Parental Gender Equality and Use of Oral Contraceptives Among Young Women: A Longitudinal, Population-based Study in Sweden

Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries

CONTEXT

Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap.

METHODS

Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16.

RESULTS

Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males.

CONCLUSIONS

More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.

Parental Gender Expectations by Socioeconomic Status and Nativity: Implications for Contraceptive Use

Parental gender expectations, which may be egalitarian or not, may vary by nativity and socioeconomic status. Parental gender expectations provide a model for children's gender role attitudes and could also have effects on reproductive health over the life course, including women's contraceptive choices. Yet, parental gender expectations are not often studied quantitatively. Using the National Longitudinal Study of Adolescent to Adult Health, we examine how parental gender expectations in the United States vary by immigrant generation and socioeconomic status, whether parental gender expectations in adolescence are associated with young women's contraceptive use, and if nativity moderates that relationship. Results show that parental gender expectations vary significantly by immigrant generation and parental socioeconomic status. Both first and second generation women are significantly less likely to have lived in households with equal gender expectations compared to the third generation. Higher socioeconomic status is associated with equal gender expectations. Among participants from households with equal gender expectations, the second generation is more likely than the third generation is to use a male-controlled contraceptive method versus no method. Using a nationally representative sample, our study demonstrates that parental gender expectations vary by nativity and by the socioeconomic context of the family in which they are embedded as well as have a unique effect on the contraceptive behavior of second generation women.