Sex and Gender in AMR; a global policy analysis

Background: This presentation will (1) share insights and reflections on sex and gender within AMR (antimicrobial resistance) research and (2) present findings from a review of all available national-level policies on AMR from a sex/gender perspective – publication forthcoming.

It is widely accepted that AMR most acutely impacts low-middle-income countries, primarily due to lack of resources and poor access to medicines. The impacts of AMR, however, are not felt equally among all social groups, even where socio-economic factors are similar. Different genders experience differentiated levels of exposure to infections, differences in health-seeking behaviours and varied access to health services and medicines. Acknowledgement of these differences is growing in recent research, though there is still some way to go; even the most recent and well-cited figures on the global AMR burden (Murray & O’Neil reports) do not use social stratifies (gender, age, ethnicity etc) to explore how AMR impacts social groups differently. This paucity in gender-focused research prompted a review of gender in policy; are there guidelines or aims in existing policy that we can refer to when planning research? To date there is little focus on either sex or gender across guidance for AMR despite gender being referred to directly within the SDGs and as a core principle in WHO and UN planning. This presentation will share insights from an ongoing review of all national action plans (NAPs) in AMR which aims to understand if and how sex/gender is incorporated into AMR policy globally.

Methods: A total of 150 NAPs were included in this policy review. All current and recent NAPs are available to download from the WHO’s online NAP library. Once downloaded, each of the NAPs was initially screened for language – all non-English NAPs were run though Google Document Translation service. Via NIVIO, key terms searches relating to sex/gender were performed; sex, gender, male/
female, men/women. These key terms were then converted into codes within NVIVO, with further analysis producing sub-themes within each of the larger areas.

Results: Results from this review are currently under development. At the point of application (April 2024) the initial codes have been generated and researchers have met to discuss sub-themes. At this stage, we can see a significant gap in gender within all NAPs, with less than half of all NAPs including terms related to sex and gender. At the point of presentation (Sep 2024) we expect to be able to
share further insights into the thematic outcomes of this review.

Conclusions: This analysis will present the current state-of-play for sex/gender within AMR policy and highlight current gaps in response. It will also highlight the potential for cross-country learning on policy and planning around AMR, particularly when considering gender as a focus point.