The founder and director of the Bill & Melinda Gates Foundation spoke to Christabel Ligami on the organisation’s efforts to give more women access to contraception, especially in African countries.

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The Bill & Melinda Gates Foundation has announced an additional $120 million in funding over the next three years — a 25 per cent increase — for family planning programmes. This comes at a time reports say the world may not meet the Family Planning 2020 [FP2020] target to reach an additional 120 million women and girls with family planning services by 2020. Why is contraception for women crucial?

Giving women contraception is an important public health initiative that has become a life and death crisis. Contraceptives unlock one of the most dormant but potentially powerful assets in the development of women as decision-makers.

When women have the power to make choices about their families, they tend to decide precisely what demographers, economists and development experts recommend.

They invest in the long-term human capital of their families. Given that many women and babies die in labour in developing countries, access to contraceptives potentially means millions of lives saved around the world.

Statistics are telling: That up to 100,000 women die each year in child birth after unintended pregnancies, and 600,000 babies born to women who did not want to be pregnant die in the first month of life. Even if these babies survive, the family is forced to feed another mouth.

And in a world where more than 1.2 billion people live on less than $1 each day, another mouth will take away from the malnourished family every day. Also studies show that women who have knowledge about access to contraceptives have a higher quality of life than those who don’t. They are healthier, better educated and more prosperous than women who are not educated about birth control.

You are also keen on putting back family planning services for the youth on the development agenda. Why is that?

We have the largest number of youth of reproductive age in history and they need education to curb things like unintended pregnancy.

The biggest killer of young girls is death during childbirth.  In Africa, for example, we know that one in two girls gets married before the age of 18, and if she gets a baby between the ages of 15 and 19, she’s twice as likely to die.

A 15-year-old girl’s body is hardly ready to have a baby. Also, the young girl is unlikely to space the births of her children, her babies will have a lower birth weight and she’s twice as likely to die. This is why we must help them make the right decision on their reproductive health.

What was your motivation for launching the family planning initiative?

I have been travelling to developing countries for over a decade and I always try to take time to talk with women, to really understand what their lives are like.

My focus was around issues of vaccines, agriculture, poverty reduction but time and again, family planning came up. I started to realise that we had stepped away from family planning, as a world, we really weren’t giving women the option to plan their lives with the use of contraceptives, something we take for granted in the US and the UK.

And I really felt strongly that it was important to help our partners put that back on the agenda, because it saves women’s lives and it saves children’s lives.

What is your foundation doing for East African countries? 

East Africa is among the areas with the most family planning needs in Africa, and the foundation’s strategy is to increase the use of modern contraceptives, improve family planning services for the poor and find ways to integrate family planning into HIV and other health care initiatives.

We are already working with the East African countries on this and have seen results especially in Kenya and Uganda, where access to contraceptives has increased in the recent past. We are increasing funding by 25 per cent to boost our work in these countries but it is up to the countries tells us about the priorities and how we can help them achieve their needs. 

It has been 15 years since you started your foundation, what has been your biggest achievement?

The work in vaccines and immunisations has really been transformative in bringing down childhood deaths. The two biggest killers of children are diarrhoea and pneumonia. We now have new vaccines in those two areas whose creation we’ve been involved in their creation, bringing the prices down and trying to get the lag time down.

When we started, the lag time in getting a vaccine from the US to somewhere like Kenya was 20 to 25 years. That’s down now to one to three years. That’s something we’re incredibly proud of.

Do you think African countries will ever get anywhere close to the developed world in terms of child health and infectious diseases like malaria and polio?

In 15 years, we won’t be far enough along to make that switch. There will still be a lot of infectious disease. I’d say at the 30-year mark if things go well there’s a chance that this agenda will be largely done.

At that point we hope the rich world will have very, very effective tools for all sorts of disease and we see it as part of our mission to see that they get out to everybody in the world faster than the natural market mechanism would make them available.