Country-level gender equality and adolescent contraceptive use in Europe, Canada and Israel: Findings from the HBSC study in 33 countries

Abstract

CONTEXT. Cross-national variation in adolescent contraceptive use is widely documented, but social explanations for this variation are scarce. Based on the assumption that societal gender equality relates to the cultural acceptability of contraceptive use and increases (young) women’s ability to actively participate in decision-making regarding contraception, this study examined whether adolescent contraceptive use was more prevalent in countries with higher levels of gender equality. METHODS. Nationally representative data from 33 countries that participated in the 2013/14 Health Behaviour in School-aged Children (HBSC) study (N = 8,181) were combined with a country-level measure of gender equality (i.e., the Global Gender Gap Index; GGGI). HBSC respondents (aged 14-16 years) self-reported contraceptive use (condom and contraceptive pill) at last sexual intercourse. Multinominal logistic multilevel regression analyses were run separately by sex to obtain associations between gender equality and contraceptive use as reported by boys and girls. RESULTS. Gender equality related positively to condom use, contraceptive pill use, and dual use (i.e., of condom and contraceptive pill) among boys as well as girls, with ORs ranging from 1.4 (condom use among boys) to 9.6 (birth control pill use among girls). Associations with contraceptive pill and dual use remained significant when controlling for national wealth and income inequality. Overall, associations were stronger for girls, compared to boys. CONCLUSIONS. Macro-level gender equality relates to contraceptive use among adolescent boys and girls. More research is needed to identify causal pathways and potential mechanisms through which gender equality and adolescent contraceptive use may affect one another.