Empowerment through Contraception
How the Gates foundation is supporting women in developing countries to control their present for a better future
By Alice Thompson
Melinda Gates and I are chatting about contraceptives: condoms or the Pill? I am talking to one of the richest women in the world, not about private jets, yachts or furs – “I would never wear those in Seattle” – but about her sex life. She makes it seem totally normal.
“Of course, I absolutely use contraceptives,” she says. “It’s not an ambition I’ve ever had, to talk about sex with Bill, but I’m happy to chat about it. Every year more than a billion couples have sex and yes, not surprisingly, we do, too.”
Her husband works in an identical office next door at the Seattle headquarters of the Bill & Melinda Gates Foundation. Most days they drive home for supper with the family discussing injectable contraceptives and sewage systems. They’ve been married for 23 years and for most of those, as founder of Microsoft, Bill has had more money than any other human on the planet.
But for Melinda, sex is more important than cash. “I have three children – it’s not a surprise they are spaced three years apart,” she explains. “Everyone should be able to have sex without the fear of becoming pregnant.”
Melinda is Roman Catholic from a good middle-class Texan family, the daughter of an aerospace engineer and a housewife mother, but that didn’t stop her from protecting herself. “I got lucky – my pregnancies weren’t difficult. Without contraceptives, I wouldn’t have been able to do what I do. I went to college, graduate school, I had a nine-year career at Microsoft, I got married. I didn’t have a child straightaway; I could plan my life. Think about it. If I hadn’t had contraceptives, my outlook would have been very different. I might have got pregnant and dropped out of college.”
She could have been a single mum living in a trailer park, though I doubt it. She is a phenomenally hard worker. The reason she is happy to talk about sex is because she is using her foundation to lead a global campaign to give 120 million women in developing countries birth control. Five years ago, she chaired the first Family Planning Summit in London with the British government, and now she’s about to host the second next week.
With their wealth, Melinda might have spent her life choosing platinum bathroom taps, amassing Hermès handbags or collecting Impressionists (she and her husband have a few); instead, her mission is to save lives. She has spent the last decade travelling the world talking to HIV positive prostitutes, trying to eradicate diseases such as polio and tuberculosis and funding research into innovations such as infection-preventing vaginal gels.
Her wardrobe as a result consists of a great many “pantsuits” in navy and brown, khaki trousers, scarves and scuffed trainers. Even today, she may be in a blue silk shirt, but it’s teamed with anonymous black trousers, almost no make-up and a simple gold chain – definitely no Botox. At 52, she is strikingly pretty, but she doesn’t look as though she has been to a hairdresser for some time, her nails are varnish-free and her body isn’t sinewy from hours on a treadmill. Nothing marks her out as belonging to any elite club except perhaps her diary, which is packed with appointments with world leaders who are also expected to listen to her sex talk.
“When I started travelling in the developing world talking to women, I began to realise the importance contraceptives had in my life,” she says. “Thinking about my friends, we’ve always discussed which tools we use, which work when, what the side-effects were. In America the advent of the birth-control pill changed everything, and we seem to have forgotten that that isn’t the case for many less fortunate women.”
She really isn’t giving up on this subject.
“I started taking them in college. I have used different methods at different times: I’ve used barriers, short-acting, long-acting ...
“Bill and I both had careers. It meant I could give up for a few years. Bill was really surprised I wanted to be a stay-at-home mum, but I knew it wasn’t going to be for ever, just to get my family started on the right track.”
She has always discussed sex with her children, Jennifer, 21, Rory, 18, and Phoebe, 14. “People don’t talk about sex because they are too embarrassed – there is a stigma around it – but it’s a normal human activity. I have this belief you should start talking to kids early and often. The sooner you answer their questions, the better, and it has to happen multiple times. Drugs, sex and alcohol are the issues you need to bring up again and again. We discuss them the whole time at home and Bill is part of that conversation.”
It was while talking to women in Africa and Asia about the importance of vaccines and education, she says, that she discovered their greatest fear was actually getting pregnant.
“I would go to these dusty villages or slums with no clean water and barely any food. When I stayed long enough, and the men had faded away, the women would finally ask me questions, and they would always bring up contraceptives. Most didn’t have access or had to travel too far for them. I wanted to turn away, being Catholic, and I knew it was a political hot button, but in the end I couldn’t ignore them.”
