LAUSR

Medical abortion is one of the WHO recommended methods for safe and effective first trimester abortion. It is often seen as an emancipating procedure allowing women to be more in control of their abortion, as opposed to surgical procedures where the surgery is “done to” the woman by a doctor. In countries where medical abortion is legal and available, rates of medical abortion (vs. surgical abortion) vary greatly, e.g. in Europe from 24% to 98%. We hypothesised that these differences may mirror how empowered women are in different aspects of their lives and be in part explained by gender (in)equality at the country level. We conducted correlation and regression analyses to assess the association between medical abortion rates and gender inequality in Europe, using several macro-level markers of gender equality such as national gender equality indices and rates of violence against women. The relevance of other structural factors, such as health system and abortion care characteristics was also investigated. Seventeen countries were included. Although the sample size was small, results pointed toward an association between several markers of economic gender equality and medical abortion rates. The Gender Gap Index (corr. coeff: 0.52, p = 0.03) and its economic component (corr. coeff: 0.64, p = 0.005), as well as the economic component of the Gender Equity Index (corr. coeff: 0.68, p = 0.003), were all positively associated with the outcome. Other dimensions of gender equality (e.g. political participation; violence against women) and health system factors (e.g. date of introduction of the method; type of abortion providers) were not associated with the outcome. Our results suggest that women's empowerment in the economic sphere may have repercussions on the use of abortion care, potentially influencing what method of abortion the women ask for and what method they are offered. Barriers to the use of medical abortion go beyond the law (if a method is legal/available or not) and include structural determinants, such as gender equality. Higher levels of economic gender equality are associated with higher rates of medical abortion, highlighting the relationship between gender equality and choice of method of abortion.