Addressing gender inequalities in antimicrobial resistance responses

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The World Health Organization (WHO) report, supported by the Fleming Fund, highlights the need to address gender disparities and practical guidance to support inequalities. The recommendations aim to support countries in tackling AMR through a more comprehensive, people-centered, and gender-responsive approach.

It's evident that gender can influence exposure to infections, behaviours relating to prevention and treatment, and access to care. National Action Plans (NAPs) on antimicrobial resistance (AMR) must address the intersection of gender in the prevention, diagnosis, and treatment of drug-resistant infections. However, The report found that 125 out of 145 publicly available NAPs did not mention sex or gender.

(Above image): WHO began building a primary health clinic in Debaga 2 camp, south of Erbil in the Makhour District of northern Iraq. It receives 50-60 patients every day (Mar 2017) - more info in WHO Report. Credit: WHO/Sebastian Meyer.

Gender and AMR

There is increasing recognition of gender as a key determinant of health, alongside other intersectional factors such as age, ethnicity, and occupation. AMR is similarly affected by gender disparities. Gender can impact infection exposure and risk, the extent of AMR knowledge, health-seeking behavior, access to sanitation, barriers to immunisation, and healthcare service access.

For example, women and girls in low-resource settings can face an increased risk of (drug-resistant) infection due to a lack of clean water and safe sanitation. The increased exposure of women's menstrual hygiene needs, frequent contact with the health system, and their responsibility for household water provision has a direct impact.

There are also risk factors that affect men, such as the risk of drug-resistant infections via increased exposure to male-dominated professions, including animal husbandry, industrial farming, and slaughterhouses, and being exposed to antibiotics and infections.

Other challenges are barriers to seeking healthcare for the prevention and treatment of infections impacted by gender, social norms, and stigma. A lack of disaggregated data by sex and age in AMR surveillance and antimicrobial use is a key limitation to further understanding how drug-resistant infections can be prevented and diagnosed and the effect of AMR interventions.

Therefore, gender-responsive NAPs on AMR are important to help further understand how to tailor AMR responses.

The WHO guidance

The guidance, 'Addressing gender inequalities in national action plans on antimicrobial resistance'', focuses on twenty practical recommendations that policymakers can use when developing or revising their NAPs on AMR, adapting them to their specific country context and needs.

This includes specific actions for improving data collection by sex and gender, involving women in decision-making processes, and ensuring that AMR treatment and prevention efforts cater to the needs of all genders.

A key message is the importance of disaggregating data by sex and gender to better understand how diverse groups are exposed to infections, how they use antibiotics and access treatment.

There is also the need to involve women and marginalised gender groups in issues and action related to AMR. Their inclusion is crucial not only for promoting more equitable healthcare policies but also for ensuring that these policies are effective in reaching the populations that need them most. The WHO calls for gender-sensitive approaches in the design, implementation, and monitoring of AMR action plans.

By putting people and their needs at the Centre of the AMR response, the WHO aims for more inclusive healthcare systems that can work against the threat of AMR more effectively. This, in turn, will contribute to a more equitable and effective global health response.