Tech + Health

06.05.14

A Plea To Melinda Gates: Stop Stigmatizing Abortion

The Gates Foundation is all about solutions that make the greatest impact on vulnerable populations. So why ignore the 68,000 women who die each year from unsafe abortions?

The Bill & Melinda Gates Foundation is the second-largest private foundation in the world. One of the foundation’s global priority areas is family planning. As Melinda Gates wrote in a recent blog post for the Foundation, “We should provide all women the information and tools to time and space their pregnancies in a safe and healthy way that works for them. This approach is simple, it works, and it saves lives.” All women—but note she doesn’t say all information and tools. Although according to the World Health Organization, unsafe abortion is one of the three leading causes of maternal mortality worldwide, the Gates Foundation refuses to fund access to abortion services. Why?

In her blog post, Melinda Gates was reflecting on her recent travels, including in Canada where the government has struck abortion coverage from its new maternal and child health program. Here’s what Gates wrote following that trip:

The question of abortion should be dealt with separately. But in the United States and around the world the emotional and personal debate about abortion is threatening to get in the way of the lifesaving consensus regarding basic family planning.

I understand why there is so much emotion, but conflating these issues will slow down progress for tens of millions of women. That is why when I get asked about my views on abortion, I say that, like everyone, I struggle with the issue, but I’ve decided not to engage on it publicly—and the Gates Foundation has decided not to fund abortion.

Look, a lot could be said to both praise the wonderful things the Gates Foundation does in the world. With over $3 billion in grantmaking annually to support college scholarships, malaria prevention, literacy and libraries and micro-lending, the Gates Foundation clearly has noble aspirations and many noble achievements. And yet whether it’s by funding the charter school movement that divests in public schools and public education infrastructure, or backing genetically modified seeds and crop efforts including reckless private corporations like Monsanto, the Gates Foundation has a history of promoting “market-based solutions” to injustices that are actually caused by the market’s inefficiencies and externalities. The Gates version of “philanthrocapitalism” has been widely scrutinized and critiqued (PDF) by foundation-watchers.

These are preventable deaths, deaths suffered by women and communities the Gates Foundation desperately wants to help and could help.

But in the case of family planning, the Gates Foundation’s funding has generally sought to get at the structural underpinnings of inequality that other philanthrocapitalism initiatives miss. According to its own documents (PDF), the Foundation supports basic education and outreach efforts to spread information about contraception and family-planning options, putting information and tools in the hands of a community’s women rather than trusting private entities to do the right thing on their behalf. And where it makes sense, the Foundation is engaging private partners to, for instance, make contraception techniques more effective and affordable and widely-available. So far, so good.

But what, then, about abortion? In its own materials, the Gates Foundation notes (PDF): “Less than 20 percent of women in sub-Saharan Africa and 34 percent of women in South Asia use modern contraceptives. As a result, each year, there are 75 million women in developing countries who experience unintended pregnancies; 20 million of whom resort to unsafe abortions.” In fact, as noted above, unsafe abortion is one of the leading three causes of maternal mortality worldwide. The Foundation continues: “It is estimated that providing these women with access to modern contraceptives would reduce maternal deaths by 25 percent, newborn deaths by 18 percent, and unintended pregnancies by 73 percent.” Wow, 73 percent would indeed be a massive reduction and a big help to women and families around the globe. Still, according to the foundation’s own numbers, 21 million women in developing countries would continue to experience unintended pregnancies and (assuming the proportion remains the same) 5.6 million women would still resort to unsafe abortions. What then, Melinda Gates?

Moreover, while providing access to abortion care is clearly a life-saving necessity in the communities whose lives the Gates Foundation is trying to save and improve, promoting abortion access reinforces reproductive choices and health in general. Making abortion safe, legal and affordable is a necessary part of a clear and consistent message to women and their communities that de-stigmatizes family planning and truly puts the power—and all options—in the hands of women. Anything short is a mixed message tinged with fear—that we only support your reproductive freedom if you don’t get pregnant. And sadly, it’s not just the Gates Foundation that stigmatizes abortion in the field of development philanthropy.

According to the World Health Organization, every eight minutes a woman dies somewhere in the developing world from complications arising from an unsafe abortion. These are preventable deaths, deaths suffered by women and communities the Gates Foundation desperately wants to help and could help—if Bill and Melinda Gates were willing to be part of solution in supporting practical access to safe abortion services, rather than part of the problem by perpetuating stigma and leaving only dangerous alternatives to prevail.