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SRHR Situation Report: Gates Foundation and Setting the Global Agenda

June 14, 2010

The Sexual and Reproductive Rights Situation Report is a monthly column devoted to international policy issues and current events around these critical rights.

At last week’s Women Deliver conference (covered by Gender Across Borders), Melinda Gates announced that the Bill and Melinda Gates Foundation would devote $1.5 billion to maternal and child health over the next five years.  They will not, however, fund abortion services.  Gates said in her remarks that she couldn’t imagine being denied the “basic right to decide how many children to have.” she also said that the Gates Foundation would focus it’s efforts “upstream,” explaining that with proper family planning abortion will not be necessary.  I don’t even think I have to address that little doozy, but if you’re interested, Columbia’s Gender and Sexuality Law Blog does a good job of taking on the problematic nature of that reasoning.

The Women Deliver Conference is part of  a swelling tide of awareness about maternal health.  Access to safe abortion is one of Women Deliver’s “Three Core Strategies to Save Lives.”  In the broader conversation, however, there is rarely an explicit recognition of the role of unsafe abortion in maternal mortality.  Because of the politicization of a public health issue, a major factor contributing to the deaths of hundreds of thousands of women every year is swept under the rug.  As The Lancet’s editor, Dr. Richard Horton, pointed out in response to the Gates Foundation’s pledge, “unsafe abortion contributes to one in seven maternal deaths across the world.”  Sadly, international donors are being allowed to turn  their faces from the issue because it is politically difficult.

The Gates Foundation’s decision not to fund abortion services goes beyond the simple failure to address a critical component of sexual and reproductive health.  The Gates Foundation, like US AID, is powerful and big enough to influence the global agenda.  If agencies that provide abortion services cannot get funding from a major funding body like US AID, some are forced to stop providing abortions so that they won’t be forced to close their doors.  This impacts the shape of the global health infrastructure by shoring up certain areas and allowing others to fall to the wayside.

This announcement is being called a “change in direction from funding specific vaccines and the fight against particular diseases,” specifically HIV/AIDS, tuberculosis and Malaria.  Several years ago, the Gates Foundation made a strategic decision to change their focus from building human capacity in the health sector.  I was working for a Gates-funded fellowship program at the time, which brought mid-career reproductive health professionals to the University of Washington for a year of study and research.  The year I worked for the program, we were invited to the Gates Foundations offices to hear about the foundation’s new strategic direction.

They talked about focusing on technologies like vaccine delivery, especially given their roots in technology, as their value-added.  I felt sad that the fellowship would end, but only grasped over time the impact of the change in direction.  When a power-player like Gates focuses on a particular issue, the rest of the world has no choice but to get on board.  NGOs all over the globe have shifted their programmatic focus toward projects that will be funded.  And while the causality is arguable, the brain drain of health professionals continues to decimate many countries’ ability to respond to health crises like maternal death.  I have seen many organizations shift their focus to HIV/AIDS projects to the detriment of other program areas because of the tremendous quantities of money available through the Gates Foundation.  In the case of a foundation as big as Gates, there is no such thing as value-added; its game-changing.

Gates’ and others refusal to fund abortion services also serves to create a separate silo for abortion, removing it from it’s rightful spot as one part of the suite of necessary services that make up holistic sexual and reproductive health care.  By categorizing abortion as different and separate from other services like prenatal care and birth control, it’s naturally going to get cut out of strapped projects.  It’s like putting an abortion rider on your health insurance plan– it sounds OK in theory to have abortion services funded separately but in reality you end up with abortion services getting shoved off the agenda and out of the clinics, and women continuing to die from the effects unsafe abortion procedures.

These deaths are preventable (when performed properly abortion is one of the safest clinical procedures available).  These are women lost because the international community has allowed ideology to trump health.  With its size and budget, The Gates Foundation wields tremendous agenda-setting power in the realm of global health.  And by removing abortion services from its equation, it will cause a ripple effect that will create the conditions for even more wholly preventable deaths over the coming years.

Brook Elliott Buettner is a freelance human rights policy researcher and writer. More information and work is available at

  1. T. Elliott permalink
    June 14, 2010 3:09 pm

    I think the value of educating and getting the Gates Foundation on board is fairly obvious. Why isn’t this mentioned?

  2. Jessica Mack permalink
    June 18, 2010 2:08 pm

    Brook, I really agree with your assessment and this is a quandary that has troubled me for a long time. Having come from the Planned Parenthood world, outrage is my instant reaction whenever abortion gets left out of the conversation, especially when it’s about practical ways to address global maternal health. Everyone needs to know that unsafe abortion is one of the top causes of maternal death, and yet the only fully preventable one. It needs to be part of the discussion and addressing it has to be part of the solution. In fact, addressing it is the only chance we have at a “solution.”

    But I’m beginning to re-think my critique of major funders who don’t fund abortion access, crazy as that sounds. When we think about the big picture and the long-term goal, we will never get there if we remain at loggerheads about funding abortion and the sad truth is that there is no way we will ever get many people, funders and supporters alike, let along everyone, on board with the notion that abortion should be legal, safe, and affordable. If funders are willing to contribute to other really important interventions that are proven to address maternal mortality, and they are not standing in the way of others ensuring safe abortion access (a la global gag rule s*&t) then I *might* be OK with that. There is a LOT to do and fund in terms of addressing maternal health. If abortion continues to be the bug bear it is, we might never get to the other stuff.

    Short of compromising on the fact that access to abortion is part of an important set of rights a woman has to be healthy and in control, I think there might be room to compensate with donors who address issues variously. Thankfully, as I’m sure you know, there is another “very large anonymous donor” (VLAD) who funds safe abortion services copiously — sort of cancelling out in the karmic sense Gates’ shortcomings on this issue.

    So, while I do agree with you in theory, in practice, where the rubber needs to hit the road, I think abortion rights advocates need to start thinking outside the box just as I would ask anti-choice activists to start getting real and admitting that abortion is a reality for women everywhere, no matter what…and that it’s a medical procedure that should be legal and safe.


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