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The billion-dollar campaign to persuade poor women they need contraception

Hundreds of millions of women apparently have an ‘unmet need’ for contraception. The concept is vague at best

By on Monday, 16 July 2012

David Cameron and Melinda Gates at the summit on family planning last week (Photo: PA)

David Cameron and Melinda Gates at the summit on family planning last week (Photo: PA)

I have blogged about Melinda Gates before. Wife of billionaire and philanthropist Bill Gates, she was in London last week to host a family planning summit for global leaders which, according to the Daily Telegraph, “would deliver safe contraception to 120 million women and girls in developing countries”. So far, several European countries between them have donated $2.6 billion to meet the “unmet need” of these Third World women. The medical journal the Lancet argues that the figure of those “in need” of contraception is actually 220 million; still, to reach 120 million of them sounds an impressive target.

It all sounds sensible, deserving and straightforward – and who would not wish to applaud a very rich woman who chooses to spend her leisure time working hard to alleviate poverty rather than on a sun bed? But “unmet need” is a worrying concept, as an article by Michael Cook at MercatorNet has pointed out. Indeed, it is a meaningless phrase, according to Lant Pritchett, a professor at Harvard’s Kennedy School of Government, who has been in correspondence with Cook on the subject. Apparently the phrase “unmet demand” was invented by the first family planning surveys of the 1960s and was echoed at the Cairo Conference of 1994 which stated: “Government goals for family planning should be defined in terms of unmet needs for information and services.” Analysing the word “unmet”, Pritchett suggests it is too vague to be useful. Even the World Bank acknowledges that “women with unmet need may still not have any intention to use contraception were it readily accessible and of good quality”. This is because Melinda Gates’ targeted millions will inevitably include women who do know about contraceptives and who can access them, but who might be worried about the side effects, or have religious objections or have husbands working away from home. It seems that even Africa’s 65,000 Catholic nuns fit the description of “unmet need”.

Pritchett adds that decades ago an enthusiast of the family planning movement, Charles Westoff, highlighted the same criticisms of “unmet need” – but the movement, and now its latest proponent, Melinda Gates, still cling to it doggedly. Perhaps this is because of its emotive connotations rather than any rational meaning? I raised the theme of this blog yesterday with someone whom I guessed would not be entirely sympathetic to arguments against Mrs Gates’s crusade. He immediately prefaced his challenge to me with “Let’s face it”; this was followed by “You must agree that”; and concluding with “Do you want millions of babies in Third World countries to die unnecessarily?” It shows how very hard it is to think and argue clearly when emotions are running high.

Cook’s article relates how Professor Pritchett wrote a paper in 1996, following the Cairo Conference, in which he pointed out that in comparison “to the need for food, water, medical care and fuel, the need for contraception was very small in poor countries”. The phrase “unmet need” is also patronising for women: how can they need something that they do not want? Pritchett comments: “It is precisely this disrespect for women and their autonomy and choices that led to the disasters in India and China.” If poor women do not recognise their “unmet need” for contraception, the consequence is that they have to be instructed, persuaded, badgered, threatened and even coerced into compliance. There is a dark side to this seeming philanthropic activity of Melinda Gates that is not discussed at all.

  • L Obrien1

    Firstly Esnofla (pretty name) – Greetings from England!

    England – the place that founded the basis of American culture – using (or misusing) our language, and as you attempted to discredit earlier, used as an exemplary example of modern society.

    If I didn’t feel so sorry for you, I would almost be offended at the lack of eduction and knowledge of the world you and I live in.

    Are you seriously suggesting that England has a higher crime and murder rate than America? Is the U.S not the place where people originate from Hick towns with a brain disorder and are allowed to purchase a gun?

    I think you’ll find that if you left your God-filled, 90 person populated town and discovered America for what is really is, you would cease to have such an unfounded hatred of England.

