March 08, 2022
Women are 27% more likely to receive an antibiotic prescription in their lifetime compared to men (Schröder et al., 2016). This disproportionate burden of antimicrobial resistance (AMR) on women is due to both demand and supply-side factors. Some demand-side factors which increase women’s vulnerability to AMR are biological factors, women’s nature and type of employment, excessive home-based care work, and limited access to healthcare (WHO, 2018). On the supply-side, gender differences in antibiotic prescription by doctors due to lack of training and gender-bias increase women’s antibiotic usage (AMU) (Bertakis, 2009; Eggermont et al., 2018). These issues are further compounded in LMICs due to stringent socio-cultural norms, women’s low levels of education, low participation in the workforce, and limited health information/networks. Despite this obvious interconnectedness of AMR and gender, it surprisingly remains unexplored in the current literature. The interaction of biology and socio-cultural norms makes women more susceptible to AMR. Women’s exposure to AMR and AMU is higher during pregnancy, childbirth, menstruation, and abortion. In addition, young women face a greater risk of contracting Urinary Tract Infections (UTIs), gonorrhea, and other diseases. Lack of adequate Water, Sanitation, and Hygiene (WASH) facilities puts women at higher risk of contracting antibiotic-resistant infections in LMICs.
Women’s health and treatment-seeking behavior may be compromised due to a lack of knowledge, networks, economic resources, and decision-making within a household. Women’s lack of decision-making about their own health and less bargaining power at home further limits their access to healthcare. Restricted mobility of women due to patriarchal norms and the resulting lack of consultation with healthcare providers also makes them prone to inappropriate AMU. Existing adverse gender norms and preferences for boys over girls lead families to prioritize health care and treatment for male children (Barasa, 2019).
Women’s nature of paid and unpaid work increases their vulnerability to AMR. Women are usually the primary caregivers in households, which increases their exposure to AMR due to their involvement in cooking, animal care, and child and elderly care work. Even within paid work, women tend to be involved in health and education sectors or low-paid farm work. Women contribute to 67% of the frontline healthcare workforce, which puts them at a higher risk of exposure to AMR due to the nature of their work (WHO, 2016). At agricultural and animal husbandry sites, women are more involved in performing menial tasks, which may result in higher exposure to animals carrying resistant bacteria (Davies et al., 2004; Smith et al., 2013; van den Bogaard, 2001).
While steps towards tackling AMR in terms of creating awareness, advocacy, and regulation have been initiated, the lived experiences of women remain unaddressed. Research on interactions between AMR and women’s health and livelihoods will be a crucial next step.
Reference List
Barasa, V. (2019). WaArusha Agro-Pastoralist Experiences with Risk of Febrile Illness: An Ethnographic Study of Social Drivers of Zoonoses and Rural Health-Seeking Behaviours in Monduli District, Northern Tanzania. 226.
Bertakis, K. D. (2009). The influence of gender on the doctor–patient interaction. Patient Education and Counseling, 76(3), 356–360. https://doi.org/10.1016/j.pec.2009.07.022
Davies, R. h., Dalziel, R., Gibbens, J. c., Wilesmith, J. w., Ryan, J. m. b., Evans, S. j., Byrne, C., Paiba, G. a., Pascoe, S. j. s., & Teale, C. j. (2004). National survey for Salmonella in pigs, cattle and sheep at slaughter in Great Britain (1999–2000). Journal of Applied Microbiology, 96(4), 750–760. https://doi.org/10.1111/j.1365-2672.2004.02192.x
Eggermont, D., Smit, M. A. M., Kwestroo, G. A., Verheij, R. A., Hek, K., & Kunst, A. E. (2018). The influence of gender concordance between general practitioner and patient on antibiotic prescribing for sore throat symptoms: A retrospective study. BMC Family Practice, 19(1), 175. https://doi.org/10.1186/s12875-018-0859-6
Schröder, W., Sommer, H., Gladstone, B. P., Foschi, F., Hellman, J., Evengard, B., & Tacconelli, E. (2016). Gender differences in antibiotic prescribing in the community: A systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy, 71(7), 1800–1806. https://doi.org/10.1093/jac/dkw054
Smith, Tara. C., Gebreyes, W. A., Abley, M. J., Harper, A. L., Forshey, B. M., Male, M. J., Martin, H. W., Molla, B. Z., Sreevatsan, S., Thakur, S., Thiruvengadam, M., & Davies, P. R. (2013). Methicillin-Resistant Staphylococcus aureus in Pigs and Farm Workers on Conventional and Antibiotic-Free Swine Farms in the USA. PLoS One 8. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0063704
van den Bogaard, A. E. (2001). Antibiotic resistance of faecal Escherichia coli in poultry, poultry farmers and poultry slaughterers. Journal of Antimicrobial Chemotherapy, 47(6), 763–771. https://doi.org/10.1093/jac/47.6.763
WHO. (2016). Working for health and growth: Investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/311616
WHO. (2018). Tackling antimicrobial resistance (AMR) together. Working paper 5.0: Enhancing the focus on gender and equity. Geneva: World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/336977/WHO-WSI-AMR-2018.3-eng.pdf
AMR and Gender image by Samantha Serrano from Canva
