Why does everything have to be about gender?
Nichola Jones, a community engagement researcher based in the University of Leeds, tells us about her recent presentation at the 8th World One Health Congress held in Cape Town, South Africa. Nichola presented on the topic of sex & gender in AMR (antimicrobial resistance) policy and reflects here on sharing insights about the role of gender and intersectionality in such a complex health issue.
From societal expectations and roles, the way we interact with health systems, levels of education and access to resources; gender and other social/demographic factors impact all areas of our lives, particularly when it comes to health outcomes. In short; everything is gendered. To deny this is to impede our understanding of complex health issues, therefore slowing our attempts to reduce their impacts.
As many of us are only too aware, AMR (antimicrobial resistance) is one of the biggest threats to health today, accounting for 1.27 million deaths in 2019 alone. This, of course, is most acutely felt in low-resource settings, with many of these deaths occurring in LMICs. A true One Health issue, AMR spans across human, animal and environmental sectors with actions and issues in all sectors each impacting on the others. Effective multisectoral approaches are essential in addressing and reducing AMR.
Though AMR is considered a universal issue, its impacts are not felt equally by all, even in settings where socio-economic factors are similar. The literature tells us that certain biological factors (such as childbirth) can drive a need for antimicrobials for some in society more than others. We also know from recent research that gender-based behaviours and societal expectations can shape exposure to infections and antimicrobial use; women are more likely to work in care-giving roles for both humans and animals, women are more likely to care for children and sick relatives, men are more likely to sustain a work-place injury that requires treatment.
What we don’t always know is exactly how these behaviours and needs break down in communities, or how we can address the needs of different social groups to effect meaningful change. Gaps in data collection for sex and gender in AMR must be addressed if we are to meet larger SDG goals and WHO guidance on gender equity.
Gender and sex in global policy
My presentation shared findings from a recent COSTAR team review of National Action Plans (NAPs) that found surprisingly little in policy that related directly to sex or gender. We found that over 70% of NAPs contained no mention of sex or gender. Where gender was mentioned in NAPs, we found that many discussed a need for equity across genders in introductory passages, but did not follow these into measurable indicators. There is, then, much room for improvement when revising these policies in the coming years. These findings aligned with the work of WHO working group on gender, who were also present at the conference to share their recently published recommending an explicit focus on gender in review processes moving forwards.
Still some way to go
Despite much progress, discussions about gender in AMR can still be met with scepticism. While I’m mostly met with enthusiasm for this work, some can see the focus on gender as tokenistic or even problematic. Responses have ranged from a polite frown to a direct challenge of the role of gender in AMR; gender can be seen as a ‘women’s issue’ that pulls focus from other areas of needed research. Others have even speculated that focusing on gender might divert funding from other areas of ‘more serious research’ such as drug development. I am, of course, always keen to point out that we all in fact experience gender (not just women) and that funding is not being siphoned away from other areas to please a feminist agenda…
Fortunately, there are many who feel that gender is a key focus area to reach equity on AMR response. Whilst attending the WOHC, I had the opportunity to speak directly with members of the WHO, Flemming Fund, and ILRI who are all working on exciting projects that focus on gender in either AMR specifically or wider One Health issues. I very much look forward to hearing of the progress of these groups and hope to link our thinking in the future.
A way forward…
It's essential to continue pushing for a more integrated approach that recognizes the relationship between gender and health, even where the health issue itself is not inherently gendered (i.e. not maternal or reproductive health etc). In my own work and in the work of CE4AMR, I see that social sciences approaches can help us to unlock community knowledge on complex issues like AMR. By engaging communities directly, we are able to identify some of the more complex social dynamics such as the role of gender in health seeking behaviours.