    Anyway Catholicism is outdated – as we grow as a race we discover that we can live in a world where we are not used as objects for men’s amusement, we don’t have to marry and we can enjoy the pleasures of sex without bearing an unwanted child. 

    I think that while religion is everybody’s choice – which I am perfectly happy to accept – Catholics are still promoting the same outdated views which were designed to control the behaviour of a society, not a little set of rules that god remembered to create after the tiresome challenge of creating all we know in 7 days!ha

    Within the Catholic church you have widely publicised deviant sexual practices involving vulnerable people who are unable to object – which you should address before you promote your sexual views to the world  -on hearing a few English statistics you have deemed us all low-life wasters…If i were to make the same judgements based solely on the catholic church i would deem Catholics sexual deviants with little to no tolerance for choice.

    Enjoy Mass – I’ll be drinking alcohol, handing out free condoms and reading more about the Higgs boson particle…pray for me :-)

  • L Obrien1

    What an angry, unsure person you are Esnofla – you’d be better to direct this tirade of nothingness toward supporting a worthy cause somewhere. 

    That is if you would prefer to spend your time constructively rather than spitting your nasty, venomous views across the web.

    I’d suggest you ask your ‘friends’ to pray for you.

  • JByrne24

    Well-said Laura and an excellent response to Ms Phillips’ rambling article. 

  • Jneyhart232

    You are looking at this from the view of society instead of individuals, and you are incredibly stupid and inaccurate. Women deserve the opportunity as individuals to choose what happens to their bodies. Any “sane” woman wants financial stability. They want time to themselves and the opportunity to give their children as much as possible. Having more and more children decreases the effects of all of these things. Have you ever even been to Africa? Many people don’t have toilets or clean water. They want more. You ignore the effect of a lack of education on society, which in many African countries must be paid for, resulting in no education for many. Your views are ignorant to say the least. 

  • Jneyhart232

    You are an idiot. Children are only valuable to a nation if the nation has the resources to invest in them, providing health services and an education. Do you think that happens in these places? I have been there so I will tell you: they don’t. No one is projecting any views. They are offering an option. True, a demographic meltdown may happen eventually. However, it will not effect the terrible standards of living currently in place. Invest in these women now so they can invest in their children. At least then, if a demographic meltdown occurs, they will have some decent standard of living to lose.

  • Julibee99

    EFFECTS OF AN AGEING SOCIETY ARE NEGLIGENT HERE! Some of these people live in shacks and drink the same water their animals poop in (I have actually witness this). Ms. Gates is offering these women an option that THEY HAVE REQUESTED. Yes, children are valuable. However, they are only valuable to a society if they are healthy and have an education. If they have no opportunities, then young people rebel against their awful standard of living (EGYPT, SYRIA). Fewer children with more opportunities (because their families have more resources to invest) is the best option RIGHT NOW. And seriously, get over your “natural methods.” If God honestly didn’t think women should have (what “artificial”?) contraception, it wouldn’t have been invented.

  • Julibee99

    But it doesn’t make your period any more bearable. I consider myself a decent Catholic, but you can pry my birth control pills from my cold, dead fingers.

  • Julibee99

    Sorry, I accidentally liked your post. How do you expect people to pay for the services you propose? Perhaps, if they had fewer children, they would have more resources to obtain them and invest them in those fewer children. Perhaps, with more education, they could modernize their economies and improve productivity. Perhaps, these wealthier people could support their ageing families. Population bulges of young people with crappy standards of living are a liability, not an asset. I direct your attention to the Arab Spring.

