Antimicrobial resistance (AMR) is no longer a distant or abstract scientific concern; it is a rapidly escalating global health emergency that threatens to undermine decades of medical progress.

AMR occurs when bacteria, viruses, fungi and parasites evolve in ways that render medicines ineffective, making once-treatable infections harder, and sometimes impossible to cure.

The World Health Organisation (WHO) classifies AMR as one of the top 10 global public health threats. Estimates suggest that nearly five million deaths each year are associated with drug-resistant infections.

Without urgent intervention, projections indicate that AMR could claim up to 10 million lives annually by 2050, surpassing deaths from cancer and other major diseases.

Globally, AMR is driven by a complex interplay of biological, environmental and social factors. The misuse and overuse of antibiotics in human health, livestock production, aquaculture and agriculture accelerate the evolution of resistant microbes. Poor infection prevention and control, lack of clean water and sanitation, and weak health systems further compound the problem.

In Nigeria, the situation reflects these global patterns but with added systemic vulnerabilities. Data from the Nigeria Centre for Disease Control (NCDC) show increasing resistance to widely used antibiotics such as ampicillin, ceftriaxone and ciprofloxacin. Hospitals across the country are reporting rising cases of resistant infections, including neonatal sepsis, urinary tract infections and drug-resistant tuberculosis.

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The consequences are far-reaching. Routine surgeries become riskier, childbirth becomes more dangerous, and common infections can escalate into life-threatening conditions. Beyond health, AMR threatens economic stability, food security and progress toward the Sustainable Development Goals (SDGs).

Yet, while AMR is often framed as a scientific and medical issue, experts increasingly argue that its roots extend deep into social structures, particularly gender inequality and gender-based violence.

Gender based violence, silence and resistance:

In a peri-urban settlement on the outskirts of Abuja, Aisha’s life has been shaped by years of domestic abuse. The physical injuries she endured often went untreated, either because she lacked the financial means or feared further violence if she sought help.

Over time, these untreated injuries developed into chronic infections. Each episode led to another course of antibiotics, often purchased from local vendors without proper guidance. Sometimes she stopped taking the drugs when symptoms subsided; other times, she rationed them to make them last longer.

She said, “I didn’t have a choice. If I went to the hospital, there would be questions. At home, there would be consequences.

Today, her infections no longer respond to common antibiotics. What began as a consequence of violence has evolved into a complex medical condition driven by antimicrobial resistance.

Her story illustrates how gender-based violence and limited healthcare access can create a pathway to drug resistance—one that is rarely captured in official statistics.

Childbirth and complications:

Also in Karmo in AMAC Area Council of Abuja, 28-year-old Zainab recalls complications following the birth of her second child. Without access to adequate postnatal care, she relied on informal healthcare providers for treatment.

“I kept buying drugs from the chemist. Each time, it worked for a while, then the pain came back.” she explained.

Repeated infections and inconsistent treatment eventually led to a diagnosis of a resistant bacterial infection. The cost of advanced treatment placed a heavy burden on her family.

Zainab’s experience highlights the gaps in maternal healthcare and the risks associated with self-medication. It also underscores how women’s health needs, particularly during and after childbirth, are often overlooked.

Poverty and impossible choices:

For Ngozi, a market trader in Kubwa, the challenge was not just access to healthcare but affordability. When she was prescribed antibiotics for a severe infection, she could not afford the full course.

“I bought half first. I thought I would buy the rest later, but money didn’t come.”

Her condition worsened, eventually requiring hospitalization, adding that doctors later explained that incomplete treatment had contributed to antibiotic resistance.

Ngozi’s story reflects a broader reality in Nigeria, where out-of-pocket healthcare costs force patients to make difficult choices between treatment and basic needs.

Rural burdens and neglected health:

In Deidei also in AMAC Area Councilof Abuja, 35-year-old farmer Grace balances farming, childcare and household responsibilities. Access to healthcare facilities is limited, and long distances make seeking treatment difficult.

“There is always work. You cannot leave the farm or the children to go to the hospital for small sickness.”

According to her, repeated untreated infections have become a part of her life. When she does seek treatment, it is often delayed and inadequate, increasing the risk of complications and resistance.

Grace’s story highlights the intersection of geography, gender roles and healthcare access in shaping health outcomes.

