By Smith Nwokocha

Why Antimicrobial Resistance Must Be Addressed Through a Gender Lens
Antimicrobial resistance (AMR) is one of the most urgent global health threats of our time. It arises largely from the misuse and overuse of medicines across human health, livestock production, agriculture, and food systems. These practices are not only undermining the effectiveness of life-saving drugs but are also contributing to environmental contamination. If the world hopes to achieve the Sustainable Development Goals (SDGs), eliminating the misuse and overuse of antimicrobials across all sectors is essential.
Yet AMR is not solely a biomedical challenge. A complex web of biological, social, cultural, and economic factors—many rooted in gender inequality—shapes how infections spread, how treatments are accessed, and how antibiotics are used. Gender norms, structural inequalities, and harmful stereotypes have historically normalized the neglect of women’s health and well-being. As a result, women and girls often face heightened vulnerability to infections and, consequently, to antimicrobial resistance.
Gender-Based Violence and AMR
Gender-based violence is one of the overlooked drivers of antimicrobial resistance. Violence increases women’s exposure to infections and reduces their ability to seek timely medical care.
According to Dr Soumya Swaminathan, former Chief Scientist of the World Health Organization (WHO), intimate partner violence and domestic abuse can lead to infections ranging from sexually transmitted infections to urinary and reproductive tract infections. These conditions frequently require antibiotic treatment.
However, women experiencing violence often face barriers to seeking care due to stigma, limited autonomy, or fear of further abuse. Even when treatment is sought, incomplete courses of antibiotics or incorrect dosing may occur, increasing the risk of drug-resistant infections.
Unsafe abortions, delayed treatment for injuries, and restricted access to healthcare further compound the problem. Without addressing gender-based violence, efforts to combat AMR will remain incomplete.
Stigma and Delayed Treatment
Social stigma surrounding diseases such as tuberculosis (TB) and HIV/AIDS disproportionately affects women. In many societies, a woman diagnosed with these illnesses is judged not only as a patient but also as someone who has brought shame upon her family.
Bhakti Chavan, a survivor of extensively drug-resistant tuberculosis and member of the WHO Task Force of AMR Survivors, describes how stigma discourages women from seeking care.
Many women delay testing, avoid visiting clinics, or stop treatment early to prevent family members or communities from discovering their condition. Incomplete treatment is a major driver of drug-resistant infections.
Her experience highlights a critical reality: AMR is not gender neutral. Effective responses must consider the social realities shaping women’s health decisions.
Power Dynamics in Healthcare
Gender also shapes power relationships within healthcare systems. Dr Esmita Charani of the University of Cape Town emphasizes that women often have less power to advocate for their health needs.
In many households, women prioritize the healthcare needs of other family members before their own. Women frequently accompany relatives to hospitals as caregivers but do not seek treatment themselves.
Financial constraints further deepen the disparity. In settings where healthcare costs are paid out of pocket, families may prioritize treatment for male members over female members.
Ironically, while women make up the majority of the global healthcare workforce—particularly nurses and pharmacists—they often have limited influence over prescribing decisions or institutional policies.
These power dynamics affect infection prevention, antibiotic stewardship, and the overall quality of care.
Social Norms and Structural Barriers
Deeply rooted social norms also shape women’s vulnerability to AMR. Dr Deepshikha Bhateja of the Indian School of Business notes that cultural expectations surrounding caregiving, menstruation, pregnancy, and financial control restrict women’s access to healthcare, education, and sanitation.
Limited access to water, sanitation, and hygiene (WASH) facilities increases exposure to infections. Reduced educational opportunities lower awareness about appropriate antibiotic use. Financial dependency restricts women’s ability to seek timely care.
Together, these factors increase infection risk while reducing the likelihood of proper diagnosis and treatment—conditions that fuel antimicrobial resistance.
The Need for an Intersectional Approach
Gender does not operate in isolation. Other social determinants—such as income, ethnicity, migration status, and geography—intersect with gender to shape health outcomes.
For example, rural women engaged in agriculture often carry multiple responsibilities: farming, caring for livestock, managing households, and raising children. With limited financial autonomy and restricted access to healthcare services, infections may go untreated or be managed with inappropriate medications.
Understanding these overlapping vulnerabilities requires an intersectional approach to AMR policy and programming.
AMR as a Social Problem
Although AMR is often framed as a technical issue involving microbial evolution and pharmaceutical development, Dr Salman Khan of ReAct Asia Pacific argues that it is fundamentally a social problem.
Power structures determine whose health is prioritized, who controls resources, and whose voices shape policy decisions. Young people—especially young women—are frequently excluded from decision-making processes despite being deeply affected by the long-term consequences of antimicrobial resistance.
Addressing AMR effectively requires inclusive governance that recognizes youth, women, and marginalized groups as key stakeholders rather than passive beneficiaries.
Women as Leaders in Combating AMR
While women face disproportionate risks, they also hold enormous potential to drive solutions.
Dr Mayssam Akroush, founding president of the Pan Arab Women Physicians Association, highlights women’s central role in combating irrational antibiotic use. Women serve as caregivers, educators, healthcare professionals, and community leaders. They make crucial decisions about family health and can influence how antibiotics are used within households.
Educating and empowering women on responsible antimicrobial use can have a ripple effect across entire communities.
Strengthening Policy Responses
There is growing consensus that national AMR strategies must incorporate gender-sensitive approaches. This includes integrating gender-based violence indicators into national AMR action plans and strengthening antibiotic stewardship in sexual and reproductive health services.
In 2024, the WHO released guidance to help countries integrate gender-responsive strategies into their AMR policies. The recommendations aim to address disparities in prevention, diagnosis, and treatment of drug-resistant infections.
Without such measures, existing inequalities will continue to undermine global efforts to contain antimicrobial resistance.
The Urgent Case of Drug-Resistant Tuberculosis
The challenge of AMR is particularly visible in tuberculosis. Despite decades of scientific advances, the global burden of drug-resistant TB remains alarmingly high.
Estimates suggest that around 400,000 cases of drug-resistant TB were recorded in 2000—and similar numbers were reported again in 2024. The persistence of these figures reflects systemic failures in infection prevention and treatment adherence.
If the world hopes to end TB by 2030, preventing drug-resistant forms of the disease must become a priority.
A Feminist Response to AMR
AMR responses must ultimately adopt a feminist and justice-based approach—one rooted in care, solidarity, and equity.
Health policies cannot be separated from gender equality. Addressing violence against women, ensuring universal access to water and sanitation, empowering women economically, and dismantling harmful social norms are not only human rights imperatives—they are essential public health strategies.
Without confronting these structural inequalities, the world risks losing the medicines that protect us from infectious diseases.
Combating antimicrobial resistance therefore requires more than scientific innovation. It demands a transformation in how societies address gender inequality, power imbalances, and access to healthcare.
Only through such holistic action can we safeguard the effectiveness of antibiotics for future generations.


















































