In her quest to end poverty among women in developing countries, Melinda Gates has championed a slew of innovations that she sees as potentially life-altering. The co-founder of the Gates Foundation—a role she shares with her husband, the philanthropist and Microsoft c0-founder Bill Gates—has talked up cell phones for mobile banking and self-help groups as game-changers.
Her current focus, however, is on access to contraception.
On Tuesday, she and her husband addressed this topic in their foundation’s annual public letter, which this year was an open Valentine to fellow billionaire Warren Buffett. The legendary investor has long supported the couple’s philanthropic mission, so the Gates’ letter—which was written as a series of shareable snippets, alternating between a comment from “Bill” and one from “Melinda”—outlined to Buffett and the world what they’ve done with the roughly $30 billion endowment he pledged to the foundation in 2006.
Access to contraceptives was a prominent theme. The Gates Foundation is a key partner in Family Planning 2020, a coalition of nonprofits, researchers, private donors, and governments that aims to ensure that 120 million women in poor countries who do not have easy access to birth control methods will get that access by the end of the decade. It is not on track to hit its target, but Melinda Gates noted significant progress in that direction. “For the first time in history, more than 300 million women in developing countries are using modern methods of contraception,” she wrote. “It took decades to reach 200 million women. It has taken only another 13 years to reach 300 million—and the impact in saving lives is fantastic.”
The two went on to explain:
Bill: When women in developing countries space their births by at least three years, their babies are almost twice as likely to reach their first birthday. Over time, the ability of women to use contraceptives and space their pregnancies will become one of the largest contributors in cutting childhood deaths.
Warren, you’ve compared your philosophy of investing to Ted Williams’s science of hitting. Williams waits for the right pitch, and you wait for the right deal. This is the right deal, Warren. Like vaccines, contraceptives are one of the greatest lifesaving innovations in history.
Melinda: Contraceptives are also one of the greatest antipoverty innovations in history. When women are able to time and space their pregnancies, they are more likely to advance their education and earn an income—and they’re more likely to have healthy children.
Bill: They are also more likely to have a number of children they can support. This leads to fewer dependents that need government services, a growing workforce that includes more women, and more resources for sending children to school.
They’re referring to what economists call the demographic dividend—when a demographic bulge of working-age adults is supporting fewer dependents. It helps explain the link between low fertility rates and higher rates of wealth. Economists have debated for centuries, however, whether reduced fertility rates and smaller families lead to more wealth in a country, as the Gates argue, or if they’re actually the result a nation becoming richer and norms changing.
Recent studies seem to support the argument that family planning services should be in the mix of any development strategy. That’s what Steven Sinding, former director of the International Planned Parenthood Federation, determined after reviewing a body of research on the topic for an article published in the journal Philosophical Transactions of the Royal Society B in 2009. One paper he highlighted, published by the International Monetary Fund in 2006 and written by economists from the Harvard School of Public Health, examined birth rates and economic growth in South Korea, Korea, Taiwan, and Thailand. It found that countries can “cash in very profitably on the demographic bonus,” Sinding wrote, when they “incorporate strong and effective population policies within the broader context of social and economic development policies.”
A more recent paper, which appeared in The Lancet in 2012, and was co-authored by economists from the Harvard School of Public Health and Yale University, examined controlled trials of expanded access to family planning services in specific regions within Bangladesh and Ghana. Fertility rates were reduced, the researchers discovered, and, in the Bangladesh trial, women’s incomes were also found to be improved over the long term. Offering improved family planning services led to higher numbers of women working for pay and stronger economic growth on a macroeconomic level in both trials.
Despite such evidence, access to contraceptives has been restricted by religious prohibitions in parts of the world. The issue has been a political football in US and, and by extension—because of the role US aid plays in impoverished nations—the world. It hasn’t always been this way, however. As Catherine Rampell reminded readers of the Washington Post, funding family planning programs in pursuit of economic security was “a bipartisan no-brainer” as far back as Richard Nixon’s administration.
A no-brainer it remains, though giving girls and women access to contraceptives and reducing the birth rate in itself is not enough to eliminate poverty. Development efforts should include education and overall health care, both areas in which the Gates Foundation has done extensive work. Educating and empowering girls and women in particular has been shown to reduce birth rates and increase use of contraceptives, creating a virtuous circle.