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By Shobha Shukla
As governments meet at the 70th Session of the UN Commission on the Status of Women is to conclude on 19th March 2026, the Global AMR Media Alliance (GAMA) and partners are hoping for stronger decisions to advance gender equality and human right to health, both of which are fundamental human rights and critical bedrocks to advance progress on right to health including preventing antimicrobial resistance (AMR). With World Water Day (22 March) and World TB Day (24 March) coming up, it is critical to ensure that we address gender inequalities and other access barriers people and communities face and ensure Health for All is a reality for all, where no one is left behind.
Antimicrobial resistance or AMR 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 any misuse and overuse of medicines in any sector if we are to deliver on SDGs. A complex mix of biological, social, cultural, and economic factors arising from gender-based inequalities and injustices impacts infection prevention and control. Gender inequalities, harmful gender norms, stereotypes, and tropes have normalised the neglect of the well-being of girls and women, making them more vulnerable to AMR,” said Shobha Shukla, Chairperson of Global AMR Media Alliance (GAMA).
AMR and gender-based violence
The lived experience of girls and women and gender diverse communities shows how violence puts them at increased risk of getting infected with sexually transmitted infections.
According to Dr. Soumya Swaminathan (former Deputy Director General for Programmes and former Chief Scientist of the World Health Organization – WHO), we cannot be successful in reducing or preventing AMR without tackling gender-based violence, as violence impacts the access of women to healthcare.
“Women are at a very high risk of intimate partner violence or domestic violence, physical or sexual. This could lead to more infections. And because of their position within the household and the community, they are less likely to seek timely and adequate care for these injuries or infections, which could lead to drug-resistant infections. Whether it is sexually transmitted infections, urinary tract infections, reproductive tract infections, or pelvic inflammatory disease, all of these are linked with sexual violence and an increased risk of antibiotic use. Also, even if the woman may seek care, quite often follow-up is poor.
She may have taken a partial course of antibiotics or the wrong doses. Women facing an unplanned pregnancy, who go for an unsafe abortion in some cases, are also at higher risk of AMR.” Dr. Swaminathan is Chairperson, MS Swaminathan Research Foundation; and former Secretary, Dept of Health Research, Ministry of Health and Family Welfare, Government of India, and former Director General, Indian Council of Medical Research (ICMR).
Stigma fuels AMR
“Diseases like TB or HIV/AIDS carry a huge stigma in our society, especially for women. In many communities, a woman diagnosed with TB or HIV is judged not only as a patient but as someone who has brought shame to the family. Her character, her marriage prospects, and even her abilities to be a good wife, daughter, and mother are questioned.
I have seen many women hide their illness because of this stigma. They delay testing, they avoid going to the clinics, some take medicine secretly, and others stop treatment early to prevent family members or neighbours from finding out about it”, says Bhakti Chavan, a survivor of extensively drug-resistant TB (XDR-TB) – one of the most serious forms of drug-resistant TB. Bhakti is also a member of the WHO Task Force of AMR Survivors.
AMR is not gender neutral. The impact of AMR is not gender blind.If we want to fight AMR effectively, we must listen to the women, diagnose them early on, ensure proper treatment, support adherence, and design policies that consider women’s realities.
Power dynamics at work
“The burden of disease predominantly remains in populations that have the least access to resources, including antibiotics, to be able to treat infections effectively. The power differential between the patient, the end user, and the healthcare provider is very strong, and that is impacted by gender. It is impacted by gender norms and roles within society as well as within healthcare services. Women often have the least power in being able to negotiate and advocate for themselves within the healthcare settings, whether they are healthcare professionals or patients.
Women often put their own healthcare needs behind those of other family members. Women often have the unrecognised and unspoken role of care providers. And what we saw in the hospitals in India was that women would often come in as carers for their family members and not necessarily seeking care themselves. Also, when there is out-of-pocket expenditure on healthcare, often male family members might be selected over female family members. We need to recognize this and identify how we can leverage power for positive outcomes”, opines Dr. Esmita Charani, Associate Professor, University of Cape Town, South Africa.
Social norms affect AMR control.
Dr Deepshikha Bhateja, Principal Research Scientist, Indian School of Business (ISB), and Visiting Fellow at One Health Trust, rues that there are norms around menstruation, around caregiving responsibilities, around what kind of jobs are suitable for women, around son preference, around pregnancy, and norms around control and ownership of financial assets. All of them lead to reduced access to WASH (water, sanitation, and hygiene).
