Stigma, Gender-based Violence Fueling Antimicrobial Resistance Amongst Women -Experts
By Alice Etuka, Abuja
The combination of Stigmatisation and Gender-based violence have been discovered to be the driving force behind antimicrobial resistant (AMR) infections especially among women.
This formed the basis of discussion at the AMR Dialogue Session tagged AMR under gender lens, hosted by the Global AMR Media Alliance (GAMA).
Former Chief Scientist of the World Health Organization (WHO), Dr. Soumya Swaminathan stated that women were at a very high risk of intimate partner violence or domestic violence, both physical or sexual. This, she said could lead to more infections. And because of their position within the household and the community, they were less likely to seek timely and adequate care for these injuries or infections, which could eventually lead to drug-resistant infections.
“Whether it is sexually transmitted infections or urinary tract infections, or reproductive tract infections, or pelvic inflammatory disease, all of these are linked with sexual violence and an increased risk of antibiotic use. Also, even if the woman may seek care, quite often follow-up is poor. She may have taken a partial course of antibiotics or the wrong doses. Women facing an unplanned pregnancy, who go for an unsafe abortion in some cases, are also at higher risk of AMR”, she said.
On her part, a member of WHO Task Force of AMR Survivors, Bhakti Chavan disclosed that diseases like Tuberculosis (TB) or HIV/AIDS carry a huge stigma in the society especially for the women. Bhakti who is a survivor of extensively drug-resistant TB – one of the most serious forms of drug-resistant TB noted that in many communities, a woman diagnosed with TB or HIV is judged not only as a patient but as someone who had brought shame to the family.
“Her character, her marriage prospects and even her abilities to being a good wife, daughter, mother are questioned. I have seen many women hide their illness because of this stigma. They delay testing, they avoid going to the clinics, some take medicine secretly and others stop treatment early to prevent family members or neighbours from finding out about it”, she said.
Similarly, Chairperson of GAMA and Host of AMR Dialogues, Shobha Shukla lamented the high burden of drug-resistant TB due to overuse or underuse of TB medicines:
“With World TB Day coming up and also as someone from India – the country with the highest TB (and drug-resistant TB) burden worldwide, I would like to draw your attention to drug resistant forms of TB. In the year 2000, the upper end estimates showed that we had around 400,000 cases of drug-resistant TB. In 2024, we also had a similar number of people with drug resistant TB. We have failed down the line to prevent drug-resistant TB as the TB bacteria continue to become resistant because of overuse, underuse or misuse of TB medicines. We could have done better. We had the science, tools, and evidence to do so. But we could not. If we are to end TB, we have to ensure zero drug resistant TB that occurs due to failure of infection prevention and control, or misuse, overuse or underuse of TB medicines”, she said.
Also speaking, Associate Professor, University of Cape Town, South Africa, Dr. Esmita Charani lamented that women often have the least power in being able to negotiate and advocate for themselves within the healthcare settings, adding that the power differential between the patient, the end user and the healthcare provider was very strong and also impacted by gender:
“The burden of disease predominantly remains in populations that have the least access to resources, including antibiotics, to be able to treat infections effectively. The power differential between the patient, the end user and the healthcare provider is very strong and that is impacted by gender. It is impacted by gender norms and roles within society as well as within healthcare services. Women often have the least power in being able to negotiate and advocate for themselves within the healthcare settings- whether they are healthcare professionals or whether there are patients. Women often put their own healthcare needs behind those of other family members.
“Women often have the unrecognised and unspoken role of care providers. And what we saw in the hospitals in India was women would often come in as carers for their family members and not necessarily seeking care themselves. Also, when there is out of pocket expenditure on healthcare, often male family members might be selected over female family members. We need to recognize this and identify how we can leverage power for positive outcomes”, she opined.
At the end of the dialogue, it was unanimously agreed that a complex mix of biological, social, cultural and economic factors arising from gender-based inequalities and injustices impact infection prevention and control. Gender inequalities, harmful gender norms and stereotypes had normalized the neglect of well-being of girls and women, making them more vulnerable to AMR. Therefore, if we want to fight AMR effectively, we must listen to the women, diagnose them early on, ensure proper treatment, support adherence and design policies that consider women’s realities.
According to WHO, AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.
AMR is a natural process that happens over time through genetic changes in pathogens. Its emergence and spread is accelerated by human activity, mainly the misuse and overuse of antimicrobials to treat, prevent or control infections in humans, animals and plants.
