Experts and survivors shed light on how gender inequality, social norms, and limited healthcare access contribute to antimicrobial resistance, highlighting the need for gender-responsive AMR strategies.
Antimicrobial resistance (AMR) is increasingly driven by the misuse and overuse of medicines across human health, livestock, agriculture, and the environment, threatening global development goals if urgent action is not taken.
Experts stress that this is not just a scientific problem but a social one, deeply intertwined with gender inequality, harmful social norms, and barriers that limit women’s access to healthcare.
Dr. Soumya Swaminathan, former Chief Scientist at the World Health Organization (WHO), warned that: “Antimicrobial resistance is caused by misuse and overuse of medicines in sectors of human health, livestock health, food and agriculture, and it is also polluting our environment. We cannot afford misuse and overuse of medicines in any sector if we are to deliver on the Sustainable Development Goals.”
Gender Inequality and AMR
A complex mix of biological, social, cultural, and economic factors arising from gender-based inequalities increases women’s vulnerability to infections and drug resistance. Gender-based violence (GBV) is a major driver, as it exposes women to infections and reduces their ability to access care.
Dr. Swaminathan explained that “We cannot be successful in reducing or preventing AMR without tackling gender-based violence, because violence impacts the access of women to healthcare. Women facing intimate partner violence often suffer untreated infections, including sexually transmitted, urinary tract, and reproductive tract infections, increasing antibiotic exposure and the risk of drug resistance.
Bhakti Chavan, an AMR survivor and member of the WHO Task Force of AMR Survivors, highlighted stigma as a barrier: “Diseases like TB or HIV/AIDS carry huge stigma, especially for women. Many hide their illness, delay testing, avoid clinics, or stop treatment early to prevent family or community judgment.”
Dr. Esmita Charani of the University of Cape Town explained: Women’s roles as primary caregivers, combined with limited decision-making power and financial autonomy, further hinder access to proper treatment.
“Women often put their own healthcare needs behind those of other family members. Power differentials in households and healthcare systems, influenced by gender norms, impact access to care and antibiotics.”
Social Norms
Social norms around menstruation, caregiving, financial control, and son preference reduce access to water, sanitation, hygiene, and healthcare, contributing to AMR. Dr. Deepshikha Bhateja (Indian School of Business) noted:
“These norms lead to delayed diagnosis, poor treatment, and increased misuse of antibiotics, all of which fuel AMR.”
There is need for an intersectional approach, considering factors such as gender, poverty, migration status, cultural identity, and rural-urban disparities. Swaminathan added:
“A rural woman farmer managing livestock and agriculture while caring for her family may have limited access to health centres and financial autonomy, increasing the likelihood of neglected or inappropriate treatment.”
AMR and Drug-Resistant TB
With World TB Day approaching, Shobha Shukla (Global AMR Media Alliance) warned that drug-resistant TB remains a major concern: “In 2000, there were around 400,000 cases of drug-resistant TB globally. In 2024, the number remains roughly the same. Misuse, overuse, and underuse of TB medicines allowed resistance to grow.”
Shukla emphasized a feminist approach to AMR: “AMR responses must include a development justice model based on care and solidarity, where no one is left behind.”
Youth Engagement and Gender-Responsive Policies
Dr Salman Khan, former member, Quadripartite Working Group on Youth Engagement for AMRhighlighted the importance of youth inclusion: “Youth are central to One Health but are often excluded from governance. Policies are designed about young people, not with them, despite their deep involvement in households, farms, clinics, and schools.”
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Dr. Mayssam Akroush stressed that national AMR plans must integrate gender considerations, including GBV indicators, sexual and reproductive health, and equitable access to antibiotics, noting that women, as caregivers and decision-makers, can lead responsible antibiotic use. “Women are mothers, teachers, doctors, and pharmacists. They are in a position to lead change in irrational antibiotic use.”
Recommendations
- Integrate AMR and GBV interventions into one-stop crisis centres.
- Strengthen diagnostics to move from syndromic to test-guided treatment.
- Include gender-sensitive stewardship indicators in national AMR plans.
- Co-create context-specific AMR messages to address gender norms.
- Disaggregate surveillance and antibiotic use data by sex, age, and socio-economic factors.
- Empower youth and women as active stakeholders in AMR governance and education.
Conclusion
Dr Esmita Charani, Associate Professor, University of Cape Town, South Africa; and honorary Reader in Infectious Diseases, AMR and Global Health, University of Liverpool said AMR is not gender-neutral. Biological factors, gender-based violence, social norms, stigma, and inequities all shape infection risks and antibiotic misuse.
Addressing these requires gender-transformative policies, intersectional approaches, and the active participation of women and youth, Dr. Charani stressed that “Antibiotic resistance cannot be managed with new antibiotics and diagnostics alone. If we do not make them accessible to those most vulnerable, we will remain in the same cycle of resistance.”
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