  • Jln232

    1. Why are you preaching your Catholic morals to the African people? Many are not Catholic so why should they listen? 
    2. Also, have you actually studied HIV in Thailand? Because their HIV rates are WAY below projections because of those same policies you dislike. 
    3. In response to your comment that small families lead to social stability, I agree. But youth bulges definitely don’t. Seriously, has no one noticed Pakistan, Syria, and Egypt? What went wrong? Tons of poor young men. 
    4. Also, the chances of more education and resources for these large families increase if perhaps, they were smaller.
    5. You are right that this is about abolishing the world’s poor. However, it will accomplish this by allowing fewer people in a smaller generation to get their hands on more resources.
    6. In response to your accusation of men, did it occur to you that this access to contraception will allow women to thwart their evil manipulators who are keeping them barefoot and pregnant.
    7. People don’t say we Catholics are evil for the pope’s (and your) draconian views on contraception. It’s more about the history of violence, corruption, and the pedophile priests. Fight for change in the church before supporting these views.
    8. “Health concerns”? Really. Look at the number of children dying of starvation and women dying in childbirth in these regions. Those numbers cannot be manipulated. Then, you can sarcastically comment that contraception couldn’t decrease these DEATHS. Nitwit.

  • Jneyhart232

    Really? Anyone with an STD should just permanently abstain. What if they don’t know (which most don’t)? As long as they as are as careful as possible and upfront and honest with partners, these people have every right to seek pleasure as everyone else. Your views on that are naive and unfair. Also, pregnancy is possible at any time. However, forms of birth control (that Ms. Gates wants to provide) are as much as 99% effective. THAT is the truth and THAT would reduce that 62% of abortions.

  • Jln232

    If a family has two kids, it can spend more money on each child. Public education IS NOT FREE in many of these countries. With fewer children, not only could parents feed them both better, they could educate them too. More of these children would survive with these resources, and if you haven’t noticed, health an education are critical to any society. Besides, Ms. Gates wants to offer them an option (that women asked from her), not grind up the pill and put in their drinking water. Not to mention, your “horrible result” is idiotic. Women should have the choice of not having children if they don’t want them.

  • Jln232

    contraception is part of better healthcare. this isn’t projecting views. it’s offering an option. and some of the moronic comments (which I am soooo ashamed to associate myself with as a Catholic) deserve nothing less than patronizing answers.

  • Julibee99

    Would you call Pakistan godless? Of course not, and they are doing quite well (at killing each other). Why? All the poor young men. 
    And are you saying we should take food and education away from children? If so, you make an excellent Catholic. 
    Also, all of those things are also happening in the developing world already. Nothing will change except to give these people more resources to invest in these same teens.

  • Jneyhart232

    Well why don’t we focus on helping people avoid those pregnancies so no one gets “killed”? Is that perhaps too reasonable?

  • http://twitter.com/LaCatholicState la catholic state

    Contraception has one aim only and it has nothing to do with health.  It’s aim is to reduce the number of children in existence.  Anything else is just a decoy. 

    And if Ms Gates is so worried about women’s health….don’t you think she would spend her money opening health clinics specialising in the care of pregnant women and newborn children..

  • Jneyhart232

    But it does not make my period any better. Take five years off my life, and I’ll keep my hormones. What do cramps, discomfort, and losing iron do to women in these countries who do manual labor all day? Hormonal birth control is no riskier than too many pregnancies, menstrual problems, etc. And while I applaud NFP for anyone who wants it, I respect those the desires of those who are not morally opposed to “artificial” bc, and I would like to see them receive it.

  • http://twitter.com/LaCatholicState la catholic state

    So how exactly does less children make for better housing and living conditions?!  They don’t.  Development and trade will help with these….plus a growing population will provide a growing market and labour source.

    Development and trade is the key.  Not contraception which has nothing to offer the poor….except more poverty and loneliness in old age.

  • Julibee99

    Soda has chemicals. As does plastic. Should we get rid of them? And where is your and her scientific support for what is good for women’s health? Are there comparisons of the effects of heavy periods during manual labor and Napo? Women should be able to choose how to empower themselves, and who is she to talk about the relationships between spouses that she doesn’t know in circumstances she clearly doesn’t understand? 

