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.

Women would tell her that they’d left their farms and walked for hours, sometimes with children in tow, often without the knowledge of their husbands, in their fruitless search for the shot. “I was just stunned by how vociferous women were about what they wanted,” she says.

Because of those women, Gates made a decision that’s likely to change lives all over the world. She has decided to make family planning her signature issue and primary public health a priority.

“My goal is to get this back on the global agenda,” she says. She is sitting in an office in the Gates Foundation’s 900,000 sq ft headquarters in downtown Seattle. It was here late last year that she announced her new emphasis on contraception at an all-staff meeting, to thrilled applause.

Now the foundation, which is worth almost $34bn, is putting her agenda into practice. In July it’s teaming up with the British government to co-sponsor a summit of world leaders in London, to start raising the $4bn the foundation says it will cost to get 120m more women access to contraceptives by 2020.

And in a move that could be hugely significant for women worldwide, it is pouring money into the long-neglected field of contraceptive research, seeking entirely new methods of birth control. Ultimately Gates hopes to galvanise a global movement.

But despite her passion, stepping forward wasn’t an easy decision. For one thing, the former Microsoft manager has always shunned the spotlight. The first time she agreed to a magazine profile was in 2008, 14 years after her marriage, when she spoke to Fortune about the foundation’s work.

“I was reluctant to speak out on behalf of any foundation issues early on, because I had little kids, and I wanted some privacy in my family life,” she says.

Perhaps more importantly, there’s her Catholic faith, which has always informed her work. “From the very beginning, we said that as a foundation we will not support abortion, because we don’t believe in funding it,” she says. She’s long disagreed with the Church’s position on contraception, and the Gates Foundation did some family-planning funding early in its history.

Still, she went through a lot of soul-searching before she was ready to champion the issue publicly. “I had to wrestle with which pieces of religion do I use and believe in my life, what would I counsel my daughters to do,” she says.

Defying Church teachings was difficult, she adds, but also came to seem morally necessary. Otherwise, she says, “we’re not serving the other piece of the Catholic mission, which is social justice.”

Gates believes that by focusing on the lives of women and children, and making it clear that the agenda is neither coercive population control nor abortion, the controversy over international family-planning programmes can be defused. Right now, she points out, 100,000 women annually die in childbirth after unintended pregnancies; 600,000 babies born to women who didn’t want to be pregnant die in the first month of life.

“She is somebody who really sees this as a public-health necessity,” says Melanne Verveer, the US ambassador at large for global women’s issues. “I think she believes, and I hope she is right, that people of different political persuasions can come together on this issue.”

This may be overly optimistic. Her first public speech on the issue, at a TEDxChange conference in Berlin in early April, was excoriated in the right-wing Catholic press and on conservative Catholic blogs. “Melinda Gates Promotes Abortion at Mtg, Attacks Catholics,” read a headline on LifeNews.com.

The UK Catholic Herald’s Francis Phillips was more measured, saying: “It is always a disappointment when a public figure of great wealth, standing or power explains that although they are loyal Catholics they think Church teaching is wrong — predictably on moral matters.”

There was a time when creating worldwide access to birth control was a thoroughly bipartisan endeavour, taken seriously at the highest levels of American government. But that was before our politics were transformed by 30 years of ideological warfare over sex and reproduction.

In the middle of the 20th century, global family planning was seen as an issue of national security, not feminism. In the aftermath of World War II, high birth rates and falling death rates in poor countries led to a panic about overpopulation, which many believed would cause widespread instability, leaving countries vulnerable to communist revolution.

By the early 1960s, US president Dwight Eisenhower was calling for foreign aid for birth control in The Saturday Evening Post, and he and Harry Truman became honorary chairmen of Planned Parenthood. In 1965, president Lyndon Johnson implored the UN to “face forthrightly the multiplying problems of our multiplying populations ... Let us act on the fact that less than $5 invested in population control is worth $100 invested in economic growth.”

Over the next 15 years, the US led the world in a massive effort to bring family planning to every corner of the globe. Powerful Americans lobbied the UN to create the UN Fund for Population Activities, or UNFPA, and then to expand its work.

But population control led to terrible excesses. During the Indian “emergency” that began in 1975, prime minister Indira Gandhi suspended civil liberties, and her younger son, Sanjay, instituted a campaign of mass, forcible sterilisation. China instituted its coercive one-child policy in 1979.

In the 1980s and 1990s, international family planning increasingly became associated with feminism rather than national security, making it subject to growing pressure from the ascendant religious right.

In 1984 Ronald Reagan instituted the Mexico City policy, denying American support for international organisations that perform abortions or even counsel about them, cutting off funding to large parts of the global family-planning infrastructure. In 1986 he cut off American funding for UNFPA. Both policies were copied by succeeding Republican administrations.

As a result of this intense politicisation, American leadership on global family planning diminished, and no other country fully replaced it. Thus Gates, in her travels, discovered what she calls a “glaring hole. Nobody was working really in a united way on contraception.”

Part of what Gates hopes to do is to re-create the former broad-based consensus behind global family planning, but in a way that’s focused on women’s needs rather than on demographics. “This is about empowering women to be educated and make a choice they want to make,” she says.

She seems convinced that empirical evidence about the public-health benefits of birth control can overcome ideological objections. Indeed, one of the themes of her initiative is “no controversy.”

But controversy won’t be easily waved away. “If she wants to put money into it, that’s fine, but she doesn’t get to say no one gets to argue with me,” says Susan Yoshihara, director of research at the Catholic Family and Human Rights Institute, a group that’s played a major role in organising international opposition to family-planning programmes.

Yoshihara says any attempt to link contraception and maternal health is “extremely controversial. You don’t tell a woman dying of an ectopic pregnancy that she should have used a female condom. To say that we’re going to help women not die in childbirth by telling them that they shouldn’t get pregnant in the first place, I think, borders on scandalous.”

Such criticism will likely increase as the Gates Foundation becomes known for its work in developing new forms of birth control. Right now, it’s funding research into contraceptives that women could inject themselves, sparing them onerous clinic trips. Aware that many women reject the birth-control pill because of side effects, the foundation is investing in a search for a contraceptive medication that works without hormones, a “potential whole new class” of drug, says the Gates Foundation’s Darmstadt.

Another of the “crazy ideas we’ve been dreaming about,” he says, “is whether we could create an implantable device that would be woman-controlled, and that you could put it in, and it could last her reproductive lifetime.” She could turn it on and off at will, and it would never need to be removed. “That’s something that I think every woman everywhere in the world could potentially benefit from,” he says.

There’s currently very little investment in contraceptive research. The single biggest funder, Darmstadt says, is the US government, through the National Institutes of Health. “It’s an area that’s really kind of stagnated,” he says. “One of the things we see that we can do is to try to really stimulate that space.”

For reproductive-health advocates, this is terrific news. For some conservatives, though, it will likely seem almost dystopian. Indeed, in response to an item about contraceptive research on the Gates Foundation website, The Catholic Herald’s Phillips wrote, “A horrid image comes to mind, of white-coated boffins hard at work in diabolical laboratories, devising new ways of depriving men and women of their conjugal dignity, their culture and their traditions.”

* (c) 2012 Newsweek/Daily Beast Company LLC. All rights reserved.


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