The Duke University economics and computer science graduate soon became obsessed. “There was no data and I am a data freak, so I started asking. Charities and clinics would say, ‘But we have condoms,’ which you and I would be fine with, but women in the developing world would tell me, ‘I can’t negotiate a condom in my marriage. It would look like either I had Aids or my partner had it.’ They needed more covert methods and were prepared to leave their fields and walk 100 miles for them. I couldn’t turn away, I couldn’t just dole mine out, but I am one of the few people with the money to do something.” The couple are worth some $89 billion (£69 billion).
Birth control, she soon discovered, was a fraught area. “In the Sixties and Seventies, horrible things happened around birth control. US aid in India was tied to sterilisation. It felt like a sinister plot to stop poor people breeding.”
This, she says, is completely different. “We are not trying to stop women having children, but choose when to have them and how many they want. This is not eugenics: it is about empowerment. Every two minutes a woman dies of pregnancy or childbirth-related complications. Whenever I went to a village in a developing country, everyone there would have a close relative who had died this way ... Why should women be forced to get pregnant over and over again if they know every time they or their baby may die?”
The statistics also showed that countries where birth control was easily available, such as Indonesia, made greater economic progress. “So then the mainly male leaders and finance ministers got interested and started coming up to me.”
She told them, “Allow women control over their bodies and they will make different choices that will affect not only their families but their communities and eventually their countries.”
Whenever overwhelmed by the thought of lecturing world leaders, she would think of the women she had met on her trips. “So many haunt my mind. There was a woman I met in Niger. She had endless children and she said, ‘Can’t you see, I have no plot of land, my husband keeps going off to the army ... If I have another child it’s not fair to the others. I won’t be able to feed them all. Some will starve.’ ”
Melinda must have encountered opposition from religious leaders? “I have met the leadership of the Muslim faith, and the Koran allows for family planning. There are just some misnomers at village level.” Once taught by nuns at the Ursuline Academy in Dallas, she admits, “It’s more of a problem with the Catholic faith. But the local priests can help. I have met priests who have seen a lot of HIV and Aids telling women and men that a condom is the right thing. At the highest level, they may still only believe in the rhythm method, but there we have to agree to disagree. In the US, 96 per cent of married Catholic women use contraceptives. It shouldn’t just be a rich Catholic’s privilege.”
Next on her wish list is better maternal health. “Once in Malawi I saw two babies on a warmer: one had been delivered in the clinic, the other on a muddy road. They were both beautiful, but one was slipping away in front of me and one would grow up. That’s devastating when you feel you could have helped.”
There are many reasons why women don’t reach clinics, she discovered. “They may not have transport or funding or the village may not approve of any intervention – often women are just told to keep pushing, even for 48 hours. You don’t need a big sterilised hospital; you just need a clinic and the option to have a C-section.”
Surely she must also be leading a crusade against female genital mutilation. On her first visit to Africa in 1993, when engaged to Bill (after graduating, she had joined Microsoft as a product manager and first met him at a trade event in New York in 1987), she went with friends on safari to Kenya. They were welcomed into a Masai village and, at the end, the men invited them, as an honour, to a female genital cutting ceremony. It was on this visit she realised that the couple needed to look beyond accumulating wealth and start dispensing it.
“I know a lot about FGM – it’s a vital social and cultural issue – and we must educate villages about the value of a girl,” she says. “But Bill and I decided we have to focus on saving lives. We can’t do everything.”
Nor will the Catholic girl become involved in the debate around abortion. “We need to bring as many people along with us as possible. We don’t want to spend the whole time caught up in controversies.”
There are even people, she says, who disagree with their desire to save lives. “I have been in forums with very intellectual people who will make the argument about not overpopulating the world. People used to have a couple of cocktails and sidle up to Bill and me and say, ‘Do we really want more babies?’ There is no point arguing with them. Instead, I say, ‘If you allow people to plan their families, they will bring down the number they have.’ ”
Equally irritating, for Melinda and Bill, are those who think aid is a waste of taxpayers’ money. “They tend to be the people also most worried about immigration, so I say to them, ‘Let’s make these investments so people can stay in their own countries.’ I have travelled an awful lot and I haven’t met a family yet that told me they want to get up on the high sea and cross the Mediterranean to come to Europe for a job unless they are desperate. They’d prefer to stay and get jobs near their families. Yes, you will get situations with dictators and conflicts, but you can stem many economic migrants.” She cites South Korea. “We pumped money in there and now they no longer need aid but give to other countries. There is a lightbulb that goes off in people when they realise investments don’t have to be for ever. People do begin to lift themselves up if they have the right push. So do countries.”
