The gender pay gap and women's sexual health outcomes: Could closing the gap close the risk?

The United States has one of the highest rates of sexually transmitted infections (STIs) among high-income countries, with women-particularly young Black women-bearing the greatest burden. Gendered power dynamics are a driver of women's STI risk, yet most research has focused on couple relationships, rather than the structural gender inequalities that shape power imbalances. This study investigates the extent to which the gender pay gap, a key indicator of structural sexism, is associated with women's sexual health outcomes in the US. Drawing on theories of household bargaining and gendered power dynamics, we hypothesize that wider gender pay gaps reduce women's agency in relationships and dating markets, thereby increasing their risk of STIs. We analyzed surveillance data from 2012 to 2023 on chlamydia, gonorrhea, and syphilis incidence rates among women aged 15-44. The primary exposure was the lagged state-level female-to-male earnings ratio within racial groups. We used fixed-effects linear regression models to estimate associations that adjusted for key economic and demographic covariates. A one-percentage point increase in female-to-male earnings ratio was associated with significant declines in chlamydia (-20.4 cases per 100,000) and gonorrhea (-8.2 cases per 100,000) rates. These associations were strongest among women aged 15-29 and among Black women. Results were robust across model specifications and geographic levels. Associations with syphilis were smaller and less robust. Findings suggest that the gender pay gap functions as a structural determinant of women's sexual health and that narrowing the gap may enhance women's agency in couple and dating relationships and reduce STI risk.