The Harvard International Review sat down with Melinda Gates to discuss her work in making contraception and family planning available in underdeveloped countries through the Bill and Melinda Gates Foundation.
What inspired you to pursue work regarding contraception and family planning? How do you see yourself in relation with the women you are helping?
When I travel to the world’s poorest places, family planning is a topic women keep bringing up. Many of the women I meet tell me that they desperately want information and tools that will allow them to plan and space their pregnancies, but those tools are not always available where they live. There are 220 million women in developing countries who do not want to get pregnant but are not using an effective method of contraception. I use contraceptives, and they afforded me the ability to plan my family, my life, and my future. Women in developing countries want these tools for the same reasons. They want the power to plan their own lives, and they want to ensure that they are able to provide the very best for the children they do have. I will never forget a woman I met in Kenya who held up her baby and told me, “I want to give every good thing to this child before I have another.” That desire is universal.
You gave a TED Talk on this topic in which you said that “both rich and poor governments alike must make contraception a total priority.” With so many competing health priorities, why do you feel that increasing access to family planning for more women should remain a priority on the global agenda? Are there broader socioeconomic benefits? Should rich governments help other countries’ initiatives in addition to working on their own?
Absolutely. Empowered women are one of global development’s strongest allies. When women have the tools and information they need to plan and space their pregnancies, it has a transformative impact on societies. When women and their partners are able to plan their families, they have more resources to spend on each child, and are better able to provide them with healthcare, nutritious food, and education. And healthier, more educated children today mean healthier, wealthier societies tomorrow. Family planning is not only one of the best investments we can make in women’s health; it’s one of the best investments we can make in the future.
Where is the Bill & Melinda Gates Foundation focusing its efforts at the global and local levels?
One of our top priorities is ensuring that family planning remains on the global agenda. In 2012, we helped organize a historic family planning summit in London, where we launched a global partnership called FP2020 that has brought countries together around a shared goal of reaching an additional 120 million women with the quality family planning tools they want and need by the year 2020. At the local level, we are working in partnership with a wide range of organizations to help us understand what women’s needs are and how we can deploy our resources most effectively to help meet those needs. It is important to understand the cultural context in which we are operating, and our local partners play a huge role in that.
How has this new momentum to advance family planning efforts translated to real impact for women and girls? What would you say is one of the greatest challenges to expanding contraceptive access for more women?
Already, we have made some really impressive progress. One year after the London Summit, 8.4 million additional women and girls were using modern contraceptives. According to FP2020 estimates, this translates to 77 million unintended pregnancies averted and 125,000 lives saved from complications due to unintended pregnancies, which is pretty incredible. In some countries we are seeing unprecedented progress. For example, Senegal recently announced that 20 percent of married women are now using modern family planning methods, an increase from 16 percent in 2013. This is the largest gain a West African country has ever made in a single year. But progress is not always the same thing as success, and there is still a lot further to go. Some countries still do not have plans in place to guide their national family planning strategies, and others do not have the financing to put their plans into action. Donors and governments in developing countries have to continue to work together and use the available evidence to build and execute strong country plans that will accelerate progress.
There are a wide variety of strongly held views about contraception in politics, religion, and various cultures around the world. How do you intend to address reservations?
I think that most people agree that women should be able to lead healthy and productive lives. And I think most people also agree that if there is something we can do to save women’s lives and help children grow up healthier and with more opportunities, we should do it. So it is important that we start these conversations by focusing on the areas where there is consensus—since there are a lot of things we agree on.
How does the Gates Foundation work with governments to help countries reach their family planning goals?
We support countries’ efforts to create and implement their national strategies to increase access to family planning. That looks different in each country because each country has different needs and different contexts. Let me give you an example. In Senegal, one thing we kept hearing from women is that they would go to the clinic to pick up their contraceptives—often traveling really long distances—but the contraceptives they needed would be out of stock at the clinics. Imagine going to a drugstore in the US to get a prescription and being told, “No I’m sorry, we’re out—and we don’t know when we’ll have more.” These clinics in Senegal were out of stock 150 days of the year! In collaboration with the government of Senegal and local partners, we piloted a new supply chain model in a few districts that virtually eliminated stockouts. Now, the government of Senegal is taking the lessons learned from that pilot project and using them to improve supply chains across the country. Generally speaking, our foundation works with governments and our partners to explore promising innovations that can be taken to scale.
When implementing a program to increase access to contraceptives, how does the Foundation convince governments to invest in this policy initiative and look at it from the perspective of individual choice, rather than from the more macroscopic point of view? How are you making sure your message is clear throughout the process of implementation?
Our approach begins with the basic belief that we can initiate a virtuous cycle of prosperity if every woman and girl is empowered to lead the lives they want and deserve. We support country governments that share this belief and are leading the development and implementation of their own national plans to expand access to family planning. Thanks to successful advocacy efforts at the global and local levels, more government decision makers recognize that family planning is a key intervention to improve maternal, newborn, and child health. They also recognize that healthy mothers and children are the bedrock of healthy and prosperous societies. So, it is easy to make the case that family planning is one of the best investments a country can make in its future.