GEAR up, supported by the UK aid Fleming Fund, is a groundbreaking research consortium looking at links between gender, equity and antimicrobial resistance (AMR), which has been named as a finalist for the ReAct Africa Art Prize for their work presented in a collage.
This recognition highlights the importance of the project’s innovative communications approach. Using art to shed light and prompt discussion on complex scientific issues like AMR, illustrating its real-world impact on communities and health systems.
GEAR up has been invited to present at the ReAct Africa and South Centre AMR Conference in Lusaka, Zambia, on 11 – 12 June 2025, and will be represented by Sneha Paul, of BRAC James P Grant School of Public Health, who submitted the collage work.
The collage series was created earlier this year when the consortium team – comprised of researchers from Africa, Asia and Europe – came together in a series of meetings to visualise their work. Team members shared their hopes and fears in the context of their work, considered the impact they would like to have and tried to visualise a world where AMR is no longer a challenge and threat.
The vibrant and thought-provoking collages use all manner of materials, from magazines and newspapers to medication packaging, fabric and beads. They explore themes of health, illness, antibiotic use, gender, communication, and the interconnectedness of people and health systems. The collages invite a deeper reflection on how we see, speak, and respond to health, gender and equity in complex, integrated systems.
Lived experience
“Facts alone don’t move people—stories and visuals do,” says Bachera Aktar from GEAR up’s partner in Bangladesh, BRAC James P Grant School of Public Health, BRAC University. “Creative communication methods, like collage, don’t just illustrate science; they humanise it. Collages are more than just art; they’re a dialogue, a way of seeing and feeling. Layer by layer, it helps us uncover the deep connections between gender, AMR, inequality, and lived experience.”
Expressing humanity within research
“We are facing a wave of health misinformation and disinformation. It’s confusing, alienating and designed to foster mistrust,” says Kate Hawkins of Pamoja Communications, who led the creative process. “Expressing humanity within our research communication and recognising the complex feelings and standpoints of receivers of health messaging is essential to create the solidarity needed to face the challenge ahead.”
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About GEAR up
GEAR up seeks to catalyse action on gender and equity within AMR through supporting Fleming Fund country grantees to mainstream gender and equity within routine AMR systems and structures. We aim to increase awareness, and contribute to the knowledge, on structural inequities driving and shaping the AMR response. We also seek to facilitate South-South exchange through building a global community of practice to guide and inspire further action and global knowledge sharing.
GEAR up is funded by the Fleming Fund. The Department of Health and Social Care’s (DHSC) Fleming Fund is a UK aid programme supporting up to 25 countries across Africa and Asia to tackle antimicrobial resistance (AMR), a leading contributor to deaths from infectious diseases worldwide.
The Fleming Fund invests in strengthening AMR surveillance systems through a portfolio of country grants, regional grants, and fellowships managed by Mott MacDonald, and global projects managed by DHSC.
By collecting disaggregated data and involving diverse stakeholders, Uganda is setting a precedent for inclusive, gender-responsive AMR strategies in Africa. In this blog by Susan Okioma, Anne Ngunjiri, Anthony Mwaniki and Rogers Kisame talk about LVCT Health’s recent successful monitoring and evaluation trip to Uganda.
Antimicrobial resistance (AMR) is a silent yet a growing crisis hitting low- and middle-income countries (LMIC) the hardest. AMR disproportionately affects genders differently due to a complex interplay of biological, sociocultural, and systemic factors. Women, children, and marginalised gender groups often face higher risks and greater barriers to accessing effective healthcare, making gender and inclusion critical considerations in AMR response strategies. Without timely, targeted interventions, the human and economic toll of AMR will continue to rise — overwhelm health systems, widening health inequities, and threatening progress towards global health goals.
In response, governments are adopting National Action Plans (NAPs) on AMR – comprehensive blueprints developed in line with the World Health Organisation’s Global Action Plan on AMR. These NAPs outline national priorities for improving infection prevention and control, regulating antimicrobial use, expanding access to quality diagnostics, and strengthening antimicrobial stewardship. Additionally, countries are investing in real-time surveillance systems and stronger laboratory capacity to detect resistance patterns, track antimicrobial use, and facilitate timely, evidence-based interventions.
