than ‘restored menses’, were being sought implies that there had been a ‘moral leap’ within society. Hionidou outlines the contemporary debates amongst physicians, within the church and by the population in general; being careful to show how changes in the political climate affected the tenor of the various arguments.

By the 1920s and 1930s, books on contraception were beginning to appear in Greek, although initially they all stressed that the use of any of the methods described would be harmful to health. By the 1950s and 1960s this message had altered as couples’ desire to limit their fertility was acknowledged. Hionidou devotes two chapters to contraception, one considering ‘natural methods’ – mainly breastfeeding, abstinence and withdrawal – and the other ‘appliances and the Pill’. Here the extracts from the interviews come into their own, and allow her to show that withdrawal was, and remained, a widely practiced method throughout her study period. More importantly perhaps, she demonstrates that in Greece it was a method used by both sexes, and not an exclusively male preserve.

A most telling observation in the discussion on appliance methods is that all the ‘methods had been employed for other purposes before they were used to prevent conception… they were repurposed once the need for contraceptives existed’ (p. 274). This evolution was not a speedy process; Hionidou estimates it took ‘up to a generation in the case of Greece’ (p. 277), and it is evident that the cohorts involved were well aware that none of the methods were foolproof.

Given the close association between fertility and health in Greece it is perhaps inevitable that doctors had a considerable influence on couples’ fertility-related behaviour; a relationship that is the focus of Hionidou's penultimate chapter. Doctors often had to tread carefully between the needs of their patients, the views of society and the demands of the law. In different societies these factors exert different pressures, so that medical discourse, practice and advice might differ markedly from one context to another.

There is not room here to do full justice to the wealth of detail and the nuanced arguments that Hionidou provides on all aspect of her subject. I would strongly encourage readers to explore these, perhaps supplying themselves with a map of Greece and a medical dictionary before doing so. A strength of the book lies in its ability to challenge readers' assumptions concerning aspects of the social, medical and demographic history of their own society that they may have taken for granted. By setting out such a well-rounded account of fertility decline and the evolution of birth control in Greece, Hionidou has thrown down a gauntlet to researchers elsewhere to broaden their perspectives and take a fresh look at fertility-related behaviour during their country's first demographic transition.