  • Julibee99

    You are right. There are no jails. Its the reason we have priests running around and raping children. You are also right that the Church (no longer) has taxes. But it doesn’t pay them either, although it takes money from those who do not agree with it. Not to mention, a considerable amount of that government money does actually go back into the people. You know, when we get things like roads. I don’t disagree that gov’t is essentially corrupt and inefficient. The church is just no better. 

  • Jln232

    You know for all the time that a lot of people have spent on this site commenting about imposing Western views on other people, that sounds exactly what she is doing. “much better deal for women…” Where are statistics? Has she asked these women that she refers to what they actually want? Melinda Gates has.

  • Jln232

    WHERE WILL THIS MONEY FOR THESE WONDERFUL RESOURCES COME FROM? An educated workforce. HOW WILL THEY GET AN EDUCATED WORKFORCE? They will increase the resources invested in their children. WHY? They will have less children to invest in. These women are being given an option. They have the choice. You wanting to deny them that is what smacks of imperialistic condescension and paternalism to me. 

  • Julibee99

    Have you ever been to Africa? I would say no for you to spout such B.S. You know how to solve long term problems? EDUCATE THE PEOPLE. You want to know how to educate the people? GIVE THEM MORE RESOURCES. And what makes this possible? WHEN THERE ARE LESS. Also, in Ghana there is a church above the former slave castle that you speak of. The prisoners would lie in their own filth with little food or water in the stifling heat waiting to be shipped out and listen to the priests above. Not to mention, Africans sold fellow Africans. Be fair in your condemnations. 

  • Jneyhart232

    How many countries has condom promotion led to a drop in HIV infections? I’m not an expert, but Thailand is at least one. Besides, this is about contraception FOR WOMEN, not just condoms.

  • Jneyhart232

    Or we can use the money for birth control and allow the people to invest the newly freed up resources in all of these things. That might give people some real choices and some real money.

  • Dawnfirebird

     Oh come on Laura, which country of the so-called ‘developing wold’ were you in? That horrible western blanket statement that covers a multiplicity of sins and disordered projects that mean nothing, go nowhere and serve nobody. Enough! Laura, enough! You and your ilk constantly and everlastingly speaking for women like me, African, and belonging to my land and continent in a way that you will never know, or understand, no matter how long you stay. Your lot never bother to ask us if we have an opinion about our destinies, you never care to wonder what life means for us. You assume that your standards are the elixir of meaning. You never notice that so often we pity you and your sort who in order to find meaning impose themselves upon our lives. The worst thing is that you purport to speak for us, decide for us, contemplate our genitals, wombs, the dreams we have for our children. Life, Laura, life, we are an old enough land to know deeply what life means, and it is not a reduction into small dollars, it is not a pretense that we do not have our ways of contracepting, natural ways. But you would never know this would you, because you never asked, you never cared to wonder that perhaps we might have thoughts of our own, or even a sense of our deepest and most profound dignity.

    I am glad you have gone away from whichever gracious land had accommodated you.

  • dawnfirebird

    How ever does contraception resolve the problem of AIDS? And if so, why is the great solution not rigorously applied to European countries where the crisis of AIDS has been forced underground, and those who suffer it dare not show their faces? Actually, if contraceptives solves the tragedy of AIDS perhaps it can also resolve the crisis of malaria, cancer, and Parkinson’s?

    Do you not notice that these puerile and nasty solutions are always targeted at brown and black people who it is assumed can neither make up their minds, nor think, and are in constant need of wise white folks to show them the way? That kind of nonsense would not be permitted in your white societies, why is it ‘ok’ when it is spewed with reference to Africa (in your minds, a country)?

    Melinda calls to mind her ancestors, the kind of white missionary and trade who stimulated, and encouraged the extermination of indigenous populations in the countries they had invaded, and justified everything in self praising chronicles in which they situated themselves under the banner of righteousness and that gross Anglo-Saxon habit of worthiness. Worthiness hides a multitude of sins, including the genocide of a people who do not look like one.