The One Health Trust, funded by the World Health Organization and the British Academy, hosted a two-day workshop focused on developing inclusive policy recommendations for our changing world. The workshop highlighted the urgent need to address antimicrobial resistance (AMR), which occurs when germs (including bacteria, viruses, fungi, and parasites) adapt to resist treatment, leading to increased illness severity and mortality.

Human activities, particularly the misuse and overuse of antibiotics, accelerate the emergence and spread of infections resistant to medicines. Factors like inadequate hygiene and limited healthcare access exacerbate AMR spread, disproportionately affecting vulnerable groups such as women and lower castes.

India, with some of the highest rates of drug-resistant infections in the world, serves as a poignant case study. Women are disproportionately affected due to biological factors such as urinary tract infections, childbirth, and menstruation. Gender inequities and sociocultural biases also increase the risk of AMR among girls/women. They make them more prone to infections and reduce their access to quality healthcare, including essential antibiotics, immunization, and diagnostics.

Women’s lack of education, poor nutrition, limited access to clean water and sanitation, as well as the demands of both paid (frontline healthcare and sanitation) and unpaid work (caregiving responsibilities), all contribute to their vulnerability to harmful pathogens..  Climate change further compounds these challenges by altering ecosystems and exacerbating unsanitary conditions. Caste discrimination hinders healthcare access and can relegate certain caste groups to jobs that expose them to unsanitary and harmful conditions, increasing the likelihood of a drug-resistant infection.

To help governments address the disproportionate impact of AMR on marginalized communities, the diverse cohort of researchers at the workshop worked together to build strategies to integrate gender, caste, and climate considerations into healthcare, environmental, and labor policies.

Dr. Deepshikha Batheja (Economist and Research Fellow, One Health Trust) said, “Gender inequities when combined with other power hierarchies, such as caste, can cause differences in vulnerability to drug-resistant infections among different genders and social groups. Climate change further amplifies existing gender-based inequities in health, antimicrobial usage, and resistance. The workshop on gender and AMR (and its intersection with caste and climate change in India) is the first step to exploring the linkages between these complex issues and is a call-to-action to build evidence on sociocultural drivers of resistance worldwide and to inform sound public health policy which can mitigate the spread of AMR.”

The workshop participants provided diverse perspectives on and potential solutions to control the spread of these difficult-to-treat infections. The experts highlighted the importance of cross-disciplinary collaboration and sector-wide efforts in addressing significant health challenges. This includes ensuring the inclusion of women in clinical trials, establishing inclusive prescribing guidelines for new antibiotic treatments, improving access to drinking water and menstruation products, and promoting education to reduce stigma surrounding gynecological issues and sexually transmitted diseases. It is evident that a comprehensive approach involving various disciplines and sectors is essential in tackling these pressing health issues.