Combating poverty with contraceptives
Melinda Gates talks about why family planning is so important — and what she’d like to say to U.S. President Donald Trump
For Melinda Gates, the key to unlocking the cycle of poverty can be found inside a condom wrapper — or birth control pill, IUD, diaphragm or any other contraceptive that gives a woman control over her reproductive fate.
But around the world, an estimated 225 million women still lack access to contraceptives, a troubling reality that the Bill and Melinda Gates Foundation has spent more than $1 billion (U.S.) trying to change. On International Women’s Day, the Star chatted with Melinda Gates, one half of the world’s wealthiest couple, about why she has “gone all in on family planning” — and what she would say to U.S. President Donald Trump if given the chance.
There are so many issues you could have chosen to devote your time and money to. Why did you settle on family planning as your signature cause?
Because I just see over and over around the world, as I would be out travelling and talking to women, this issue came up again and again and again. Women will tell you that they need to be able to space their births. They’re very vociferous about it in the developing world.
It just became this rallying cry and if you look at the data, we know that one of the places you’ve got to start — if you’re going to lift women out of poverty — is you’ve got to have access to contraceptives.
How do we know there’s a link between contraceptives and reducing poverty?
One of the long-standing global health studies was back in Bangladesh, in the 1970s. It was a fantastic study, a long-term longitudinal study. They took a set of villages in Bangladesh and offered them the same sets of services as other villages — but those other villages had family planning and contraceptives offered to women.
In those villages that had access to contraceptives, the families were healthier at the end of the study, the families were wealthier — not just the kids, but the family overall — and the kids were better educated. And so it’s like this gold-standard proof that you can have that contraceptives make a difference.
In 2012, you embarked on a campaign to provide120 million women with access to contraceptives by 2020. What have been some of the challenges?
I’ll just give you a couple examples of what we underestimated. We knew going into this (that) we had terrible, terrible data about women and access to contraceptives — and without data, you don’t know how and where to act. So we had to go and build a measurement system.
In addition, we have supply chain issues all over the world. We knew we had those issues; we didn’t know the depth of the problem to be quite frank, country to country.
And you know, let’s be honest, there are cultural issues and they’re different in different places. We knew about them in general; we’re learning about them in depth now.
Can you tell me about a surprising cultural issue that came up?
Well, it’s interesting. I knew, for instance, that in India it’s quite often the mother-in-law who has resis- tance to her daughter-in-law using contraceptives — she wants a lot of grandkids. I knew there were places in Africa, particularly West Africa, where the men want lots of children, and they decide and determine access.
What I didn’t understand was how the solutions would come about. So Niger is a perfect example. (Nigerois) themselves came up with their own solutions . . . They came up with a husband school, where they first taught the husbands why their children would be healthier — and why their wives would be healthier — if they allowed the women to use contraceptives.
And it’s that kind of solution that has to be done in the right cultural context — and guess what? It works.
There’s been a lot of talk in the U.S. around (the reinstatement of ) the “global gag rule,” which we know will dramatically hurt family planning efforts globally. (Also known as the Mexico City Policy, it prohibits foreign NGOs from receiving U.S. funds if they perform, counsel or refer women for abortions.) What impact do you think this will have?
The Mexico City Policy is something I’m very concerned about. I don’t think we even know yet the impact on women and girls because as this administration has put it on, it looks like it will be put on more broadly than in the past. And so we’re still all waiting to see exactly what the specificity of that is.
But I would say this: If you’re a woman and you’re getting HIV services, and this policy is now applied to an HIV clinic, it could have serious ramifications. So I think it’s a concern, for certain.
I know that your husband, Bill Gates, has had some opportunities to speak with the new president, but I’m wondering if you’ve had any chances to meet with President Trump?
I have not yet. I haven’t chosen yet to do that. Bill has been engaged; Bill’s talking with them, with President Trump. I’m talking to many, many people inside the administration — we both are — also on Capitol Hill, as you can imagine. But when Bill goes into a meeting like that, he’s talking about all the foundation’s issues, including family planning.
I’m wondering if there’s anything you would say to the new president if he were here right now?
I would say women’s access to a full range of health services is always important. If you want to improve society, if you want peace and stability around the world, we have to lift up women. You have to empower women. And empowering women starts with empowering them around health. That I know and I believe from all my travels around the world for over 15 years on behalf of the foundation.
What about in your own life? How has family planning and access to contraceptives impacted your own life and trajectory?
We wanted to have three children and it’s not actually serendipitous that they’re spaced three years apart. For me, I graduated with a degree in computer science; I went to business school; I came to work at Microsoft. I couldn’t have done those things if I had started my family earlier.
I think for a woman to be able to plan and space her family has profound implications for her, no matter what country she lives in. And for me, thank goodness, it wasn’t about lifting myself out of poverty. But the women I meet around the world — it’s about lifting themselves out of poverty.
The Canadian government just announced $650 million to promote sexual and reproductive health over three years. Is there anything you want to say about what Canada on this front?
Canada has been a real leader on the maternal and child health work now for a number of years . . . For them to come in now at the midpoint (of the 2020 campaign) with this funding just shows a lot of very progressive thinking, you know, very forward-looking and saying, ‘This is what’s right for women.’ And I actually think it’s going to help re-energize some of the global health community around this. I couldn’t be more excited about it.
We’re talking on International Women’s Day. What does being a feminist means to you?
It means having your voice in the world and doing whatever you want to do. Being fully empowered. To me, that’s being a feminist.
And the thing that I’m excited about on International Women’s Day is seeing both men and women stand together. It’s going to take all of us . . . we’re not done in my country, we’re not done in your country, we’re certainly not done in Senegal or Kenya or Bangladesh. It’s going to take all of us standing up for what’s right.