Uganda is one of the leading African countries in AMR response, having recently launched its second generation 2024/25-2028/29 National Action Plan: Prevent, Slow Down and Control Spread of Resistant Organisms. The NAP sets Uganda apart by explicitly prioritising gender and equity mainstreaming, positioning the country at the forefront of inclusive, multisectoral AMR policy and implementation in Africa.
Through the GEAR UP project, led by LVCT Health as the East Africa regional partner, Phase II of the Fleming Fund is making significant progress in embedding gender and equity considerations into AMR programming. A recent milestone was the LVCT Health team’s monitoring and evaluation visit to Uganda, conducted from 3rd to 7th March 2025. The goal of the meeting was to strengthen monitoring and evaluation (M&E) approaches by integrating gender, equity, and other social dimensions into Uganda’s routine AMR surveillance and program review processes.
The visit achieved the following objectives:
Raised awareness and initiated dialogue on gender and equity in AMR surveillance — particularly in human health and animal health domains.
Assessed the integration of gender and equity into surveillance tools and their ability to generate disaggregated data and inform more inclusive AMR prevention, diagnosis, and response efforts.
Strengthened capacity across institutions to mainstream gender and equity within AMR surveillance, including enhancing understanding of how to analyse and use sex-disaggregated and equity-relevant data.
Promoted the use of sex, gender and equity-disaggregated data to uncover disparities in AMR burden, access to diagnostics, treatment outcomes, and service use.
By doing so, the participating teams gained a comprehensive understanding of the impact of AMR across diverse subpopulations. They also reflected on how AMR programming can be responsive to the needs, rights, preferences, and power dynamics among women, girls, men, boys, and other vulnerable groups in monitoring and evaluation processes.
Insights from the Field
The M&E visit was an enlightening experience that underscored the critical intersection of gender, equity, and AMR surveillance. Hosted by Baylor College of Medicine Children’s Foundation Uganda (Baylor Foundation Uganda),the visit brought together stakeholders from the Uganda One Health platform, who are custodians of various data sets. Participants included pharmacists from key ministries responsible for antimicrobial use and consumption data (AMU/AMC) in both human and animal health, as well as representatives from the Uganda National Health Laboratory Services (UNHLS) and the National Animal Disease Diagnostics and Epidemiology Center (NADDEC).
The LVCT Heath team ran gender and equity capacity strengthening sessions for participants across the One Health space
Gendered patterns in AMR – What UTI data revealed
One of the core activities involved analysing the AMR human health data related to urinary tract infections (UTIs), presenting an invaluable opportunity to explore gendered patterns of infection and resistance from the AMR surveillance data. This analysis was led by Prof. Andy Ramsey from the Liverpool School of Tropical Medicine (LSTM).
Prof. Ramsey guided the team through trends emerging from Uganda’s AMR surveillance data, alongside comparative insights from Tanzania. A notable observation was the overrepresentation of women in UTI cases, particularly those aged 15–54, while men were more frequently affected in the older age group (54 and above). This pattern aligns with global trends, where anatomical and hormonal factors predispose women to UTIs.
For comparison, Prof. Ramsey provided insights from Tanzania, where UTI cases among older men were often associated with prostate-related complications. These cases involved different pathogen profiles than those typically seen in younger populations.
Analysis of the Uganda and Tanzania AMR datasets revealed sex-based differences in both pathogen prevalence and antimicrobial resistance profiles. These disparities may be influenced by factors such as healthcare-seeking behaviors, prior antibiotic use, or underlying comorbidities. These insights prompted important questions about how age, sex, and underlying health conditions influence infection patterns and resistance outcomes.
This finding sparked important questions during the discussions at the Central Public Health Laboratory (CPHL):
What explains the over-representation of women aged 15–54 in UTI cases?
What are the predominant pathogens in male versus female UTI cases?
Are there notable differences in AMR profiles based on sex and age?
Are there comorbidities, health conditions or characteristics such as age or sex that are associated with particular UTI pathogens or AMR UTI profiles?
