Menu

Gender

TW and LI - GEAR up (7)

Gendered vulnerabilities to infectious disease: A call to action for global health equity

, , , 0

GEAR up colleagues Meenakshi Monga and Katy Davis give in-depth report back from last month’s ‘Gendered vulnerabilities to infectious disease: A call to action for global health equity’ webinar.

Gender profoundly influences health outcomes globally, with women and girls bearing a disproportionate burden of infectious disease, due to complex biological, social, and economic factors forming health obstacles. However, gender considerations often remain on the periphery of global health responses, with policies and programs frequently adopting a “one-size-fits-all” approach that overlooks the distinct needs and experiences of women and girls and non-binary people.

In a recent webinar that underscored the urgent need to dismantle these barriers, experts examined the current landscape of gender inequality and identified innovative and actionable strategies for progress. This included fresh perspectives on vulnerability as a crucial lens for understanding deeper systemic inequities in global health and the critical need for gender-responsive Universal Health Coverage (UHC). Speakers also explored how sustained financial investments are pivotal for closing gender health gaps, while our own GEAR up colleague Dr. Katy Davis spoke about how gender norms and power imbalances influence Antimicrobial Resistance (AMR).

Hosted by the Infectious Disease Alliance (IDA) the webinar served not only as a pivotal platform to examine the current landscape of gender inequality, but also a forum for identifying innovative and actionable strategies for progress.

The webinar featured compelling presentations from Dr. Jessica Ogden and Kinza Hasan, and a dynamic panel discussion with Dr. Irene Aninye, Debanjana Choudhuri, Dr. Katy Davis, and Dr. Michelle Remme, focusing on advocating for gender equity within the infectious disease sphere, particularly concerning equitable policy and the protection of vulnerable populations. A subsequent Q&A session fostered engaging dialogue and exploration of potential solutions.

Keynote highlights: Rethinking vulnerability and universal health coverage

Dr. Jessica Ogden challenged traditional public health frameworks by reframing vulnerability not as an individual deficit, but as a crucial lens for understanding deeper systemic inequities. Drawing lessons from the AIDS crisis, she emphasised the need to shift focus towards structural and social determinants of health. Dr. Ogden critiqued interventions that superficially label themselves “gender transformative” without addressing the underlying systemic issues, often placing the onus of change on marginalised populations. While acknowledging recent positive global developments, she stressed that these are insufficient amidst shrinking global health funding. Her powerful call to action urged collective, cross-sectoral coalition-building across gender, health, education, and economic development sectors.

Kinza Hasan underscored the urgent need for gender-responsive UHC amidst declining international aid and the rise of anti-rights movements. She highlighted the stagnation of progress in gender equality in health, exacerbated by the COVID-19 pandemic, political instability, and backlash against gender rights. Ms. Hasan emphasised that UHC must be inherently gender-responsive, integrating sexual and reproductive health and rights (SRHR) and addressing the unique barriers faced by marginalised groups at every level of care. Her recommendations included systemic transformation through primary health care, establishing accountability mechanisms for governments, and safeguarding multilateral spaces from anti-gender movements. She also advocated for intergenerational leadership and the meaningful inclusion of youth in shaping future health systems.

Panel discussion: Advocating for gender equity in infectious disease

The panel discussion, featuring Dr. Irene Aninye, Debanjana Choudhuri, Dr. Katy Davis, and Dr. Michelle Remme, delved deeper into how to promote gender equality across different sectors and at all levels of public health policy and programs.

Key insights from the panel

  • Dr. Aninye, Chief Science Officer, Society for Women’s Health Research: Sustained financial, temporal, and institutional investments are crucial for closing gender health gaps. Global health initiatives must be context-specific, and disaggregated data collection by sex, gender, and other social markers is essential for equitable interventions.
  • Debanjana Choudhuri, Executive Director, Women’s Global Network for Reproductive Rights: Gender norms and biases in the Global South significantly limit women’s access to healthcare, particularly SRHR. Addressing stigma, increasing information access, and building the capacity of healthcare providers are vital mitigation strategies, especially amidst global funding cuts impacting SRHR.
  • Dr. Katy Davis, Post-Doctoral Research Associate, Liverpool School of Tropical Medicine, GEAR up Consortium: Gender norms and power imbalances influence AMR, affecting exposure, care-seeking, and socioeconomic outcomes. AMR interventions should address social drivers of disease, led by community priorities, and health surveillance needs intersectional, community-led data collection.
  • Dr. Michelle Remme, Manager, Thematic Cluster for Human Rights, Gender and Health Equity, The Global Fund: Achieving UHC requires focusing on structural factors like gender inequality, rather than solely on individual behaviour. Addressing women’s lack of agency and investing in community-led organisations and multi-sectoral approaches are critical for tackling gender and social determinants of health.

The Q&A session further emphasised the importance of community-led responses, drawing lessons from HIV and TB activism, and the need for gender and equity considerations in AMR surveillance, including intersectional data analysis to reach marginalised populations.

Conclusion

The webinar underscored that embracing vulnerability could catalyse empathy and drive social change, while equitable health systems demand structural transformation centred on gender-responsive universal health coverage and intersectional justice. Achieving this requires dismantling entrenched inequities through cross-sector collaboration, context-specific interventions, and amplifying marginalised voices, particularly in the Global South. Prioritising disaggregated data, community-led solutions, and sustained investment in grassroots and feminist initiatives is vital to counter misinformation, address gender biases, and reverse setbacks in sexual and reproductive health rights. By reorienting health systems to tackle structural drivers—from antimicrobial resistance to agency barriers—and fostering multi-sectoral alliances, global health can progress towards inclusive, resilient outcomes. The path forward hinges on centring equity, challenging power imbalances, and ensuring that no community is left behind in the pursuit of health justice.

