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Family planning gets global Gates boost, but will it boost women’s health overall?

Today, in London, Melinda Gates and a few big guns in the British government did a much-needed and celebrated thing — getting billions of dollars from the international community to fund family planning services for some 120 million women and girls.

Yes, this is another one of those promises of foreign aid that rich countries seem to make all the time and then break later when you’re not paying attention. But it’s important to recognize they do keep some of these promises (see funding for AIDS, malaria and child vaccines over the past 10 years) and this one does appear to have momentum.

Improved access to contraception has been estimated to reduce maternal mortality by a third. Providing women with greater control over reproduction is widely regarded as fundamental to empowering women, and as a basic human rights issue. Finally, the public does seem a bit more worried about global population growth these days.

So this campaign — largely led by Melinda Gates, against her church — may indeed represent a significant turning point for family planning and for maternal health worldwide.

But the question some raise, usually those way in the back of the room without access to the microphone or TV cameras, is if this is actually good for women’s health overall.

As the Seattle Times’ Sandi Doughton reported, the new emphasis on family planning and maternal & child health also represents a shift of sorts for the Bill & Melinda Gates Foundation, a return to one of its original philanthropic goals — reducing global population growth.

Internally at the philanthropy, this is widely seen as a sign of Melinda’s rise in influence regarding the foundation’s overall mission and strategy.

Bill, though he shares the same goal of reducing inequity and diseases of poverty, is clearly much more interested in finding scientific and technical solutions to these problems. Melinda, in contrast, is not afraid to jump with both feet into messy problems like, well, reproductive health.

The original stab in this direction in the mid-to-late 1990s didn’t get too far, probably for two reasons:

  • First, rich white people in America need to be, uh, fairly ‘nuanced’ in how they call for population control in poor nations. The young and still forming Gates philanthropy at the time didn’t do nuance and got a rough reception when it started out exploring birth control as a primary philanthropic mission. This, and other things, helped shift the nascent Gates Foundation toward child’s health, vaccines and what came to be known as ‘global health.’
  • Secondly, back in the 1990s and into the early 2000s, Bill Gates was still viewed as a ruthless, scheming monopolist. In stunning contrast to the new public image of Bill as Humanitarian-in-Chief, almost everything he or his foundation did back then was considered suspect. Even donating computers to libraries got slammed, as “backdoor  marketing” of Microsoft software.

So, now, with a more nuanced and popular message maker, Melinda, the Gates Foundation has over the past few years shifted much more emphasis to improving maternal health.

A good thing, taken in isolation. But some women’s right advocates wonder:

Does the high-profile attention given to family planning, maternal health, as the new cause célèbre of global health send the wrong message — that the primary concern for women is their ability to make babies (or not), as opposed to women’s health overall?

I hear this grumbling often at meetings or press conferences held to promote reducing maternal mortality or improving women’s reproductive rights. Usually, the women (and they are almost always women) doing the grumbling feel a bit awkward about it — because they don’t want to look as if they are opposed to efforts to fight death in childbirth or family planning.

So they usually don’t say anything, or if they do offer the critique almost as an apology.

But I think it is actually a very important question, and one that should not be ignored.

One tragic example of the unintended consequences of emphasizing maternal health in isolation from health in general is illustrated in this (sorry, academic and wonky) series of reports on poor access to long-term HIV treatment for pregnant Kenyan women by Laura Ferguson at the London School of Hygiene and Tropical Medicine. As Ferguson says in a :

There is increasing concern about whether or not women diagnosed with HIV in pregnancy-related services access long-term HIV care and treatment services, but little is known about the factors affecting this.

Translated, what Ferguson is saying is that these Kenyan woman often fail to sign up for even brief courses of anti-HIV treatments aimed at preventing ‘mother-to-child transmission’ of HIV because they know that once they give birth they will no longer get the drugs. These programs are aimed at preventing the child from getting HIV, without providing for the mother long-term.

Global health causes often seem a bit like pushing on a balloon. Poke it in here, it bulges out over there.

Women do need improved access to family planning, to contraception services and empowering information. But will pushing in on this side of the balloon, the global health issue du jour, really work if the international community fails to adequately support other critical needs like AIDS prevention and treatment or just basic health system improvements?

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