It’s hard to talk about women’s health worldwide without talking about birth control, but somehow, when the first Women Deliver conference convened in London in 2007, that’s largely what happened. At the time, support for international contraceptive programs had dried up for a number of reasons, including the urgency of the AIDS crisis and the hostility of the George W. Bush administration. Some feminist groups, meanwhile, shied away from anything that might smack of population control. And so while Women Deliver, a major global gathering devoted to reproductive health, helped draw attention to the scandalous level of maternal mortality in the developing world, it ended up sidelining one of the most important tools we have to address it. When it came to family planning, no one was taking the lead.
At this year’s Women Deliver conference in Kuala Lumpur, Malaysia, it’s clear that there’s been a huge change. In session after session at the largest international conference on women and girls in a decade, speakers from all over the world affirmed the need for universal access to birth control, and spoke excitedly of new programs to provide it. “The machinery of international family planning had been in a relatively low gear and now is ramping up again,” says Karl Hofmann, president of Population Services International, a group that distributes reproductive health supplies worldwide. “We feel more wind in our sails, and I think other organizations like ours do too.”
There are several reasons that things look so different today, but a major one is the work of Melinda Gates. A year ago, Gates, co-chair, with her husband, Bill, of the world’s largest philanthropy, decided to devote herself to getting family planning back on the global agenda. As she told me then, the intense politicization around the issue had created “a glaring hole. Nobody was working really in a united way on contraception.”
Last July the Gates Foundation helped convene a summit in London where international leaders pledged $2.6 billion to provide 120 million women and girls with access to contraception by 2012. “Now there’s huge momentum,” says Poonam Muttreja, executive director of the Population Foundation of India. “I think we can give a lot of credit to the Gates Foundation for taking leadership.”
It also helps that some of the biggest obstacles have fallen away. Not only is Bush long gone from the White House, in what seems a sign of the times, his daughter Barbara P. Bush spoke at the summit. “If we can ensure that young people right now have access to reproductive health, family planning, [and] education … we really can leverage young people to be drivers of economic growth,” she said. The founder of an international volunteer organization called Global Health Corps, she also serves on the board of Population Services International. She declined to speak about her policy differences with her father, but while his administration restricted access to reproductive health care, she’s working on the ground to expand it. According to Hofmann, in countries including Burundi, Bush’s volunteers augment Population Services International’s programs.
“I think she’s from a generation where maybe it’s a little bit easier to address some of these issues without all the stigma,” says Hofmann. If so, it suggests things are coming full circle. Before the rise of the religious right, her grandfather, George H.W. Bush, was such an ardent proponent of birth control that he was nicknamed “rubbers,” though he reversed his support for family planning when he joined Ronald Reagan’s ticket.
It’s not just in the United States where the opponents of family-planning programs are in retreat. It was particularly heartening to see the Filipino Secretary of Health Enrique Ona speak, given the fact that, until recently, the country’s administration has aligned with the Catholic Church against reproductive rights. Another speaker from the Philippines, Sen. Pia Cayetano, told me that in her village growing up, you needed a prescription even to buy condoms, and some municipalities banned birth control altogether. But in 2010 a president who supports expanded access to family planning was elected, and in December Cayetano managed to pass a historic bill to create a national reproductive health program, though it has been stayed pending a Supreme Court challenge.
As Cayetano walked around the convention center where Women Deliver was held, people stopped her to shake her hand; shortly after we spoke, she was to receive an award from Melinda Gates. A noted triathlete, Cayetano likened attending the conference to carbo-loading before a long race. “These are women who understand what I’m going through, who understand my fight,” she says. “I get tired too. This renews my energy.”