Treatable infection turns fatal:

Elizabeth still struggles to reconcile how a condition that began as a small boil could end in death. Her 58-year-old grandaunt, Hajiya Aisha, died from sepsis, a severe and life-threatening response to infection, after weeks of self-medication that masked the seriousness of her condition.

What started as a seemingly minor swelling under her armpit lingered for nearly three weeks. Rather than seek medical care, Aisha relied on a commonly used antibiotic, Ampiclox, convinced it was a routine issue she could treat at home. That decision, shaped by a mix of habit, limited access to timely care and deeply rooted health-seeking behaviors, would prove fatal.

Her condition deteriorated rapidly. One night, she collapsed and was rushed to the hospital. By the time she arrived, the infection had advanced significantly. She slipped into a coma and remained unconscious for two days, never regaining awareness before her death.

Medical experts say her story reflects a broader and often overlooked crisis: the misuse of antibiotics and delayed access to proper treatment, both of which are key drivers of antimicrobial resistance. But beneath these clinical explanations lies a deeper, structural issue—gender inequality.

In many communities, women’s health concerns are frequently deprioritised, both within households and across healthcare systems. Financial dependence, caregiving roles, and social expectations often mean women delay seeking care, resorting instead to self-medication or informal drug vendors. For older women like Aisha, these barriers can be even more pronounced.

Elizabeth believes her grandaunt’s death was not simply the result of an infection, but of a system that made it easier to treat symptoms at home than to access qualified care. What appeared to be a minor boil became a fatal condition because it was neither properly diagnosed nor adequately treated.

Her story underscores a critical intersection in public health: where gender inequality quietly fuels antimicrobial resistance, turning preventable and treatable conditions into deadly outcomes.

Experts increasingly argue that AMR cannot be effectively addressed without confronting gender inequality. Social norms and power dynamics influence who gets access to healthcare, who controls resources and whose health is prioritised.

The former Chief Scientist of the World Health Organisation, SoumyaSwaminathan, a globally recognised public health expert and former Director General of the Indian Council of Medical Research, emphasises that gender inequality directly impacts infection prevention and treatment outcomes. Women are often less likely to seek timely care due to financial dependence, cultural restrictions and caregiving responsibilities.

In many Nigerian households, men control financial resources, leaving women with limited autonomy over healthcare decisions. This can result in delayed diagnosis, reliance on informal providers and incomplete treatment.

Women are also more likely to prioritise the health of their children and spouses over their own. This self-sacrificing behaviour, while culturally valued, can lead to neglected health needs and worsening infections.

Educational disparities further exacerbate the problem. Limited access to health information means many women are unaware of the risks associated with improper antibiotic use.

Dangerous link between violence, infection and stigma:

Gender-based violence is a critical but often overlooked factor in the AMR crisis. According to the United Nations, nearly one in three women globally experiences physical or sexual violence.

Swaminathan highlights that violence increases the risk of infections, particularly sexually transmitted infections and injuries that require medical treatment.

“Because of their position within the household and community, they are less likely to seek timely and adequate care,” she explains.

In Nigeria, survivors of violence often face stigma and lack access to support services. Fear of judgment or retaliation discourages many from seeking medical help.

Healthcare systems also struggle to address the link between violence and infection. Without integrated services, survivors may receive treatment for infections without addressing the underlying cause, leading to repeated cycles of illness and antibiotic use.

Stigma remains one of the most persistent and damaging barriers to effective healthcare, particularly for women living with infectious diseases such as tuberculosis (TB) and HIV. It operates quietly but powerfully, shaping behaviour, delaying diagnosis and undermining treatment adherence.

Bhakti Chavan, a survivor of extensively drug-resistant tuberculosis and global advocate for patient-centred AMR response, highlights how stigma creates a culture of silence that fuels antimicrobial resistance. Women, she explains, often internalise societal judgment, leading them to hide symptoms or avoid seeking care altogether.

“They delay testing, avoid clinics, take medicines secretly or stop treatment early,” she said.

In Nigeria, where TB remains a major public health concern, stigma has serious implications. The country is among the high-burden nations globally, with hundreds of thousands of new cases recorded annually. Drug-resistant TB, in particular, thrives in environments where treatment is inconsistent or incomplete.

Women face unique challenges. A diagnosis of TB or HIV can lead to social exclusion, marital instability or even violence. In some communities, illness is linked to moral failure, placing an additional burden on women who are already navigating restrictive gender norms.

