The first time I had to make a choice about birth control, I don’t remember factoring in society’s gender norms as I waded through my options: a ring, a shot, an IUD, a pill, or a condom (or, cringe, nothing?). But as it turns out, we are decidedly not alone when it comes to decisions around contraception. Researchers are increasingly finding that birth control is linked to a variety of factors beyond mere personal preference, and one much larger issue: the equality of the sexes.
A new study has shown that teens who live in more gender-equal societies are far more likely to use contraception. Among the study’s fascinating conclusions: Girls in more equitable societies were nearly 10 times more likely to report using the pill, twice as likely to report using condoms, and about six times as likely to report using both the last time they had intercourse, compared to girls in less equal societies. For boys, those figures were about six times, 1.5 times, and two times.
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While the link has been established among adults in the past, this is first time a similar correlation has been found in teens. The study, published in February in the journal Perspectives on Sexual and Reproductive Health, used sexual health survey data from 2013–2014 from adolescents aged 14 to 16 in 33 countries, including Canada. Researchers compared the data to the World Economic Forum’s 2014 Global Gender Gap report, which ranks gender equality countries based on factors including economic participation, education, health, and political empowerment (Canada ranked 16th in 2018 and 19th in 2014).
The findings suggest that women’s contraception use is far more likely to change in equitable societies, compared to men’s. In other words, when girls are given agency over their own sexuality, they use it. That could be especially important for young women, notes Aubrey S. Madkour, one of the study’s authors and an associate professor of public health at Tulane University in Louisiana, for whom unintended pregnancies can have major impacts on education and future income.
“A lot of times the hormonal contraceptives are put on the young women, as they’re supposed to take care of it, and even in gender equitable societies there was still quite a few young men who reported they didn't know if their partner had been using hormonal methods such as the pill,” Madkour says. “The responsibility still falls on young women.”
Or, to quote the title of a separate Swedish study referenced in the research, it’s still “a girls’ issue.”
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In contrast, the study found that condom use increased at a lower rate than pill use in gender equitable societies, Madkour adds. The division of labour is partly by design: There is still no hormonal birth control for men (though a new male pill and even a new gel may be on the way).
Even so, the correlation remains, and it’s not dissimilar to one found in a previous study looking at young parents (including adolescents) in Toronto where young fathers who viewed the genders more equally were also more likely to use condoms.
Madkour and her colleagues posited their results could mean women especially “feel more empowered” to make choices related to reproduction and sexual health when they’re treated equally, but they were careful to avoid any claims that one actually causes the other. The fact is, we don’t know what comes first: reproductive agency or gender equality?
“If women don’t have the capacity to control when and whether they want to have children, then it's going to be extremely challenging for them to achieve gender equality,” notes Dr. Sheila Dunn, a researcher at the Women's College Research Institute and associate professor of public health at the University of Toronto. The two factors “circle around each other.”
Dunn was part of a team that conducted wide-ranging interviews with health-care providers about contraception and family planning in Canada. In the resulting 2015 study, Dunn and her co-authors documented a litany of barriers to contraception in Canada, including cost (the number one reason), physician biases both against birth control overall and specific types of birth control, lack of access to health services, and lack of education.
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But she also stresses that promoting birth control use isn’t as simple as giving people good information and assuming they’re going to use it. About 15 per cent of youth at risk of pregnancy choose to use zero contraception, she says, and the reasons are “really complex.”
The 2015 study called for a “national strategic approach to family planning,” which Dunn would still love to see implemented in Canada. She says the single biggest action the federal government could take would be to fully fund contraception: “That would be huge.”
It might also signal a shift away from the idea that birth control beyond condoms is the purview and responsibility of women (especially low-income women at the mercy of pharmaceutical price changes), towards a more equitable view of splitting the bill.