Improved health care and family planning services, reduction in sociogeographic isolation, and increased economic development were found to be responsible for declining fertility rates in a rural Eastern Kentucky county during 1960-1980. Contemporary fertility patterns in an area historically exhibiting one of Appalachia's highest fertility rates were found to be similar to patterns throughout the United States. Interviews with 407 married women under 45 years of age measured demographic factors, perception of availability/accessibility of family planning services, approval of birth control, family size preferences, knowledge and use of contraceptives, and effectiveness of fertility regulation. Results were compared by age group. Educational levels were found to decrease as age increased, employment increased with age, and family income was highest in the middle age group. Similarities were found among women in the three age groups in level of birth control approval and use and motivation toward family limitation. Differences were found in initial timing and method of contraceptive practice and effectiveness of fertility regulation. Younger women knew about and started using birth control at an earlier age, were more effective in fertility regulation, and more successful in achieving family size goals. Tables provide data on population and perceived availability of family planning services. (LFL)