The findings and discussions underscored the critical need for gender-responsive and equity-based approaches to AMR surveillance. And the critical need to generate sex- and age-disaggregated data to better understand AMR patterns and inform more tailored, gender-responsive strategies for prevention and treatment in tackling these public health challenges.
Strengthening laboratory capacity for gender- and equity-responsive AMR surveillance and M&E
The visit underscored the importance of building institutional capacity on gender and equity integration into AMR surveillance and monitoring systems across all One Health domains – human, animal and environmental health. The sessions revealed significant gaps in participants’ understanding of how gender and equity intersect with AMR data in each domain. These gaps point to a broader challenge: existing systems may be missing critical patterns and disparities that shape exposure, access to care, treatment outcomes, and risk of resistance among different population groups. Without this lens, AMR responses risk being less effective and potentially inequitable.
However, there was a palpable enthusiasm for learning and change. For instance: during discussions at the Uganda National Health Laboratory Services (UNHLS), participants emphasised the need to disaggregate data beyond sex and age by including other social determinants /health statifiers like marital status, disability status, geographical location and economic status. Dr. Susan Nabadda, Director of the Uganda National Health Laboratory Service (UNHLS), requested that the capacity of the laboratory staff be strengthened on gender and equity in AMR programming, and especially in collecting disaggregated diagnostic data that is clear, representative and can be used to inform policy and interventions. This means:
Ensuring patient-level data includes key variables like sex, age, location, and—where possible—socioeconomic markers (e.g. referral source, facility type).
Flagging AMR data patterns by analysing the sex-, age- and socioeconomic-disaggregated data in a way that enables meaningful comparisons;
Collaborating with epidemiologists and data analysts to use those insights to design interventions that address systemic inequities, not just biological differences.
Building this capacity is essential to ensuring that AMR programming is truly inclusive, effective, and equitable—and that it serves all communities, not just the majority or most visible.
LVCT Health team, Baylor Foundation Uganda and the National Health Laboratory and Diagnostic Services partners during the meeting.
Need for a One Health approach in integrating gender and equity
Following the capacity-building sessions with human health laboratory stakeholders, focus shifted to the animal health sector—an essential pillar of the One Health approach. At the National Animal Disease Diagnostics and Epidemiology Center (NADDEC), participants discussed how gender and equity considerations were being reflected in veterinary AMR surveillance. They examined existing AMR surveillance data from the animal health sector, particularly in relation to antimicrobial use (AMU) in poultry farming. The analysis indicated that the data was primarily on large-scale and medium-scale farms, including poultry reared for export, with limited attention given to practices in small holdings. These settings were better monitored and more consistent with veterinary oversight and antibiotic tracking.
They acknowledged gaps in their animal health surveillance systems. Small-scale farmers, many of whom are women, were left out on the surveillance activities, as the focus was on large scale farmers, providing very limited data on antibiotic practices and resistance patterns. This gap meant the experiences and contributions of women in the livestock sector were being missed in both AMR data and policy conversations. Where the data existed, the NADDEC team observed that small- to medium-sized poultry farms managed by women had higher rates of AMR compared to those managed by men. This raised important questions about gendered differences in farming practices, access to veterinary care, and antibiotic usage. Interestingly, this could be linked to the gendered health-seeking behaviour, as women tend to seek veterinary health services more promptly than their male counterparts, leading to frequent antibiotic use, and their cases being more likely to be tested, documented, and reported for resistance patterns. This highlighted a critical need to strengthen surveillance in smallholder settings, expand data disaggregation by gender and farm type, and investigate how social and gender dynamics shape AMU behaviors and AMR risks across farming systems.
Participants from the animal health domain raised a significant challenge in Uganda: the difficulty in obtaining reliable data on veterinary antibiotic use and management (AMU) and biosecurity practices on farms. They noted that many farmers may not fully understand the antibiotics being administered to animals, and in some cases, veterinarians often fail to record what has been administered. For lay farmers, even dewormers might be mistakenly recorded as antibiotics, rendering AMR/AMU data unreliable.
