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Policy  –  Implement the plan

Gender mainstreaming

Gender plays a role in determining who has access to and control over resources and whether these can be used for prevention and treatment.

Both ‘sex’ (as a physical dimension) and ‘gender’ (as a psycho-social dimension), and the interaction between them, play a significant role in antibiotic resistance. Sex and gender is important to consider in enhancing the understanding of the ‘human face’ of antibiotic resistance and antibiotic use, and how it affects a variety of people in different ways throughout their daily lives.

What is gender?

Gender refers to the differences between men and woman as constructed by societies. These differences include the roles that men and women are expected to undertake in a given setting.

On the other hand, sex is the biological and physiological factors that inform the state of being male or female.

Although sex and gender are often presented as two separate concepts, they are inherently interrelated and do not exist independently of one another.

Sex and gender are important factors to consider when developing policies, interventions and strategies to address health and other drivers for antibiotic resistance.

  • Although sex is universal, gender is context specific
  • Addressing gender in relation to health and disease, and creating greater opportunities for inclusion and participation, is an important way of tackling inequality and inequity in society
  • Men’s and women’s bodies are different and they experience disease differently

Health programs and services are not equally available, accessible, affordable and acceptable to all members of a population, even where there are legislative or policy provisions for universal coverage

  • Gender plays a role in determining who has access to and control over resources and whether these can be used for prevention and treatment.
  • Gender affects people’s exposure to animals and the risk of zoonotic infection or enhanced exposure to antibiotic resistance.
  • Gender affects the kinds of employment and work that people do, thereby increasing some people’s exposure to risky activities and products.
  • Gender influences who has access to health care and shapes healthcare encounters, the nature of medication prescribed and the risk of infection in these settings.

Gender mainstreaming

Gender mainstreaming is a strategy which is adopted to enable equal opportunities, access and choices for women, men, girls and boys. It entails ensuring that, in all areas and at all levels before any decisions are taken and throughout a project, men’s and women’s concerns and experiences are part of the design, implementation, monitoring and learning, with the goal of promoting gender equality.

A gender mainstreaming approach can help answer crucial questions about how men, women and people with diverse genders might be differently at risk of disease and/ or impacted by antibiotic resistance. It can also inform the design and implementation of programs to address antibiotic resistance and identify the multi-sectoral linkages that should form part of intervention design. Gender mainstreaming may present opportunities for sharing program costs, enable more holistic perspectives and lead to program results that can be sustained over a longer term.

Gender mainstreaming poses questions such as:

  • Are the benefits of healthcare appropriately distributed among men and women?
  • What kinds of barriers (biological, social, cultural, political, economic) exist that might exclude certain categories of people from benefiting from healthcare, and how can these be addressed?
  • How might an intervention or action, designed to enhance people’s access to medical drugs, for example, differentially affect the men and women that are targeted?
  • What sorts of unintended harm might result from implementing such an intervention, and how might these be minimized?

Through these questions, gender mainstreaming can reveal a need for changes in goals, strategies and actions to ensure that both women and men can influence, participate in and benefit from development processes.

Case study: Considerations of Sex and Gender for Antibiotic Resistance

The third most common infections in people are urinary tract infections (UTI), but treatment has become more complicated as a consequence of increased antibiotic resistance. UTIs occur more often in females than in males. The reason is mainly attributed to anatomical differences between males and females, including urethra length and sex-based variation in the levels of testosterone or estrogen. However, other factors also contribute. For instance in lower income settings, lack of clean water and sanitation for personal hygiene during menstrual cycles and the lack of sanitized menstrual products also contribute to UTIs. Cultural and gendered norms and practices shape both how diseases are experienced and treated, and potentially reinforce the scope for antibiotic resistance to develop. In some contexts, illness and disease are interpreted as evidence of women’s poor moral quality, sexual misdemeanors and other deviant behaviours and as a consequence, women often self-treat for sexual health and urinary problems such as UTIs.

There is no “one-size-fits-all” solution to ensure appropriate use of antibiotics and contexts must be carefully studied and gender dynamics understood before strategies are designed. More examples can be found in ReAct’s gender report, that illustrated the importance of mainstreaming gender in designing options for reducing antibiotic use and managing antibiotic resistance (in human health and in animal production) by engaging all actors, particularly women who are often excluded from all processes that lead to interventions.

Selected Resources

Resource Description
Tackling antimicrobial resistance (AMR) together. Working Paper 5.0: Enhancing the focus on gender and equity”] Working paper from the WHO to assist countries towards gender and equity considerations in antibiotic resistance work; informs the implementation of strategies in national action plans.
Scoping the Significance of Gender for Antibiotic-Resistance”] Report from ReAct that contains an overview of how sex and gender interacts with antibiotic resistance. The report includes four case studies that highlight these interactions.
1.
World Health Organization - WHO. Tackling antimicrobial resistance (AMR) together. Working Paper 5.0: Enhancing the focus on gender and equity [Internet]. WHO. 2018 [cited 2019 May 28]. Available from: https://www.who.int/publications/i/item/tackling-antimicrobial-resistance-together-working-paper-5.0-enhancing-the-focus-on-gender-and-equity
1.
ReAct. Scoping the Significance of Gender for Antibiotic Resistance [Internet]. 2019 [cited 2020 Dec 7]. Available from: https://www.reactgroup.org/wp-content/uploads/2020/09/Scoping-the-Significance-of-Gender-for-Antibiotic-Resistance-IDS-ReAct-Report-October-2020.pdf
1.
WHO. Taking sex and gender into account in emerging infectious disease programme: an analytical framework [Internet]. Geneva: World Health Organization (WHO); 2011 [cited 2020 Oct 21]. Available from: https://iris.wpro.who.int/bitstream/handle/10665.1/7977/9789290615323_eng.pdf