Antimicrobial resistance (AMR) continues to pose a serious global health threat, but experts at a recent AMR Dialogues session warned that solutions must go beyond science and medicine to include gender equity, youth participation, and community-centered approaches.
The discussion highlighted how women, gender-diverse communities, and young people experience disproportionate risks of infection, drug resistance, and barriers to care, particularly in high-burden settings like tuberculosis (TB).
Shobha Shukla, Chairperson of the Global AMR Media Alliance (GAMA) and host of AMR Dialogues, stressed the urgency. “Despite promises by governments for health and gender equality, less than 58 months remain to keep them. Yet the urgency is seldom seen when it comes to the human right to health. We cannot dislocate the right to health from gender equality,” she said.
Shukla explained that AMR arises from the misuse and overuse of medicines across human health, livestock, agriculture, and environmental contamination. Gender-based inequalities amplify this problem. “The lived experiences of girls, women, and gender-diverse communities show that violence puts them at risk of infections, including sexually transmitted infections, and increases unplanned pregnancies. Gender norms and harmful stereotypes normalize the neglect of their well-being, making them more vulnerable to AMR,” she said.
Dr Soumya Swaminathan, former Chief Scientist at WHO and former head of India’s ICMR, highlighted the connection between gender-based violence and infection risk. “Women exposed to intimate partner violence often delay care for infections. They may receive incomplete antibiotic courses or inappropriate treatment. Whether it is urinary tract infections, reproductive tract infections, or pelvic inflammatory disease, these situations increase the risk of drug-resistant infections,” she said. Swaminathan also noted that even in well-resourced hospital settings, misuse of antibiotics can occur, particularly in emergency rooms, ICUs, or post-operative wards, compounding resistance risks.
The gendered impact of AMR becomes particularly visible in TB, including drug-resistant TB (DR-TB). Shukla noted, “With World TB Day approaching, it is critical to focus on drug-resistant TB. In 2000, upper estimates suggested 400,000 DR-TB cases globally. In 2024, the number remained almost the same. We had the science, the tools, and the evidence to prevent it, but we failed. Overuse, underuse, and misuse of TB medicines continue to drive resistance.”
AMR survivors brought the issue to life with personal stories. Bhakti Chavan, a member of the WHO Task Force of AMR Survivors, described her experience with extra-pulmonary XDR-TB. “I took two years of daily painful injectable treatments and multiple antibiotics. I recovered, but the side effects were devastating—my skin tone changed, I lost a lot of weight, and my appearance became socially stigmatized,” she said.
Chavan also recounted how a family member’s recurrent urinary tract infections worsened due to repeated empirical antibiotic treatments without culture tests, eventually leading to infections resistant to multiple drugs. “AMR is not gender neutral. If we want to fight it effectively, we must listen to women, ensure early diagnosis, proper treatment, and policies that reflect their realities,” she said.
Dr Esmita Charani, Associate Professor at the University of Cape Town, emphasized the need for an intersectional approach. “Drug-resistant infections primarily affect populations with the least access to resources, including women who prioritize their families over themselves. In India, for instance, women often enter hospitals as carers for family members, not patients. Health interventions must account for these gendered power dynamics,” she said.
Dr Deepshikha Batheja of the Indian School of Business stressed that human decision-making drives AMR. “From buying antibiotics in pharmacies to livestock treatment, every action is shaped by gender, access, and behavior. Social norms around caregiving, menstruation, and resource control all impact antimicrobial use,” she said. Batheja noted that most community health and nursing workers are women, yet they face burnout and harassment, which affects infection prevention and antibiotic stewardship.
Youth engagement was another major focus. Dr Salman Khan, a youth advocate and former member of the Quadripartite Working Group on Youth Engagement for AMR, said, “Young people, particularly young women, operate at the interface of human, animal, and environmental health. Yet they are excluded from AMR governance. Youth must be empowered to co-create policies rather than simply be beneficiaries.” He emphasized that inequities intersect with socioeconomic status, gender norms, and geographic location, affecting access to healthcare and responsible antimicrobial use.
The social dimensions of AMR also affect TB outcomes. Shukla explained that girls and women in rural areas often present late for TB care, having sought treatments from traditional providers or informal practitioners. “Delays in diagnosis, poor adherence to antibiotics, and lack of proper follow-up all contribute to the emergence of drug-resistant TB,” she said.
Dr Maisam Waid Akroush, a consultant internist from Jordan, described national AMR strategies that integrate women’s leadership. “Women are mothers, educators, prescribers, and community influencers. Targeting them in AMR awareness campaigns multiplies impact. Our initiatives reach remote areas, schools, and refugee communities, teaching responsible antibiotic use and the importance of following medical advice,” she said.
Education, data, and policy reform are central to these efforts. Dr Charani stressed that health interventions must consider social determinants of health, including ethnicity, socioeconomic status, religion, and gender. “AMR cannot be managed with antibiotics alone. Policies must address inequities in access, decision-making power, and the broader social context that shapes antimicrobial use,” she said.
Dr Batheja added practical recommendations: co-create context-specific AMR messages, integrate gendered data into surveillance, optimize antimicrobial use in humans and animals, and involve gender and equity experts in AMR coordination. “Evidence from local communities and indigenous knowledge can help design alternate solutions to AMR,” she said.
The session concluded with a strong call to action. Shukla said, “Ending violence, improving health access, and empowering women are not just human rights imperatives—they are essential to saving the medicines that protect us.” Chavan added, “Youth must be included structurally in policy-making. Without their voices, interventions miss key realities that drive AMR and drug-resistant TB.”
Experts agreed that addressing AMR and DR-TB requires gender-transformative approaches, youth empowerment, and integrated social and biomedical strategies. Only by centering women, youth, and marginalized populations can the world reduce antimicrobial misuse, prevent drug resistance, and improve health outcomes for all.
