Published in POLITICO
With one speech about family planning in the developing world, Melinda Gates appears to have injected the world’s largest charitable foundation into the domestic fight over contraception.
Her words in a speech last week are being cheered by some public health advocates, who fear that the recent politicization of contraception in the United States could affect global policy. In many parts of the world, they say, access to family planning is vital to saving lives and alleviating poverty.
But by speaking out in the way she did, Gates risks creating friction with the opponents of the Obama administration’s contraception coverage mandate — including the United States Conference for Catholic Bishops — who have escalated the contraception fight in the first place.
“I’d like to talk to you about a totally uncontroversial idea … which unfortunately has become incredibly controversial,” Gates said in an April 5 speech at a Berlin conference co-sponsored by the Bill and Melinda Gates Foundation and the nonprofit idea incubator TED. “My idea is this: All these men and women should be free to decide whether they do, or do not, want to conceive a child. And they should be able to use one of these birth control methods to act on their decision.”
Gates Foundation spokesman Chris Williams said Gates was simply reiterating her long-standing support for family planning, and that viewing these remarks in light of domestic politics would be “using the wrong lens.”
But multiple global health experts heard her comments as an intentional effort to push back on the politicization of birth control in the United States following the Obama administration’s new contraception coverage policy, which they fear could spill over into global health policy.
“For better or for worse, the president’s handling of the contraception issue has really ignited a much bigger conversation that Melinda has now taken global,” said Tom Sheridan, a long-time political strategist who cut his teeth in the HIV/AIDS movement and has more recently represented clients including Bono’s ONE Campaign and Catholic Charities USA.
The politically cautious foundation is taking “a step into the advocacy space,” Sheridan added, because “the debate that we’ve had on contraception [in the United States] driven by incredibly right-wing bishops put everybody’s teeth on edge.”
The United States Conference for Catholic Bishops isn’t thrilled by the Gates speech.
Sister Mary Ann Walsh, spokeswoman for the bishops, said in an email that while the church supports “natural family planning,” she lamented that “the U.S. government sends much of its family planning aid to groups that promote abortion or that support coercive programs; domestically, the administration wants to force all women to accept contraceptive coverage or lose their health coverage altogether.”
“If the Gates Foundation wants to join with us in fighting these trends, we will have common ground,” Walsh said.
Gates’s speech was primarily focused on explaining why family planning is important in the developing world. Expanding access to contraception, she said, is “a life and death crisis” because “100,000 women who don’t want to be pregnant die in childbirth” each year and 600,000 unwanted babies die in their first month of life.
But in making this case, she went out of her way to push back on opposition to birth control in the Catholic church, describing the importance of contraception in her own life as a Catholic woman. Without it, she said, she would not have been able to launch her career at Microsoft before having her three children.
“In the tradition of the great Catholic scholars, the nuns” who taught Gates at Ursuline Academy high school “taught us to question received teachings,” she said. “One of the teachings most of my classmates and I questioned was the one saying that birth control is a sin.”
To a domestic audience, this sounded like a rebuttal to the bishops’ ongoing campaign against the Obama administration’s new rule requiring contraception coverage for employees — and a message to the politicians who have taken up the bishops’ cause.
“What Melinda Gates is saying from Berlin, interestingly, is speaking to the … members of Congress who are out of touch with reality in terms of the importance of contraception in women’s lives here and the rest of the world,” said Guttmacher Institute Director of Government Affairs Susan Cohen. “She’s also trying to communicate to the rest of the world that notwithstanding about what they may be reading in the newspapers, [birth control] is not controversial among American women or American men.”
TED is amplifying Gates’s message with an online campaign under the “#nocontroversy” hashtag, soliciting personal stories about the importance of contraception on Twitter and through a website.
Catholic opposition to birth control in global health policy is nothing new, said Jennifer Kates, vice president and director of global health and HIV policy for the Kaiser Family Foundation. But the new attention the issue is getting domestically is causing increased concern that “it could impede the global response” to health threats abroad.
That is why Gates’s comments are so important, Kates said. The Gates Foundation gave out almost $1.5 billion in grants in 2010, a larger contribution to global health than made by some governments.
“It was a decision by her and the foundation that this was such an important public health issue … [that] she wanted to elevate the discussion,” Kates said. “When they decide to speak about something … it is noticed.”