Antibiotic consumption, structured vulnerabilities, and networks of survival in Southern Pakistan

Pakistan ranks among the top ten countries globally in antibiotic misuse, calling for anthropological attention to explore the underlying contributing factors. We look at antibiotic use as a complex social practice embedded within the critical structures and informal networks of Sindh, Pakistan. Using ethnographic methods, we show that antibiotic misuse is not a “knowledge gap” but rather a reasonable response to structural neglect. The Pakistan Economic Survey 2024–25 highlights that only 0.9% of GDP is spent on health. With limited healthcare services, people often skip formal biomedical clinics to avoid a “cascade of costs,” and pharmacies have become a key part of a makeshift network of care. We show that antibiotic circulation is influenced by gendered social networks and domestic hierarchies, where high maternal and infant mortality rates illustrate the life-threatening impact of restricted female health agency. Addressing antimicrobial resistance (AMR) requires shifting focus from individual “awareness” to the political economy of health, advocating for structural reforms that target the socioeconomic factors influencing medicine use in resource-limited settings.