The impact of gender inequities on antimicrobial resistance in low-income countries: a comprehensive review

INTRODUCTION: Antimicrobial resistance (AMR) is a leading public health threat, the burden of which falls disparately on low- and middle-income countries (LMICs). Despite increasing efforts to slow the progress of AMR, gender, an important determinant of health, remains unaddressed in most major policy frameworks. This omission leaves gaps in our social understanding of AMR, undermining the efficacy of public health interventions. AREAS COVERED: We searched databases and gray literature, adopting a narrative approach to identify and present evidence. In this article, we examine three domains where gender impacts AMR. First, we analyze gendered healthcare access and antimicrobial use, identifying how gender norms can influence healthcare-seeking behaviors and create gendered diagnostic and antimicrobial usage disparities. Second, we explore differential AMR exposure associated with healthcare, childbearing, caregiving, agricultural, and sex-work occupational roles. Finally, we discuss how structural and systemic barriers, like poverty and healthcare access, perpetuate gender inequities in AMR and facilitate suboptimal antibiotic usage patterns. EXPERT OPINION: Current gender-blind AMR policies are insufficient at addressing the root social causes of AMR. Effective responses will require a shift to gender-responsive interventions, including the integration of sex-disaggregated data to AMR surveillance systems and reducing the structures that limit women's economic and healthcare autonomy.