Through the prism of gender relations within the couple, this article analyses how married couples manage birth control in the Palestinian Territories, where fertility remains high despite women’s high level of education. Using data from the Palestinian Family Health Survey conducted in 2006 and from detailed interviews of married men and women conducted in 2010-2011, we analyse the prevalence of contraceptive use in the Palestinian Territories and its determinants, as well as the influence of each spouse in contraceptive choices according to their type of conjugal relationship, and the link between gender relations within the couple and the type of contraception used. Although contraceptive use is widespread, it remains subordinate to the powerful social norm of having many children, especially sons, which prevails irrespective of the woman’s socio-demographic characteristics. The organization of fertility control varies according to the type of conjugal relationship, and depends on individual reproductive histories. Contraception and reproduction nevertheless always involve both spouses, and the couple is emerging as the main decision-making unit.