Advancing equity in AMR data collection and use
Our discussions with the human and animal health stakeholders highlighted Uganda’s already existing and robust AMR surveillance framework while also identifying opportunities for enhancement. A notable suggestion was piloting the collection of additional variables related to health equity at selected sentinel sites to capture better how resistance burdens and access to treatment vary across population groups. These variables could include:
Enhancing data disaggregation: Incorporating gender, socioeconomic status, and geographic variables into AMR surveillance tools, such as Marital status, disability status/type, number of live births (for women), health insurance coverage, and access to antibiotics.
Household and environmental characteristics: Data on sanitation facilities, access to protected water sources, antibiotic use in livestock rearing, and proximity of waste sites to homes
Conduct further analysis: Explore associations between comorbidities/characteristics, e.g., occupation, rural residence, and specific pathogens or AMR profiles
By integrating these variables into existing tools like the Microbiology Request Form, we can better understand how social determinants influence UTI risk and AMR patterns
The learning loop: From insight to impact
As the GEAR up lead for East Africa, LVCT Health has embarked on a transformative journey with Uganda as the key technical partner in mainstreaming gender and equity. This collaboration has achieved significant milestones in promoting inclusive, gender-responsive AMR programming. The most notable achievement is the integration of gender and equity into Uganda’s second-generation 2024/25-2028/29 National Action Plan: Prevent, Slow Down and Control Spread of Resistant Organisms, marking the first time a Fleming Fund Phase II national plan has incorporated these critical elements.
A particularly affirming moment was captured in a LinkedIn post by the Baylor Foundation, which reflected on their achievements in their gender and equity mainstreaming journey.
The post reads: “Have you ever done everything right but still wondered why the results aren’t showing? We are often told that, that is a sign that strategy, not effort, needs to be changed. That’s what the Fleming Fund Country Grant II is doing—fine-tuning its approach, tightening the nuts and bolts, and driving impact in the fight against antimicrobial resistance (AMR)—leaving no one behind.”
The post acknowledges that, as a result of the process – a multi-phase, consultative which aimed to mainstream gender and equity into Uganda’s antimicrobial resistance (AMR) response – tangible resultsare now evident. LVCT Health played a key role in this process by providing targeted technical assistance to government institutions and AMR stakeholders. This included:
Facilitating gender and equity-focused M&E sessions;
Supporting the review of AMR surveillance data to assess gaps in equity representation;
Advising on the inclusion of disaggregated indicators within data collection tools
The integration of gender and equity into Uganda’s NAP for AMR, the M&E framework, and the AMR data collection tools marks a significant milestone in the GEAR up project’s efforts to strengthen AMR governance. This achievement reinforces the need for national commitment, stakeholder buy-in, and new entry points for institutional learning across sectors to achieve an inclusive, gender-responsive plan. As we look to the future, we are hopeful that our efforts to address AMR will be effective, targeted, inclusive, and equitable, benefiting all population groups, including women and other underserved populations.
Staff from UNPHL contributing to the M&E review actions
The Road Ahead
Our discussions in Uganda underscored a crucial insight that addressing AMR requires more than just laboratory surveillance; it demands a people-centered approach that considers the social and economic realities of those affected. By embedding gender-transformative methodologies and breaking down data silos, we can ensure that AMR programming is not only effective but also inclusive and sustainable. Uganda’s commitment to integrating gender and equity into AMR surveillance provides a promising foundation for change.
As we move forward, the insights gained during this visit must now translate into actionable policies and refined data management practices that ensure no population is left behind in the response against antimicrobial resistance. With the foundation laid by the second-generation NAP, Uganda is well-positioned to lead the way on gender-responsive AMR programming in the region.
Acknowledgements
We sincerely thank the Ministry of Health Uganda, the Uganda National Health Laboratory Services (UNHLS), NADDEC, and Baylor Foundation Uganda for their collaboration and openness during the M&E visit.
Thanks to Michael Gaitho, Jane Thiomi, Pacific Owoundo, Dr. Cleophas Ondieki, Festus Mutua and Hayley Stewart for their help in reviewing this blog.
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.
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.
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.
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.
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.
