This article examines the sociocultural conditions underpinning the so-called ‘abortion culture’ in Soviet Ukraine. Unlike previous studies on abortion in the Soviet Union which have primarily used country-level data, this study employs original sources – in-depth biographical interviews and archival materials – to investigate local conditions and the manner in which decisions regarding abortion were made. The author studied couples whose reproductive years comprise the period from 1955 to 1970, when modern contraceptives were not readily available but abortion was legal. Two localities in Ukraine – the cities of Lviv and Kharkiv – are included in the investigation. The findings suggest that local patriarchal gender regimes and their associated spousal dynamics defined when and how women exercised their agency in birth control and abortion decisions. In couples where spouses communicated about birth control and abortion decisions, the women sought less abortions. These women did not feel a need to exercise their agency, as the husband took over both responsibilities. When abortion was practised as a routine family-size-limitation method, spouses did not communicate about birth control and abortion, and the two were practised solely as a husband's and wife's responsibility, respectively. These women sought abortions to fulfil their own goals and, at the same time, to maintain the dominant patriarchal order in marital relationships as they understood it. Additionally, peer networks seemed to be the crucial element reinforcing women's agency in these processes.