In the Caribbean, gender plays a salient role in ASRH and provides a clear picture of how the macrosystem affects individual behavior. The social and cultural construction of gender, a macro-level force, in the Caribbean defines masculinity as a man who is “heterosexual, virile and even promiscuous, knowledge- able, aggressive and in control of his environment, including the women around him,” and femininity as a “woman being inno- cent and self-sacrificing, placing the needs and desires of her male partner before her own” [53]. Thus, this review’s findings that male adolescents were more likely to engage in higher risk behavior, such as having multiple sexual partners, and female adolescents were more likely to be vulnerable to negative SRH outcomes, such as experiencing sexual coercion, are an example of how the macro-level social construction of gender has influenced adolescents’ behaviors. In fact, the youth in the qualitative studies of this review echoed this. Moreover, in the case of young women, gender norms tend to condone violence against women and coercive sex, which place them at increased risk of negative SRH [52,54]. Therefore, to improve ASRH health in the Caribbean, programs must address the larger macro-level forces in addition to the individual factors.