Violence, gender inequality fueling rise in drug-resistant infections – Global Health Experts

… Warn AMR fight will fail without gender justice
By Chioma Obinna

Global health experts have raised the alarm that violence against women, stigma around infectious diseases, and deep-rooted gender inequalities are fueling the rise of drug-resistant infections worldwide, cautioning that antimicrobial resistance, AMR, cannot be contained without addressing these barriers to healthcare.

Although AMR is often seen as a medical or scientific problem caused by the misuse and overuse of antibiotics, the experts said social factors including gender norms, violence, and unequal access to healthcare are playing a major role in driving the crisis.

Speaking during a dialogue session on the theme: “AMR Under Gender Lens”, the health experts say gender-based violence is one of the hidden drivers of infections and antibiotic use among women.

Speaking as a survivor of extensively drug-resistant tuberculosis (XDR-TB) and a member of the World Health Organisation Task Force of AMR Survivors, Bhakti Chavan said: “AMR is not gender neutral. If we want to fight AMR effectively, we must listen to women, diagnose them early, ensure proper treatment, and design policies that consider women’s realities.”

The expert said stigma surrounding diseases such as tuberculosis and HIV further worsens the problem by discouraging women from seeking diagnosis and treatment.

Chavan said women diagnosed with these illnesses often face judgment and discrimination within their communities.

“In many communities, a woman with TB or HIV is judged not only as a patient but as someone who has brought shame to the family,” she said.

“Her character, marriage prospects, and even her role as a wife or mother may be questioned.”
She said that because of stigma, many women hide their illness or delay seeking care.

“I have seen many women hide their illness, delay testing, or stop treatment early so family members or neighbours will not find out,” Chavan said.

Also, a former Chief Scientist of the World Health Organisation, WHO, Dr Soumya Swaminathan said women facing intimate partner violence or domestic abuse often suffer untreated injuries and infections that later require antibiotics.

“Women are at a very high risk of domestic violence, physical or sexual and this can lead to infections. Because of their position within households and communities, many women are less likely to seek timely and adequate care, which can lead to drug-resistant infections.”

Swaminathan noted that sexual violence can increase the risk of sexually transmitted infections, urinary tract infections, and reproductive tract infections conditions frequently treated with antibiotics.

Swaminathan noted that limited access to healthcare means many women receive incomplete or incorrect treatment.

“Women may take a partial course of antibiotics or the wrong doses,” Swaminathan said.
“This misuse accelerates antimicrobial resistance.”

Women facing unplanned pregnancies who undergo unsafe abortions are also at higher risk of infections and antibiotic exposure.

Swaminathan also stressed that gender intersects with other factors such as poverty, migration, race, and rural residence.

Swaminathan cited the example of rural women farmers who manage livestock and agriculture while caring for their families.

“These women may have less financial autonomy and limited access to health centres,” she said. “In such situations, infections may be neglected or treated inappropriately.”

She said such conditions can increase antibiotic misuse and accelerate the development of resistance.
The public health experts stressed that national action plans on antimicrobial resistance must address gender inequality and violence against women if the world hopes to control the crisis.

Swaminathan urged governments to integrate gender-based violence indicators into AMR policies and improve diagnostic testing to reduce unnecessary antibiotic use.

Also speaking, Associate Professor at the University of Cape Town, Dr. Esmita Charani noted that interruptions in treatment allow bacteria to survive and evolve, contributing to the global rise of drug-resistant infections.

The Associate Professor noted that findings have shown that gender norms and economic inequalities also influence how antibiotics are accessed and used.

The Associate Professor said women often have limited decision-making power within households and healthcare systems.

“Women frequently prioritise the health of other family members over their own,” she said.
In many households where healthcare expenses must be paid out-of-pocket, male family members are often prioritised for treatment.

Women may accompany relatives to hospitals as caregivers while neglecting their own health needs, which can delay diagnosis and lead to more severe infections requiring stronger antibiotics.

Speaking, Dr. Deepshikha Bhateja, Principal Research Scientist at the Indian School of Business also noted that social and cultural norms around education, financial control, and caregiving responsibilities also influence women’s ability to access healthcare.

Bhateja said these factors reduce women’s access to sanitation, healthcare services, and essential medicines.

“These norms reduce women’s health-seeking behaviour and increase susceptibility to infections,” she said.

Research shows that women are prescribed significantly more antibiotics than men in some countries, while greater female education and workforce participation are associated with lower antibiotic consumption.

“This shows that antibiotic stewardship policies must go beyond the health sector and address gender inequalities,” Bhateja said.

On her part, Dr. Mayssam Akroush, founding president of the Pan Arab Women Physicians Association, noted that despite these challenges, women can also play a central role in combating antimicrobial resistance.

She said women influence health decisions within families and communities.
“Women are mothers, leaders, teachers, prescribing doctors, and pharmacists. They are in a great position to lead change on irrational antibiotic use.”

She stated that educating women about responsible antibiotic use could help influence an entire population.

“If we educate women, we educate communities.”

Stating that the consequences of failing to control antimicrobial resistance are already visible in tuberculosis, Shobha Shukla, chairperson of the Global AMR Media Alliance, noted that the number of drug-resistant TB cases worldwide has remained stubbornly high for decades.

“In 2000, estimates suggested around 400,000 cases of drug-resistant TB. In 2024, we still see similar numbers.

“We had the science, tools, and evidence to prevent this,” she added. “But misuse and overuse of medicines allowed resistance to persist.

“AMR is not just about microbes. It is about power, inequality, and whose health matters.”
The advocates also stressed the importance of improving sanitation, strengthening healthcare access, and ensuring women have the power to make decisions about their health.

With less than five years remaining to achieve global development goals, the experts warned that ignoring these social drivers could undermine efforts to control one of the world’s most serious public health threats.

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