With AMR deaths projected to exceed 10 million annually by 2050, a gender-sensitive, intersectional approach is critical to tackling this silent epidemic
When antibiotics or antimicrobials, impactful the first few times, lose their efficacy as their intake increases, sometimes unthinkingly and unnecessarily, it indicates that the bacteria, fungi, viruses and parasites it was being used to treat have become resistant to these drugs. Prevention and treatment of infections then become increasingly difficult and can lead to fatal consequences.
While this antimicrobial resistance (AMR) is invisible, the people affected by it are not. In 2021, deaths linked to AMR numbered a staggering 4.7 million and approximately 1.5 million were directly caused by it.
Worryingly, India has one of the world’s highest AMR rates. Equally worrying is that the impacts of AMR are not the same for everyone. Since the drivers of AMR in India include lack of access to clean water, sanitation and hygiene (WASH), and limited access to healthcare facilities among others, AMR disproportionately affects certain groups compared with others. Thus, marginalised and vulnerable communities, especially women, face a higher risk of acquiring bacterial infections, including drug-resistant infections and AMR.
It is a good fact that women face more barriers to accessing health information than men. Limited mobility prevents them from attending public health awareness events and learning about the safe use of antibiotics.
Low levels of education lead to ignorance on the use and misuse of antibiotics not just for themselves, but for their children also. Studies have found that misuse of antibiotics while breastfeeding can contribute to the development of AMR, particularly in intestinal microbiota in a child, through breast milk transfer. They are more prone to seeking antibiotics to get better as fast as possible, to work. Medicines used for self-medication are often purchased without prescriptions from unlicensed local shops as limited financial resources often dictate whether it is worth paying a visit to a health facility.
It has been proven that treating viral infections with antibiotics, not buying the full course of treatment, interrupting treatment and sharing medicines can lead to an increased risk of AMR with the emergence of resistant strains of bacteria. Sexual orientation and associated sexual behaviours among individuals also contribute to the risks of acquiring AMR.
Laws that criminalise homosexual relationships coupled with stigma are deterrents to health-seeking behaviour by key populations such as men having sex with men (MSM), lesbian gay, bi, trans, queer and other identities (LGBTQ+) individuals. This enhances their exposure to pathogens, such as an increased risk of sexually transmitted infections (STIs) and antimicrobial drug resistance. Gender-based violence also plays a significant role in AMR among women. Multiple studies have shown that women, including married women, are at a higher risk than men of being exposed to STIs through sexual violence, having a spouse with multiple partners, male resistance to condom use and women’s low ability to negotiate safe sex.
This increases women’s risk of contracting STIs, particularly gonorrhoea, one of the most transmitted STIs which has the potential for drug resistance. The more frequent the UTIs, the greater the use of ciprofloxacin and the higher the risk of AMR. With the possibility of deaths associated with AMR rising to over 10 million annually by 2050, there is an urgent need to adopt a robust intersectionality approach. Greater data disaggregated by sex, gender, disability, geographical location, occupation, sexual orientation and socio-economic status is urgently needed to implement policies to prevent AMR, especially among women, LGBTQ, people living with HIV and other vulnerable groups.
(The author is a journalist writing on development and gender; views are personal)