International Womens Day

International Women’s Day: Fighting AMR and empowering women across the life course

, 0

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.

Key takeaways and next steps from our workshop on gender and equity within AMR in Indonesia

Key takeaways and next steps from our workshop on gender and equity within AMR in Indonesia

, , , 0

In October a diverse group of stakeholders in Indonesia came together for a productive workshop focused on addressing the intersections of gender, equity, and antimicrobial resistance (AMR). The workshop was hosted by the Ministry of Health with support from the Fleming Fund country Grant to Indonesia (FFCGI), and was coordinated by Desrina Sitompul, Senior Technical Programme Lead, FFCGI. As part of a broader discussion on One Health economic assessments and the burden of disease, the workshop explored crucial issues such as how gender dynamics influence AMR patterns, the role of women in AMR stewardship, and antimicrobial use across both human and animal health settings. Here Ralalicia Limato shares five key insights and outcomes from the workshop.

  1. Domains of gender equity within AMR

      Saraswati, the gender equity lead facilitator for Indonesian country grantee, presented a framework with three main domains for potential research and intervention:

      • Gender equity and drug-resistant organisms: The relationship between gender and the prevalence or transmission of AMR, including how specific groups of people are disproportionately impacted by AMR, and how norms, values or underlying beliefs in society maintain or perpetuate the different risks of drug-resistant organisms’ exposure among genders and other intersecting identities.
      • Women’s leadership and agency in AMR surveillance and stewardship: Understanding how cultural norms, beliefs and practices hinder or foster women’s meaningful participation; how women, both in healthcare facilities and community settings, are involved in AMR management, AMU decision-making, and how their roles can be strengthened; and how women have the access to and control of resources in AMR containment and stewardship initiatives.
      • Antimicrobial use (AMU) in human and animal health settings: Investigating how gender dynamics influence AMU practices in different contexts. This includes examining how cultural norms, beliefs, and practices influence AMU in the community, as well as how health-seeking behaviours differ between men and women and among other intersecting social stratifiers, such as age, socio-economic status, ethnicity and education level. Besides, it is crucial to understand the distinct roles and responsibilities of men and women in the purchasing, use, and administration of antimicrobial drugs

        This framework serves as the foundation for further investigation and the integration of gender-sensitive indicators into AMR surveillance in Indonesia.

        2. Integrating gender equity into burden of disease data

          There is a plan to integrate gender-specific indicators and perspectives into broader burden of disease and AMR data collection. This integration will help capture nuanced insights on how AMR affects different populations, including women and marginalised groups, and how gender influences AMR risk and outcomes. In doing so, a further discussion will take place to plan the quantitative and qualitative data.

          3. Stakeholder feedback: insights from both human and non-human sectors

          There were initial concerns regarding the relevance of gender equity within AMR research in the Indonesian context. However, in this workshop, stakeholders were overwhelmingly supportive of studying AMR through a gendered lens. They suggested several avenues for further research to better capture the diversity of experiences and risks across different population groups, and emphasised the need for multi-sectoral studies that cut across different population groups and geographical contexts.

          • Stakeholders from the Ministry of Health recommended including the clinical aspects, for example, guideline compliance in the research framework. Understanding how gender influences adherence to clinical guidelines could reveal important gaps in AMU and stewardship, which would be crucial for improving treatment outcomes.
          • Stakeholders from the Ministry of Agriculture and Ministry of Marine Affairs and Fisheries pointed out the importance of studying farming communities, especially where the majority of farmers are male or female. By examining gender-specific roles in these communities, researchers can better understand the gendered dimensions of AMU and resistance in agriculture and livestock management.
          • A recommendation from the Chairperson of the Committee on AMR Control called for comparative studies between urban and rural populations. These studies could help illuminate the disparities in access to antibiotics, healthcare services, and public knowledge of AMR. Such research could provide critical insights into the barriers and opportunities for improving AMR governance and stewardship, especially in underserved or rural areas.

          4. Way forward: continued consultation and stakeholder engagement

          In light of the valuable feedback received during the workshop, Saraswati and the DAI team have given stakeholders a month to provide further input or specify any domains they wish to explore in more depth. This period will allow for a more comprehensive understanding of the nuances in gender and AMR, as well as refine research questions and methodologies.

          Meanwhile, discussions with DAI are set to continue regarding the budget for data collection and analysis related to gender equity. The goal is to ensure that sufficient resources are allocated for gender-sensitive AMR research, allowing for the collection of high-quality data and the formulation of evidence-based policies and interventions.

          5. Looking ahead: the One Health approach to AMR

          The workshop reinforced the importance of adopting the One Health and gender-sensitive approach to tackling AMR. As AMR continues to threaten global health, it is essential to understand the diverse and often hidden ways in which gender influences both the causes and consequences of AMR. By considering gender alongside other factors like economics, healthcare access, and education, we can develop more equitable and effective strategies for combating AMR.

          The next steps in this important work will involve refining the research agenda, collecting data, and continuing to engage with stakeholders from multiple sectors. The workshop has laid the groundwork for a more inclusive and comprehensive understanding of AMR, one that accounts for the lived realities of all affected populations. Stay tuned for more updates on the progress of this initiative.

          GEAR up is funded by the Department of Health and Social Care (DHSC)’s Fleming Fund using UK aid.

          The views expressed on this website are those of the authors and not necessarily those of the UK DHSC or its Management Agent, Mott MacDonald.

          fleming_logo
          UK AID
          Mott Macdonald

          GEAR up is funded by the Department of Health and Social Care (DHSC)’s Fleming Fund using UK aid.

          The views expressed on this website are those of the authors and not necessarily those of the UK DHSC or its Management Agent, Mott MacDonald.

          fleming_logo
          UK AID
          Mott Macdonald