This study examines the situation of women in Mali who use modern contraceptive methods and compares this to the situation of women who do not, in order to understand how and why women take action to use family planning. The research sought to discover if certain elements in social and family relationships influence the decision to use family planning or not. In Mali, as in many other West African countries, rates of contraceptive use have remained very low. How is it that some women who are not ready to become pregnant do not use family planning? To compare women who use family planning to those who do not, this study explored a number of themes: women’s experiences growing up, their participation in the choice of a husband, creating a family of their own, their knowledge of contraception, their fertility preferences, their access to services, their preferences for different types of services, and their socioeconomic status in the household. The study explored the relative importance of elements that affect the use of modern family planning methods from the perspectives of married women, married men, and service providers who offer family planning methods.