This year, the Aspen Institute awarded Melinda Gates with its Public Service Award to honor her work with the Bill & Melinda Gates Foundation. At the Aspen Institute 33rd Annual Awards Dinner in November, she sat down with Walter Isaacson for a conversation on her work and the motivation behind it.
This conversation has been edited and condensed.
Walter Isaacson: Your work is grounded in other people. You go on “listening tours.” Explain to me what those are.
Melinda Gates: I’m in the developing world a minimum of three times a year. They just think I’m a woman from the West, and that I’m here to hear about their lives. I ask: Is there anything that they think the West should do to help them?
I always give at least half the time to listen to what they want to bring up. They’ll eventually, a lot of times, invite you into their home and tell you what their lives are about. The thing that I have come to learn is that whatever work you begin, you have to ground it culturally. If people don’t buy in, if they don’t agree, it’s just not going to stick.
You have to listen carefully. While we, for example, might want to talk about vaccines on behalf of the Foundation, they want to tell you about their lives and what they really need – where their hardships are. I listen carefully because it helps me inform the strategies of the Foundation. I’m a big believer in not just raw data and numbers, but also the stories and anecdotal data. If you mix both of those together, you know how to help people lift up and transform their own lives.
WI: What surprises you when you’re on a listening tour?
MG: What surprised me in the beginning was how connected we are. I meet mothers and fathers around the world. I think if I asked you what you care about, you’d probably talk about your kids. When I’m out in the field, they talk about their kids, too. They talk about the incredible lengths they go to and the investments they’re making to give their kids an education and get them out of poverty. They know what it’ll take and they’re ready to do it. When I ask about their hopes and dreams, they talk about their children. It’s unbelievable.
WI: The Bill and Melinda Gates Foundation works in contraceptive health. What about birth control? Did you have to wrestle with that decision?
MG: It took me almost two years to decide I was going to come out publicly on birth control. I kept looking for the leader who would come out and do it, and I knew it needed to be done.
There are 225 million women that are crying out to us for birth control. The pill, in the US, has been around now for more than 50 years. It’s what allowed women to have healthy timing and spacing for the birth of our children, and allowed us to go into the workforce or to get a college degree.
Women are asking us for this. I was out in the field talking about vaccines, and they were constantly asking me for birth control. In Africa, the predominant thing that they get is a shot every three months. It’s painful and intramuscular, but it’s covert so their husbands don’t know about it. They would say, “You’re asking me about shots for my children. I know about those, I care about them, and they’re in stock. But what about my shot? I go to that clinic, I walk ten kilometers, make up an excuse to leave my field, take my babies…”
It was a rallying cry. I looked at the data, and I knew that contraceptives were in stock, but not the type that women were telling me that they wanted.
That’s what happens when you listen. I kept wanting to turn away, to say, “No, let’s keep working on vaccines.” But eventually as I started to learn the history of this field – and how global health has backed away from contraceptives – I knew someone had to take it on. I couldn’t find that person. I kept looking for them. And I realized I had to step up and do it.
I have a deep Catholic faith, but I believe in life and in saving lives. If we can save mothers’ lives and children’s lives, we have to do that. If 93 percent of Catholic women in our own country use birth control, I think [increasing access] is the right thing to do.
WI: Tell me how a gender lens applies to your work.
MG: When I first got into philanthropy, I wanted to stay away from gender issues. I saw them as the soft things. I thought, “No, I’m a hardcore technologist. I believe in data.” But as you’re out there, you realize that women are the ones that are carrying the burden. The unpaid labor, the second shift at home. In the developing world, I see women coming up against these inequities over and over again, and we don’t collect the data to understand. The number – millions – of women who go unregistered at birth and at death around the world is huge. How can you ever get your property rights, your bank account, or have a cell phone?
When you empower a woman, she empowers everyone around her. She decides who eats in the house, who gets what. She’s the one in charge of the malaria medication, or for paying the school fees when they are due. We don’t invest at a huge scale in women. And I think that’s a really big mistake. Unless we collect the data and make the investments, we won’t change.
WI: In the philanthropy world, people aren’t necessarily saying, “Let’s collect the data.” How do you make science apply to philanthropy?
MG: How will Bill know if he’s at the “end game of polio” if he’s not getting a spreadsheet? How will I know, for reproductive health, if I’m actually fixing the supply chain in West Africa unless I have the data?
In places where we work, people go out with their cell phone and collect the data so I can know: Was the shot coerced? Was it voluntary? What tools was she talking about? Was it available?
The interesting thing that we’re finding is that there’s value in not only knowing the data, but in the women telling us the story of their lives. Women will tell you, “Nobody has asked my story. No one has ever cared enough about me to ask.” Sometimes the man of the house will turn the researcher away, and the woman will find a way to come out and say, “meet me at the well in an hour.”
Without that data we don’t know how to act. One of the things Bill and I are incredibly cognizant of is that our resources may look enormous to people. But truthfully, at the depth of the problems of our society, our resources are tiny. It takes governments to scale these programs up. I can’t call on the government to invest unless I know that I personally am willing to put down my dollars – and I won’t put down that money unless I have the data to know it’s a good investment. To know that I’m getting a return. And that’s why the data’s so important.