Mission to control

IN the 12 years since Melinda Gates and her husband, Bill, created the Gates Foundation, the world’s largest philanthropic organisation, she has done a lot of travelling.

A reserved woman who has long been wary of the public glare attached to the Gates name, she comes alive, her associates say, when she’s visiting the foundation’s projects in remote corners of the world. “You get her out in the field with a group of women, sitting on a mat or under a tree or in a hut, she is totally in her element, totally comfortable,” says Gary Darmstadt, director of family health at the foundation’s global health programme.

Visiting vaccine programs in sub-Saharan Africa, Gates would often ask women at remote clinics what else they needed. Very often, she says, they would speak urgently about birth control. “Women sitting on a bench, 20 of them, immediately they’ll start speaking out and saying, ‘I wish I had that injection I used to get’,” says Gates. “‘I came to this clinic three months ago, and I got my injection. I came last week, and I couldn’t get it, and I’m here again’.” They were talking about Depo-Provera, which is popular in many poor countries because women need to take it only four times a year, and because they can hide it, if necessary, from unsupportive husbands. As Gates discovered, injectable contraceptives, like many other forms of birth control, are frequently out of stock in clinics in the developing world, a result of both funding shortages and supply-chain problems.