For Melinda Gates, Birth Control Is Women’s Way Out of Poverty

Nov 6, 2016

By Celia W. Dugger

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.


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6 comments on “For Melinda Gates, Birth Control Is Women’s Way Out of Poverty

  • 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.

    You go Melinda! In my view, governments must employ millions of Melindas to distribute contraceptives so that countries can gradually bring overpopulation down to sustainable numbers. Governments working with social support must embark on informed, deliberate, advertised plans to promote a range of optimal population size compatible with limiting resource use and extraction; pollution reduction, conservation, open land and quality of life.



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  • I’ve long championed Melinda Gates contraceptive promotion and the comprehensive health and poverty programs covered by the Gates Foundation.

    What she’s attempting is very tough.

    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.

    Several years ago she said astutely that a woman will not take on contraception until she knows that her few children will live. Child healthcare must be improved and be seen to work first. Time is needed for this.

    But further, as statistics unerringly show, children are also had as a hedge against an uncertain older age. Promising wealth if child freer is a tougher ask and depends on the further efforts of the Foundation’s primary aim of poverty alleviation to dramatise the wealth uplift. Melinda’s promise has substance but needs to be believed to do its job. Indeed the money used for this purpose (poverty alleviation) is part of the cost to achieve contraception.

    But further, if you look at the Foundation’s spend profile you’ll see it is health and poverty that take the bulk of the money, not contraception. If poverty could be reliably relieved through the simple expedient of promoting contraception they would surely put more eggs in the contraceptive basket, netting two…er… birds with one stone. (I think that must be a mixed metaphor jackpot.)



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  • Phil: But further, as statistics unerringly show, children are also had as a hedge against an uncertain older age. Promising wealth if child freer (sic?) is a tougher ask and depends on the further efforts of the Foundation’s primary aim of poverty alleviation to dramatise the wealth uplift. Melinda’s promise has substance but needs to be believed to do its job…But further, if you look at the Foundation’s spend profile you’ll see it is health and poverty that take the bulk of the money, not contraception. If poverty could be reliably relieved through the simple expedient of promoting contraception they would surely put more eggs in the contraceptive basket

    The Gates foundation is a charity and cannot begin to supply resources adequate for poverty relief on a national scale. Global reductions in infant mortality has nearly completed the penultimate phase of demographic transitions from low infant mortality + high birthrates to the last phase: low infant mortality + low birthrates.
    Many developing nations have completed the transition to replacement or near-replacement fertility rates, including, surprisingly enough, India. For reasons too expansive to discuss here, some countries stay trapped in explosive-growth birthrates. Notably in Sub-Saharan Africa where the 5-child average fertility rate per woman holds ground and is projected to generate 25% of world population by 2050, poverty does not conform to the old conventional wisdom linking it to high fertility. Poverty persists most widely in rural areas where subsistence farming is the regressive economic model, government is ineffectual or absent; and cultural practices and norms are primitive.

    Melinda is right about the main cause of women’s immiseration in poverty, illiteracy and squalor: lack of access to contraception (“unmet need”) applied to the timing and spacing of children. Simply put, women’s empowerment depends first on her ability to avoid unwanted pregnancy, especially in her teens, to defer child birth beyond school years and reduce family size to two or three (preferably two) children. Certainly many more re$ources must simultaneously be invested in her education, healthcare and job opportunities..and the men must be brought on board if a better life is to materialize. But despite everything else if she winds up at 17 or 18 with a child in tow and another in the belly, hoeing a dusty patch of ground to raise field corn to be sold on street corners, her chances of seeing daylight are woefully diminished.



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  • “Contraceptive first” then wealth is nearly impossible to sell and is not a realistic policy as Melinda is half admitting (“tougher than expected”). Poverty alleviation first is the realistic one which the Foundation recognises and funds accordingly. Of course it is entirely appropriate that Melinda tries to promote contraceptive first to get some pull to go with the push.

    This is not the walk over you are imagining….



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  • Bill and Melinda are excellent people. The difference between Steve Jobs and Bill Gates (I think) couldn’t be more stark. Jobs was clearly cooler, more hip, but Bill is making the world a much better place. Nice to see the wealthy giving so much back.



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  • Phil: “Contraceptive first” then wealth is nearly impossible to sell and is not a realistic policy as Melinda is half admitting (“tougher than expected”). Poverty alleviation first is the realistic one which the Foundation recognises and funds accordingly. Of course it is entirely appropriate that Melinda tries to promote contraceptive first to get some pull to go with the push.
    This is not the walk over you are imagining….

    You are entitled to this belief. China’s one-child policy – imposed because Chinese leaders, gaining sufficient public support, recognized an overpopulation crisis that called for “extreme” measures – has proven a factor in bringing total fertility rate down to a subreplacement level of 1.6 children per woman. India has reduced TFR to 2.3 children per woman nearly equal to replacement fertility, adjusted for slightly higher infant/childhood mortality, because of the population-wide dissemination and use of contraception. India (nor China) could “solve” the problems of hundreds of millions of people living in abject poverty “first” before implementing population stabilization measures. Overbreeding would have outpaced and crushed attempts to lift subsistence farmers out of poverty in the countryside while diverting vital resources from developing economies in urban centers. The relatively low birthrates of better educated, desperately cramped, city dwellers had to be exported to the rural agrarian villages via contraception if city and countryside alike were not to collapse under the weight of people piled on top of people until carrying capacity collapsed. (As shrinking incomes increasingly fail to support large families in farming, millions of people with their progeny began to pour into cities from the countryside, smothering livable environments, widening and deepening cesspools of urban poverty.)

    As much as I admire the accomplishments of the Bill Gates Foundation, charities cannot bring resources on a scale necessary to solve the poverty or demographic problems of countries. With limited funds -even wow! billions of dollars! – the mission remains focused within small population parameters. Food, shelter, healthcare, education is provided to local organizations at no cost to individual recipients. When the money runs out, it must be replenished by continuing donations, often with shrinking revenue forcing cutbacks in already underfunded operations. Melinda Gates is my hero because she speaks out on the crucial role of contraception -reproductive choice and rights – for the empowerment of women; she makes a hearty contribution to providing access to contraceptives; and she is working by implication to stabilize and likely reduce obscenely bloated populations. I take her at her word without expecting her Foundation’s funding strategies to lift Africa’s unique basket case out of poverty or provide authority for arguments like yours… No one is idiotic enough to confuse any efforts to ameliorate life-and-death threats on a global with “a walk over.”



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