Gender Inequalities, Violence Fuel Antimicrobial Resistance – Experts Warn

Experts have warned that gender inequality, stigma and gender-based violence are worsening the global crisis of antimicrobial resistance (AMR), stressing that efforts to curb drug-resistant infections must address social and gender dynamics.

The health experts also noted that beyond biological factors, gender inequalities and harmful social norms increase women’s vulnerability to infections and limit their access to timely treatment, further accelerating antimicrobial resistance.

According to Soumya Swaminathan, former Deputy Director-General and Chief Scientist of the World Health Organization (WHO), addressing gender-based violence is critical to controlling AMR.

She explained that many women face intimate partner violence or sexual violence, which increases their risk of infections such as sexually transmitted infections, urinary tract infections and pelvic inflammatory disease.

However, due to social and economic barriers, many women are unable to seek timely or adequate care.

“Women are at a very high risk of domestic or sexual violence, which can lead to infections,” she said. “Because of their position within households and communities, they are less likely to seek care quickly, which can result in drug-resistant infections.”

Swaminathan noted that incomplete antibiotic treatment, incorrect dosing and unsafe abortions resulting from unintended pregnancies can also increase the risk of antimicrobial resistance.

Stigma and delayed treatment

Stigma surrounding diseases such as tuberculosis and HIV further complicates the fight against drug-resistant infections.

Bhakti Chavan, a survivor of extensively drug-resistant tuberculosis and member of a WHO AMR survivors task force, said women often hide their illness due to fear of social judgment.

“In many communities, a woman diagnosed with TB or HIV is judged as someone who has brought shame to the family,” she said. “Many women delay testing, take medicine secretly, or stop treatment early so that others do not find out.”

Health experts warn that interrupted treatment increases the risk of drug resistance and worsens public health outcomes.
Power dynamics in healthcare

Experts also highlight power imbalances within households and health systems as a barrier to effective AMR control.

Dr Esmita Charani, Associate Professor at the University of Cape Town, said women often have limited power to advocate for their health needs.

“Women frequently place the health of other family members before their own,” she said. “In situations where healthcare costs are paid out-of-pocket, male family members are often prioritised over women.”

Charani added that women often visit hospitals as caregivers for relatives rather than patients themselves, leaving their own health needs unattended.

Social norms worsen risks

Dr Deepshikha Bhateja, Principal Research Scientist at the Indian School of Business, said harmful social norms around menstruation, caregiving roles and financial control limit women’s access to water, sanitation and hygiene (WASH), education and healthcare.

These barriers increase susceptibility to infections and reduce women’s ability to seek proper diagnosis and treatment, contributing to inappropriate antibiotic use and rising antimicrobial resistance.

Experts say tackling AMR therefore requires an intersectional approach that considers gender, culture, religion, economic status and social identity.

Women can lead the fight against AMR

Despite the challenges, health advocates say women can play a powerful role in combating irrational antibiotic use.

Dr Mayssam Akroush, founding president of the Pan Arab Women Physicians Association, said women’s roles as mothers, caregivers, teachers and health professionals position them to influence responsible antibiotic use.

“Women are decision-makers in families when it comes to health,” she said.

“Educating women about appropriate antibiotic use can help change behaviour across entire communities.”

Ending drug-resistant TB

Experts also warned that the global fight against tuberculosis cannot succeed without addressing drug-resistant strains.

According to Shobha Shukla, Chairperson of the Global AMR Media Alliance, the number of drug-resistant TB cases globally remains alarmingly high.

She noted that around 400,000 cases of drug-resistant TB were recorded in 2000, a figure that remained similar in 2024 due largely to misuse, overuse and incomplete treatment of TB medicines.

“If we are to end TB by 2030, we must ensure zero drug-resistant TB caused by failures in infection prevention and misuse of medicines,” she said.

Call for gender-responsive policies

Experts are now calling for stronger gender-responsive policies in national AMR strategies.

They recommend including gender-based violence indicators and gender-sensitive antibiotic stewardship measures in national action plans to better address the social drivers of antimicrobial resistance.

According to Shukla, a feminist and justice-based approach to health is essential,“AMR responses must be rooted in care, solidarity and equity,” she said, noting that WHO’s 2024 guidance encourages countries to integrate gender-responsive approaches into their national AMR policies.

Health advocates say addressing gender inequality, improving access to healthcare and promoting responsible antibiotic use are critical steps toward containing the growing threat of antimicrobial resistance.

AMR occurs when bacteria, viruses and other microbes evolve to resist medicines designed to kill them.

It is largely driven by the misuse and overuse of antibiotics in human health, livestock, agriculture and the environment, threatening progress toward the United Nations Sustainable Development Goals (SDGs).