Experts Advocate for Gender-Focused Strategies Against Drug-Resistant Infections

Public health specialists and researchers are urging the implementation of gender-sensitive policies to combat antimicrobial resistance (AMR).

They express concerns that existing measures often fail to address the unique health challenges and barriers women encounter in preventing and treating drug-resistant infections.

The call to action was made during the March AMR Dialogue session themed "AMR under the gender lens," organized by the Global AMR Media Alliance (GAMA) in anticipation of International Women’s Day and other global health observances in March.

Experts assert that incorporating gender perspectives into national AMR strategies is crucial for enhancing prevention, diagnosis, and treatment outcomes.

They emphasized that gender-responsive policies would enable AMR programs to tackle issues such as gender-based violence, challenges in accessing reproductive healthcare, inequitable treatment access, and societal norms impacting women’s use of antibiotics.

The experts suggested that national AMR action plans should integrate gender- sensitive indicators, facilitate improved access to sexual and reproductive health services, and connect initiatives addressing gender-based violence with infection prevention and treatment services, given that these areas often expose women to infections requiring antibiotic intervention.

Antimicrobial resistance arises when bacteria, viruses, fungi, and parasites become unresponsive to medications designed to treat them, posing a significant global health threat. In 2019 alone, it is estimated that bacterial AMR directly accounted for approximately 1.27 million deaths worldwide and contributed to another 4.95 million.

The dialogue also highlighted the specific infection risks faced by women. Soumya Swaminathan, chairperson of the MS Swaminathan Research Foundation and former chief scientist at the World Health Organisation (WHO), pointed out that women experiencing domestic or sexual violence are at greater risk of developing infections that necessitate antibiotic treatment.

Swaminathan noted, "Women are at very high risk of intimate partner violence or domestic violence, physical or sexual, which can lead to infections."

She further explained that delayed healthcare seeking due to stigma, financial dependency, or lack of decision-making autonomy could exacerbate infections and heighten the chances that stronger antibiotics would be needed. Unsafe abortions and inadequate access to reproductive healthcare also contribute to higher infection rates among women.

"These are areas where women are exposed to infections, yet they are rarely discussed in AMR strategies," she added.

Bhakti Chavan, a drug-resistant tuberculosis survivor and member of the WHO Task Force of AMR Survivors, stated that the stigma associated with diseases like tuberculosis and HIV often deters women from seeking prompt treatment. "In many communities, a woman diagnosed with TB or HIV bears not just the burden of illness but also societal shame, affecting her healthcare decisions," she said.

Chavan emphasized that addressing AMR necessitates overcoming these social obstacles: "AMR is not gender-neutral. To combat AMR effectively, we must listen to women and ensure they receive timely diagnosis and treatment."

The influence of gender norms on healthcare-seeking behavior was also discussed. Deepshikha Batheja, a Principal Research Scientist at the Indian School of Business, noted that social constructs surrounding menstruation, caregiving roles, and limited control over household finances hinder women's ability to access timely medical care. She highlighted that research indicates women may be prescribed significantly more antibiotics in certain contexts, emphasizing the importance of understanding gender dynamics in antibiotic usage.

Associate Professor Esmita Charani from the University of Cape Town explained that gender dynamics within households and healthcare systems significantly impact antibiotic stewardship. She asserted that women often prioritize the health needs of family members over their own, saying, "In many environments, women visit healthcare facilities mainly as caregivers for relatives rather than for their personal health issues."

Despite the challenges faced, experts believe women can significantly contribute to mitigating antimicrobial resistance. Maisam Akroush, the Founding President of the Pan Arab Women Physicians Association, remarked that women can substantially influence healthcare decisions within families, reinforcing their potential role in promoting responsible antibiotic usage.

The experts proposed that governments should incorporate gender analysis into AMR strategies, enhance access to reproductive healthcare, and ensure that programs addressing gender-based violence are integrated with areas focused on infection prevention and treatment.

Shobha Shukla, chairperson of the Global AMR Media Alliance, asserted that the fight against antimicrobial resistance must also tackle broader issues of social inequality. "We cannot dissociate the struggle against AMR from the pursuit of gender equality and health rights," she declared.