By Milica Barać
C ontraceptive knowledge and use in Serbia vary across multiple categories such as age, education levels, and proximity to urban centers. According to data collected through the Multiple Indicator Cluster Survey (MICS) and published in “Gender aspects of the life course seen through MICS6 data in 2022” by UNICEF Serbia, 99.7% of respondents are familiar with at least one modern contraceptive method. The survey includes both a national sample and a sample from settlements of Roma communities, who live in conditions of extreme poverty and social marginalization.
In the national sample, only 62% of married women and 75% of sexually active unmarried women reported having used some form of contraception. In Roma settlements, 98% of women are familiar with at least one contraceptive method, and 97% with modern methods. Only 60% of married women use contraception and, in 56% of cases, this is a traditional method, compared to 7% who use a modern method.
Across married and unmarried women, there is a difference in the type of contraception used: unmarried women (56%) resort more often to modern methods compared to married women (21%). And results also show that women in urban areas and those with higher education use modern contraception more frequently than rural women and those with lower levels of education.
The male condom is the most commonly used modern method, while withdrawal remains the most common traditional method.
Barriers to contraceptive access: Limited coverage and financial obstacles
The European Parliamentary Forum on Sexual and Reproductive Rights’ Contraception Policy Atlas 2025 shows that Serbia has lower contraceptive coverage compared to other European countries. There is no coverage for young people (under 19 or 25), no special coverage for vulnerable groups (unemployed or low-income), no long-acting reversible contraception (LARC) covered by the national health system, and no emergency contraception included in reimbursement.
As a result, most modern contraceptives must be paid for out-of-pocket. Only one contraceptive pill is available with minimal participation under the national health fund, while others require a 70-90% co-payment or full payment. Despite repeated proposals from civil society to exempt young people from these costs, none have been adopted. These proposals are based on the argument that reduced contraceptive use is often a consequence of poverty and lack of knowledge among youth regarding reproductive health.
In some cases, reduced contraceptive use leads to unwanted pregnancies. In recent years, the number of unwanted pregnancies has decreased, but in 2023 the adolescent birth rate for women aged 15-19 in Serbia was still 14 per 1,000 women.
Maja, 20, has been using contraception since her teenage years. “So far, I’ve only used condoms and pills. I haven’t even considered other options because I’m pretty sure I couldn’t afford them. It would be great if these products were less expensive. More people would use them.”
Abortion procedures in Serbia are regulated by the Law on Termination of Pregnancy in Health Institutions. Every clinic must provide abortion services upon a woman’s personal request, but the procedure itself is not covered by health insurance unless the abortion is required for medical reasons.
Reduced contraceptive use is often a consequence of poverty and lack of knowledge among youth regarding reproductive health.
Lack of sex education and information
Sex education is still absent from Serbia’s formal education system. A few lessons appear in biology classes, but these offer only basic information on sexual and reproductive health, with no comprehensive guidance or resources.
“Most of what I know about contraception and sexual and reproductive rights comes from conversations with my mom and friends,” Maja confirms. “At school, this topic was barely ever mentioned, maybe in one class, and not in a way that was adapted to our age at the time. I don’t feel comfortable discussing these topics with doctors or nurses, and they usually don’t seem interested in offering additional information. I normally only go to get a prescription when I have a serious problem.”
In many parts of the country, especially for young women, the lack of adequate information about their bodies and reproductive choices is acute. While condoms and birth control pills can be purchased in pharmacies, LARCs require a visit to a medical center and a prescription. Although appointments with gynecologists at state clinics are free of charge, it can be impossible to get an appointment: it is estimated that there are currently only 500 to 520 gynecologists working in state clinics, while some cities do not have any gynecologists in their local medical centers at all. This often leads to women having to wait a long time for an appointment, or having to visit a private clinic, where every examination must be paid for.
The absence of sex education, the limited availability of information and counselling, and persistent taboos continue to undermine knowledge about contraceptive options, despite the existence of national programs, mandated institutions, and NGOs working on these issues.
Branka, 52, emphasizes the importance of social and institutional support, especially because these issues are considered taboo. “I have two daughters,” she says, “and I am very open with them about all topics, especially their health. Many girls and women don’t talk about this because they feel embarrassed or think they lack knowledge. But so many health problems could be avoided. I don’t think we’ve progressed much in this field. I’ve seen that in some countries, women receive state support or discounts for contraception. I think that would be a good model for Serbia too. Ideally, contraception would be free and used properly under medical supervision. But if it cannot be free, it should at least be cheaper. It’s the minimum we deserve.”
Although appointments with gynecologists at state clinics are free of charge, it can be impossible to get an appointment: it is estimated that there are currently only 500 to 520 gynecologists working in state clinics, while some cities do not have any gynecologists in their local medical centers at all.
Domestic legal and policy framework: Constitutional and legislative commitments
Gender equality is protected under the Constitution of the Republic of Serbia and is recognized as a fundamental human rights principle. The Law on Gender Equality (2021) and 2021-2030 Gender Equality Strategy set out policies to advance gender equality, combat discrimination, and prevent gender-based violence.
While the 2021-2030 Strategy explicitly includes “Promoting sexual and reproductive health and rights” as a key objective, the 2021 Law stipulates that public authorities in health and social care must implement special measures for monitoring, supporting, and improving sexual and reproductive health.
Unfortunately, cases of gender-based violence and discrimination remain present in daily life in Serbia—especially affecting women. According to official statistics, in 2024, 19 femicides were registered in Serbia, and in 18 out of the 19 cases, the killer was the victim’s family member or partner. Additionally, in 2024, a total of 27,211 incidents of domestic violence were registered: in 82.6% of these cases, the perpetrators were men, and in 71.6%, the victims were women, according to the thirteenth report on monitoring the implementation of the Law on Prevention of Domestic Violence by the Autonomous Women’s Center (AWC).
National program on sexual and reproductive health
According to the National Programme for Safeguarding and Improving Sexual and Reproductive Health (2017), all people must have access to comprehensive and accurate information and to contraceptive methods that are safe, effective, accessible, and acceptable. In addition, everyone should be educated on how to protect themselves from sexually transmitted infections, as sexual and reproductive health is part of the universal right to the highest attainable standard of physical and mental health, as outlined in the Universal Declaration of Human Rights and other international agreements.
The Programme emphasizes equal access to sexual and reproductive health for all people, regardless of sex, gender, age, economic status, ethnicity, cultural background, or vulnerability, and the importance of enabling individuals to participate in the development of health protection programs and make informed decisions about their sexuality and reproduction.
Domestic and international frameworks affirm that sexual and reproductive rights are basic human rights. Yet lived reality in Serbia often diverges from what is written on paper. institutions must work to improve access to validated information, expand education, introduce reimbursement mechanisms, and strengthen counselling services for women of all ages and from all regions. Ultimately, no right should be treated as a luxury—anywhere.
Main photo by Marta Branco
This article was carried out with the support of the Tunis Office of the Rosa Luxemburg Foundation.