Nor should the British complain about 0.7 per cent of GDP being spent on aid, she suggests. “Britain is a world leader. This century we’ve cut child mortality in half and maternal mortality nearly in half, partly because of you. British people are so self-critical, but they should feel proud. Saving lives is not a bad thing to be good at.”
Which brings us to President Trump. “Ah,” she says. “I need to be careful here.” She must think he has been a disaster after he pledged to withhold federal funding for family planning services. “Well, it’s reignited women across the United States. Women are coming out in droves saying we need family planning, so that’s good. It’s ironic that we are educating people abroad about contraceptives and meanwhile it might go backwards in the US. But people are saying if you are for women, you can’t do this.”
She has talked about the issue to Trump, a conversation that sounds brief and which would have been fascinating to overhear. “I don’t think he is changing much,” is all she will say. Instead, she is trying to enlist the help of more billionaires, urging them to donate, as the US government steps back. “It would be great if others gave more. We need to help the rich see they can make a difference, either in their own backyard or globally.”
In the past Melinda hasn’t always called herself a feminist. “I am absolutely a feminist,” she says now. “To be a feminist is to be for all women, to empower them and give them the chance to make decisions – that is 100 per cent me. Bill has become more of a feminist having daughters, but his mother was always a very strong personality – she was on endless boards at a time when women weren’t on boards ... Our son is also a feminist. We have to educate our sons and husbands. America doesn’t have a good track record: fewer than 20 per cent of Congress are women and 5 per cent of CEOs.”
She refuses to feel any guilt about working. “But you have to re-enter sensitively. With my elder daughter, she hated me coming back in my business suit and just talking to Bill about what I had seen in Africa or Asia. She wanted to meet me by the door in the boot room, by the galoshes, and I would have to wear my mummy clothes, my jeans, and sit on the floor and read books to her. They need to know that at home I am just their mum.”
She laughs when I suggest it’s amazing Bill and her have stayed together so long – few billionaires do. “It’s hard to sustain a normal family life, but I started dating Bill when he was already in the public eye, so I saw the benefits and the downsides. We talked about our hopes and dreams when we got engaged [Bill first asked her out in a Microsoft car park and they’d dated for seven years before marrying in Hawaii in 1994] and I really thought about how I wanted to live, what it would be like to raise kids when their father was so well known all around the world.”
Melinda is obsessed by being normal in her very abnormal world. “I always used my maiden name, French, at school for weeks so mothers wouldn’t know who we were, and by the time they figured it out, they had realised we were like them. Now they protect us. My [younger] daughter is about to go to high school and I am already asking her to think about what she wants to tell her new friends.”
It can be awkward, she admits, having a house worth an estimated $100 million. “You don’t want friends to come over just because you are the one who has the swimming pool. We have a rule about no photos in the house. It’s our personal and private space.”
The family all feed and walk the dogs and tidy their rooms. “After dinner we do the dishes together. Dinnertime is vitally important: we all sit down, no cell phones. I don’t cook – I am terrible at it – so, yes, we have a cook.”
It is the first luxury she has admitted to. “I feel a bit bad having help, but it’s self-centred to worry. We do take a nicer vacation than others, but often it is to buy privacy. I also buy time. If I am not cooking that is two more hours of the day to spend with the family or the foundation.”
At dinner they chat about everything. “I am hopeful about my kids’ generation. They are less sexist, racist and gender-based. The 14-year-old is always talking about gender fluidity and keeping Bill and me on our toes. We’re not allowed to sound old-fashioned; they are not allowed to sound entitled.”
She is constantly in touch with the family during the day. “Do I nag? Not as much as they get older. They do their own homework now.” Bill is not allowed phones at the table either and he has to do the washing-up, even if Warren Buffett’s popped over to play bridge.
The children have pocket money. “They get a budget: anything they don’t spend I triple and put in their savings for charity.” She doesn’t want them to end up living off Gates’ money and the plan is to spend all the foundation’s $89 billion within 20 years of the couple’s deaths. “These huge disparities of wealth are not good. If you have $1 billion you don’t need all of it. You need to help equalise society.”
Few would argue with her, except perhaps her super-rich contemporaries who believe they made it thanks to their ingenuity and sweat. “But if you earned that much money you were lucky in some way. It’s not just about hard work,” she counters. “You grew up in the right country perhaps. Bill benefited from the stability and the infrastructure of America, and he was in the right place at the right time, so he ought to give something back. It’s only fair.”
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© The Times Magazine/News Syndication. 8 July 2017