This stigma extends into healthcare settings as well. Fear of being recognised at clinics or judged by healthcare workers discourages women from accessing services. As a result, many resort to self-medication or discontinue treatment prematurely.

The consequences are severe. Incomplete treatment allows pathogens to survive and adapt, leading to stronger, drug-resistant strains. Over time, this not only affects the individual but also contributes to the broader spread of resistant infections within communities.

Addressing stigma requires more than medical intervention. It demands community engagement, education and the dismantling of harmful stereotypes that prevent people, especially women, from seeking care.

Power dynamics in healthcare systems:

Gender disparities within healthcare systems further complicate the fight against AMR. Access to care is not just about availability but also about influence, communication and trust.

Esmita Charani, a global health researcher specialising in antimicrobial resistance, health systems and implementation science, notes that women often have limited power to negotiate their care, both as patients and as healthcare professionals. This imbalance can affect diagnosis, treatment decisions and adherence to medical advice.

In clinical settings, women may feel unable to question prescriptions or seek clarification about their treatment. This lack of agency can lead to misuse of antibiotics, either through misunderstanding or lack of proper guidance.

Moreover, healthcare systems themselves may inadvertently reinforce gender biases. For instance, services may not be designed to accommodate women’s schedules or responsibilities, such as childcare and household duties. Long waiting times and lack of privacy can further discourage women from seeking care.

In Nigeria, systemic challenges such as understaffed facilities, inadequate infrastructure and limited resources exacerbate these issues. Women from rural or low-income backgrounds are particularly disadvantaged, facing both geographic and social barriers to access.

Within the healthcare workforce, women make up a significant proportion of frontline workers, including nurses and community health workers. However, they remain underrepresented in leadership and decision-making roles. This limits the incorporation of gender-sensitive perspectives in policy development and implementation.

Addressing these power imbalances is essential for improving healthcare outcomes. Empowering women within healthcare systems—both as providers and patients—can enhance communication, promote appropriate antibiotic use and strengthen overall health system resilience.

Economic barriers and antibiotic misuse:

Economic constraints are among the most significant drivers of antibiotic misuse, particularly in low- and middle-income countries like Nigeria. The high cost of healthcare, combined with limited insurance coverage, forces many individuals to rely on out-of-pocket payments.

Deepshikha Bhateja, a health economist and AMR researcher focusing on access to medicines and health systems, explains that these financial barriers often lead to delayed diagnoses and inappropriate treatments. Women, who frequently have less financial independence, are disproportionately affected.

In many households, limited resources mean that difficult decisions must be made about who receives treatment. Men and boys are often prioritised, leaving women to delay care or seek cheaper, less effective alternatives.

This economic reality drives practices such as purchasing partial doses of antibiotics, sharing medications among family members or relying on informal drug vendors. While these strategies may provide short-term relief, they contribute to long-term resistance.

The prevalence of unregulated pharmaceutical markets further complicates the issue. In many Nigerian communities, antibiotics are readily available without prescriptions. This accessibility, combined with limited awareness, leads to widespread misuse.

Substandard and counterfeit medicines also pose a significant risk. These drugs may contain incorrect dosages or ineffective ingredients, increasing the likelihood of treatment failure and resistance.

Addressing economic barriers requires systemic reforms, including expanding health insurance coverage, subsidising essential medicines and strengthening regulatory frameworks.

Cultural norms and daily risks:

Cultural norms and daily realities shape how women experience health and illness. In many communities, traditional practices and social expectations influence exposure to infections and access to care.

Women are often responsible for household tasks such as water collection, food preparation and caregiving. These roles increase their exposure to environmental risks, particularly in areas with limited access to clean water and sanitation.

Poor sanitation is a major driver of infectious diseases, including diarrhoeal illnesses and urinary tract infections. These conditions often require antibiotic treatment, increasing the risk of resistance when not properly managed.

Cultural taboos surrounding reproductive health further complicate the situation. In some communities, discussing or seeking treatment for conditions such as sexually transmitted infections is discouraged. This leads to delayed care and reliance on informal or unverified remedies.

Menstrual hygiene is another critical issue. Limited access to sanitary products and facilities can increase the risk of infections, particularly in rural areas. These infections, if untreated or improperly treated, can contribute to AMR.

Addressing cultural barriers requires community-based interventions that respect local traditions while promoting health education and behaviour change.