They lead to lower education and awareness amongst women and prohibit women and girls from seeking healthcare freely. This impacts the intermediary drivers of AMR, which increases susceptibility to infection among girls and women. It reduces their health-seeking behaviour and ability to seek and afford essential antibiotics and quality healthcare, and leads to inappropriate diagnosis and management by healthcare providers. This, in turn, impacts AMR outcomes of inadequate access to essential antibiotics, lack of appropriate diagnosis, and leads to increased antibiotic intake and increased AMR.
Dr. Esmita Charani, we have to understand the gendered roles within society and culture. “We have to understand whether it is the access to barriers within the community? Is it the husband or is it the family members who are not allowing the women to actually make it to the clinic in the first place?”
Intersectional approach
Dr. Esmita Charani said that we need an intersectional lens because our position within society, within the family, within the community in which we live is very much dependent on gender and also on our religion, culture, caste, our migration status, or on race and identity in some settings. We have to take an intersectional lens to understand how access is compromised based on intersectional identities, and also how we can leverage the power that we have within the community to develop interventions that are more likely to be taken up.
Dr. Soumya Swaminathan cites the example of feminisation of agriculture. “From an intersectional perspective, here is a woman who lives in a rural area, she is also a small farmer, she has some livestock, she does some agriculture, and she has a family to look after. And she is alone because she has a migrant husband. And therefore, she has less access to health centers. She has less financial autonomy as well. In such a situation, she would probably be more likely to either neglect infections or take inappropriate treatment”.
In the opinion ofDr. Salman Khan, former member, Quadripartite Working Group on Youth Engagement for AMR, and Youth Engagement consultant at ReAct Asia Pacific, AMR is a deeply social problem.
“We often frame AMR as a technical problem where microbes evolve, drugs fail, and antimicrobial pipelines dry up. But AMR is shaped by those who have power, whose health is prioritized, who control resources, and whose voices are ultimately heard in decision-making”.
‘One ounce of prevention is worth a pound of cure.’
So said Dr. Mayssam Akroush, Founding President of The Pan Arab Women Physicians Association. For her, women can play a leading role in combating irrational antibiotic use, which fuels AMR.
“Women are the head of the pyramid and a very important part of the equation. They are mothers, they are leaders, they are teachers, they are prescribing doctors, and they are in the pharmacy who sell the product. So they are in a great position to lead the change on irrational antibiotic use. As a mother, she might be in a hurry to recover and might need to buy the antibiotic for herself. But as a mother, she is also the decision maker for her child’s health- whether to give or not to give the antibiotic.
She might be the only one who can change the mindset of the youth on using antibiotics for their health. She should be the targeted person in our campaigns where we must educate women and thus get the whole population educated on how, when, and whether to use antibiotics or not. Women as caregivers, as educators and decision makers, can be our targeted audience for any AMR campaign”.
There is a common consensus on the need to address gender inequalities in our National Action Plans on AMR.
“We must include gender-based violence indicators in AMR National Action Plans, recognizing that sexual health and violence services are hotspots for antibiotic exposure, and we must also include gender-sensitive stewardship indicators”, said Dr. Swaminathan.
End drug-resistant TB if we are to end TB by 2030
“With World TB Day coming up and also as someone from India – the country with the highest TB (and drug-resistant TB) burden worldwide, I would like to draw your attention to drug-resistant forms of TB. In the year 2000, the upper-end estimates showed that we had around 400,000 cases of drug-resistant TB worldwide. In 2024, we also had a similar number of people with drug-resistant TB.
We have failed down the line to prevent drug-resistant TB as the TB bacteria continue to become resistant because of overuse, underuse, or misuse of TB medicines. We could have done better. We had the science, tools, and evidence to do so. But we could not. If we are to end TB, we have to achieve zero drug-resistant TBthat occurs due to failure of infection prevention and control, or misuse, overuse, or underuse of TB medicines,” said Shobha Shukla, who also coordinates the Prevent-Find-Treat ALL TB campaign.
Feminist response to preventing AMR is critical.
“AMR and other health responses must have a feminist response which warrants a development justice model based on care and solidarity for each other, where no one is left behind in the truest sense of the words. In 2024, the WHO released its guidance on addressing gender inequalities in national action plans on AMR. This guidance provides practical recommendations for countries to integrate gender responsive approaches into AMR policies by addressing key gender disparities in the prevention, diagnosis, and treatment of drug-resistant infections,” added Shobha Shukla.
