This International Women’s Day our colleague Meenakshi Monga explains that it’s a time to celebrate progress, but also an opportunity to confront the persistent inequalities that hold women back. One crucial, often overlooked, area is the gender-specific impacts of antimicrobial resistance (AMR) on women. AMR is a growing global threat, posing serious challenges to health, and its consequences influence women at every stage of life.  

As GEAR up we seek to catalyse action on gender and equity within AMR by supporting Fleming Fund country grantees to mainstream gender and equity within routine AMR systems and structures. GEAR up aims to increase awareness, and contribute to the knowledge, on structural inequities driving and shaping the AMR response, including those affecting women.

What is AMR and why should we care?

AMR occurs when bacteria, viruses, fungi or other parasites become resistant to antibiotics. This makes infections harder to treat, sometime untreatable, thus increasing the risk of severe illness, disability and death. This can be increased by non-completion or non-recommended use of antibiotics (WHO).

The ways that people use antimicrobials are often due to persistent inequities that limit health seeking autonomy, purchasing power when it comes to appropriate medicines and access to diagnostic testing. This can particularly affect women whose choices are limited by social norms and economic inequalities (Gautron et al, 2023). This is not about women misusing medicines, but instead harmful power structures that affect the decisions they can make.

Understanding the impact of AMR on women across life course

AMR is not merely a global health crisis; it is a critical gender equity issue, profoundly impacting women throughout their life course.

Girl infancy and childhood: Vulnerability from the start

• Malnutrition increases susceptibility to some resistant infections such as MDR-TB. In food-insecure households, girls may face unequal access to nutritious food and healthcare, compounding this vulnerability.
• People can be exposed to AMR through water sources. Girls and women are often responsible for collecting water for households and are therefore more exposed to contaminated water. Furthermore, inadequate sanitation systems increase the risk of resistant infections spreading among girls.

Women in reproductive years: Bearing the burden

• Women are largely responsible for household domestic labour, which includes cooking and food handling. Handling uncooked food increases the risk of exposure to resistant infections. Smoke inhalation while cooking can also increase susceptibility to resistant infections such as pneumonia.
• Menstruating teenagers and women in many contexts are particularly vulnerable to drug resistant UTIs (Urinary tract infections) and RTIs (Reproductive Tract Infections).
• Women often face greater barriers to accessing health information, and associated knowledge about antibiotic use, than men.
• Rates of unnecessary prescribing of antimicrobials to pregnant women are very high. Increased exposure to antimicrobials, especially during pregnancy increases their risk of developing resistance.
• Women may have to seek permission to access health services from men or older relatives, creating barriers to accessing timely diagnosis and treatment.
• Frontline health workers are often predominantly women, and these roles increase exposure to resistant infections, particularly in hospital settings.
• Gendered division of farming work may mean that women are particularly exposed to resistant zoonotic disease and antibiotics used in livestock yet may be least targeted in animal vaccination and agricultural or aquacultural AMR training initiatives.

Elderly women: Facing isolation and caregiving challenges

• Elderly women have limited access to social networks, social media and health facilities hindering their access to vital information about AMR and antibiotic use.
• Hormonal shifts during menopause can further increase susceptibility to infections, thus, highlighting the need for timely treatment.
• In many contexts, older women take on caregiving roles of children and ill family members, which can increase their likelihood of exposure to resistant infections.

Accelerating action: A gender-transformative approach

The disproportionate burden of AMR on women and girls calls for serious actions and policy advancement. To effectively combat AMR, a gender-transformative approach can support in addressing the root causes of inequity.

• Research on intersectional drivers: We must accelerate actions on the intersectional drivers of AMR, recognising the complex interplay of factors affecting women’s vulnerabilities.  This means moving beyond simplistic gender analyses to consider how overlapping social locations, such as socioeconomic status, ethnicity, and geographical location, compound risks. This highlights the need to address social determinants of health in AMR responses (GEAR up).

• Gender specific policies: National action plans for AMR should explicitly integrate gender and equity considerations to ensure that interventions are tailored to the diverse needs of all populations, thereby promoting effective and sustainable solutions. Furthermore, it is imperative to involve women leaders at the national level to ensure research-led policy decisions incorporate gender equity considerations into healthcare treatments and AMR national action plans (Lynch I et. al, 2024). This ensures the diverse needs and experiences of women are reflected in national strategies, leading to more effective and equitable outcomes.

• Gender-transformative AMR interventions: We need to accelerate the development and implementation of gender-transformative AMR interventions that address the unequal drivers of AMR in human health and agriculture. This approach acknowledges that social and gender norms significantly influence human, environment and agricultural practices that contribute to AMR. For instance, research indicates that women in agricultural settings may have limited access to veterinary services or information on responsible antibiotic use, impacting livestock health and contributing to AMR spread (Bridging the Gender Gap in Animal Health Services, FAO 2024). Interventions that specifically address these unequal drivers of AMR across One Health will ensure equitable access to resources and knowledge.

• The participation of women in decision-making:  Women-led participation is essential for: Informing research on the intersectional factors driving AMR; shaping gender-specific policies; and delivering gender-transformative interventions for AMR. Their voices are central to addressing AMR in communities. This strategy aligns with the growing recognition that gender-transformative interventions are essential for public health initiatives. For example, in rural communities facing low rates of antibiotic continuation, a woman-led initiative could involve establishing local workshops where women, often primary caregivers, share knowledge about hygiene practices and responsible antibiotic use, fostering community-driven solutions (Barasa V, 2024 and Batheja et al, 2025).  

This International Women’s Day, let’s commit to empowering women as change agents in the fight against AMR. By addressing their unique vulnerabilities, we can create a healthier future for all.