The feminisation of agriculture:

The increasing involvement of women in agriculture, often referred to as the “feminisation of agriculture”, adds another layer to the AMR challenge.

In Nigeria, women play a vital role in farming and livestock management. However, they often lack access to training, resources and decision-making power.

Swaminathan highlights that women in agriculture may be exposed to antibiotics used in livestock without adequate knowledge of proper usage. This can lead to misuse, such as incorrect dosing or unnecessary application.

Additionally, women’s dual responsibilities such as managing farms and caring for families, leave little time for personal healthcare. Minor infections may be ignored or self-treated, increasing the risk of complications.

The use of antibiotics in agriculture also contributes to environmental contamination, which can spread resistant bacteria through soil and water systems.

Strengthening agricultural extension services and providing targeted training for women can help address these risks.

AMR beyond medicine:

Salman Khan, a global advocate working on community engagement and social dimensions of antimicrobial resistance, argues that AMR is fundamentally about power and inequality.

“It is shaped by who has power, whose health is prioritised and whose voices are heard,” he says.

This perspective shifts the focus from purely technical solutions to broader social and political considerations. Addressing AMR requires tackling systemic inequalities that limit access to resources and decision-making.

In many contexts, women’s voices are underrepresented in policy discussions. This exclusion can lead to interventions that fail to address the realities of those most affected.

Incorporating gender perspectives into policymaking can improve the effectiveness of AMR strategies and ensure that interventions are inclusive and equitable.

Nigeria’s response, progress and gaps:

Nigeria has taken important steps to address AMR, including the development of a National Action Plan and the establishment of surveillance systems.

These efforts have improved awareness and data collection, providing a foundation for further action. Public health campaigns have also helped to educate communities about the risks of antibiotic misuse.

However, significant gaps remain. Implementation of policies is often inconsistent, particularly at the local level. Limited funding, weak enforcement of regulations and inadequate infrastructure hinder progress.

Gender considerations are not fully integrated into national strategies, limiting their effectiveness. Without addressing the specific challenges faced by women, efforts to combat AMR may fall short.

Strengthening coordination between government agencies, healthcare providers and community organisations is essential for achieving sustainable progress.

Women as agents of change:

Despite the challenges, women are central to the solution.

Mayssam Akroush, a physician and global advocate for women’s leadership in healthcare, emphasises that women’s roles as caregivers, educators and healthcare providers position them as key agents of change.

Women often make healthcare decisions for their families, particularly for children. Educating them about responsible antibiotic use can have a ripple effect across communities.

In Nigeria, female community health workers play a crucial role in delivering primary healthcare services. With proper training and support, they can promote antibiotic stewardship and infection prevention.

Women in leadership positions—whether in healthcare, education or policymaking—can also drive systemic change by advocating for gender-responsive policies.

Empowering women through education, economic opportunities and leadership development is essential for tackling AMR.

The global TB challenge:

Drug-resistant tuberculosis remains one of the most pressing challenges in the fight against AMR.

Shobha Shukla, a global health advocate and campaigner for ending tuberculosis, warns that progress has stalled despite decades of knowledge and available tools.

The persistence of drug-resistant TB highlights the consequences of inconsistent treatment and weak health systems. Globally, hundreds of thousands of cases are reported each year, with little reduction over time.

In Nigeria, TB control efforts face challenges such as limited diagnostic capacity, stigma and inadequate treatment adherence. Women, in particular, may struggle to complete treatment due to social and economic pressures.

Addressing TB requires a comprehensive approach that includes early diagnosis, consistent treatment and community support.

Bridging science and society:

Experts emphasise that AMR cannot be addressed in isolation from other social determinants of health.

Intersectionality, the idea that multiple factors such as gender, culture, economic status and geography interact—provides a framework for understanding these complexities.

Charani notes that effective interventions must consider these overlapping influences to be successful.

For example, a rural woman with limited education and financial resources faces different challenges from an urban professional. Tailoring interventions to these contexts is essential.

A holistic approach that integrates health, social and economic policies can improve outcomes and reduce the burden of AMR.

Antimicrobial resistance is both a scientific and social challenge.

Addressing it requires tackling gender inequality, violence and systemic barriers to healthcare.

The experiences of women across Nigeria and beyond highlight the urgent need for inclusive, equitable solutions that bridge the gap between science and society.

Without such efforts, the global fight against AMR risks falling short, leaving millions vulnerable to infections that medicine can no longer cure.