Melinda Gates has made providing poor women in developing countries access to contraception a mission. The Bill & Melinda Gates Foundation, which she leads with her husband, has donated more than $1 billion for family planning efforts and will spend about $180 million more this year.
Since 2012, she has helped lead an international campaign to get birth control to 120 million more women by 2020. Four years later, a report explains why achieving that goal is proving tougher than expected. This is a condensed and edited version of our conversation about family planning.
Why is this the cause of your life?
If you allow a woman — if you counsel her so it’s truly voluntary — to have a contraceptive tool and she can space those births, it unlocks the cycle of poverty for her. In the early days, I’d be out traveling for the foundation, I’d be there to talk to women about vaccines, I’m going be frank, for their children, and what they would say to me is: ‘O.K., I have questions for you. What about that contraceptive, how come I can’t get it anymore?’ To me, it’s one of the greatest injustices.
One of the statistics in the report that most struck me was that contraception prevented tens of millions of unsafe abortions by preventing unwanted pregnancies. You’re Roman Catholic. Is that part of the moral imperative for you?
Yeah. I mean this is obviously something I’ve had to wrestle with very deeply. The Catholic Church doesn’t even believe in these forms of modern contraceptives. I’m in the developing world minimum three times a year now, and I’m out in slums, in townships, in the rural area, and when you see a needless death of a woman or a child because she literally just didn’t have a very inexpensive tool that we not only believe in, we use in the United States — more than 93 percent of married Catholic women report using contraceptives — the moral imperative is that we give these women what we believe in and actually use.
I’m curious. As you travel around the developing world, do you find there is resistance among the leaders of countries who are overwhelmingly men and often don’t want to give up control of a woman’s fertility and of their own wives’ fertility?
We see it all over the world. I mean, you even see it sometimes in the United States, right? Men wanting to take control of women’s health. And I think that’s why I’ve been so adamant about this effort that we’re working on. It has to be grass-roots, ground-up. We can’t do the top-down planning that happened in the world in the 1970s, where we told women what to do. It was about population control, it was about coercion.
Looking at the charts on the types of contraceptives available across the developing world, I’m struck by how little of them are the long-acting contraception that is changing the face of family planning in the United States, particularly for poor women: IUDs and implants. What are the barriers to expanding access to those across the developing world?
Because the funding had stagnated, we weren’t investing as a world in new contraceptives for women. So the partners, the philanthropists, have been investing in long-acting tools. There is now an injectable that’s a tiny, little blister pack with a tiny, little needle, sort of like you’d give yourself a diabetes drug. We’re working on a formulation that could go in a health community care worker’s kit. When she goes out into these villages, she can give it to women. A woman doesn’t have to go to a clinic and get it from a nurse or a doctor. And eventually, a woman could give it to herself. So you could give her a two-year supply, and she can just take it home and administer to herself every three months or every six months.
How far-off are those possibilities?
Well, the one that’s the tiny, little injectable, that’s actually available now and we’re working on the registration. We have about 14 countries that have already registered around the world, and we have another 16 countries that will come online very soon. And then we’re doing the deep policy work so that they’ll start to not only put it in the village health care worker’s kit but also then eventually let women take it home and use it themselves.
So that’s actually very near-term. That’s happening now and will continue to roll out over the next three to five years. The other pieces of research are more upstream. So those are probably more like five to seven years off. But we’re finally putting the money in.
Here in the United States, the Buffetts have been great champions of family planning, and obviously, Warren E. Buffett has made a huge commitment to the Gates Foundation. Is he excited about this?
Oh, this is the No. 1 thing that Warren and I talk about. I can’t come off of an event with him, whether it’s the foundation’s annual meeting, whether it’s an event he and I go to with the other billionaires who are part of our Giving Pledge, that Warren doesn’t catch me backstage and say, ‘Melinda, I think this is the most important thing you are doing at the foundation, the most.’ And his wife, Susie, was very dedicated to family planning when she was alive. So that’s where their roots started.
What would be the payoff if you can get to 120 million women?
You’d start to break the cycle of poverty. Women in the United States, when we were finally able to really use contraceptives, look what it did to women going into the work force. All over Africa, young girls getting pregnant early when they don’t want to keeps them out of school. So you’d keep more girls in school, and then you’d have educated girls who would go into the work force.
And we know that when a girl or woman has economic means in her own hands, it shifts the whole power dynamic in the family, whether it’s with her mother-in-law or her husband. It’s the beginning thing that unlocks a woman’s potential.