Q&A: Melinda Gates on the World’s Missing Data About Women

“What we don’t measure, we don’t work on.”

Businessweek Debrief: A Conversation with Melinda Gates

This year’s annual letter from the Gates Foundation takes a slightly different format: It’s written to Warren Buffett, who 10 years ago pledged $30 billion to the foundation.

Warren’s really inspired us. For years he’s written an annual letter for Berkshire Hathaway to talk to the shareholders about how he’s thinking about the business. Given that it’s the 10-year anniversary of his gift, we thought, let’s use that as a marker to really spend some time, Bill and I, reflecting on what we have accomplished, as if we’re trying to tell him what his return on investment has been. It ended up being a really good exercise for both of us.

We don’t normally think about foundation work as returning a value on investments.

One of the things that we realized is you feel a responsibility to give your own wealth thoughtfully. But boy, if it’s somebody else’s wealth, you really better do it in a very careful and thoughtful way. We do think about what’s the return on that and how many lives have been saved. Have we done it in the best possible way, the most efficient way, used the best partners? The other thing I’ll say, though, is Warren does say, “I don’t want you to be risk-free. You’re taking on society’s hardest problems. So take risks, swing for the fences.” We’ve had some failures along the way, and Warren’s been OK with that, because he knows we’re trying to move very difficult problems forward.

Photograph: Victoria Hely-Hutchinson for Bloomberg Businessweek

There’s a line right at the end of your letter that says, “The future will surprise the pessimists.”

Despite the things that people read in the headlines, the world is getting better. Poverty has been cut in half—in half—in 25 years. We talk about the fact that 122 million children are alive because of the malaria vaccine work that’s happened and bed nets getting out there. I travel to the developing world three times a year, and I’m out in remote, rural, dusty villages. Farmers are hooked up to markets; they’re having more income; they’re putting their kids in school. You have to look at the numbers, to rely on the facts, but it’s palpable when you’re out on the ground.

Still, it’s not getting better fast enough. Bill and I are impatient optimists. We want it to get better faster, and we see things we have in the U.S. that, if brought in the right way to these countries, people will take them up and use them.

You and Bill talk in the letter about going on safari in Africa 20 years ago. You saw children dying because they were poor, not because of any other factor—simply because they were poor—and you found that the most unjust thing you’d seen. You say that experience has defined your marriage and also your partnership ever since.

We don’t wake up a single day where we’re not talking or thinking or doing something about the foundation. Even when we’re on vacation at a beautiful beach somewhere in Hawaii, the foundation still comes up. One of us is probably reading a book, or we’ve seen something in the news, or we’re reading a report. Bill left Microsoft earlier than he’d told me he would when we first got married. He’d already said, “I’m going to do philanthropy, but I’ll do it when I’m in my 60s.” In fact, he left Microsoft eight years ago to devote his life, to devote his time, to this. [Bill Gates is 61.]

It’s reoriented our lives. We spend the most time on our family life and on the foundation. I think it constantly pulls at you. Are we putting our voices behind the things we most care about? Are we teaching our kids in the right way about the responsibility we feel that we have as a family? We’ve been so incredibly blessed and lucky to grow up in the United States and for Bill to start Microsoft. We’ve oriented our lives all around, basically, the foundation work.

I want to talk about one of the initiatives you’ve been a pretty fierce public advocate for, which is access to contraception and family planning. It remains politically sensitive. What do you see as the quickest ways to make further inroads in that battle?

I absolutely believe in universal access to contraceptives. When you can plan and space the births of children, they are healthier, and the woman’s healthier. She’s less likely to die in childbirth, and this is incredibly important in the developing world, because many women still die in childbirth. It’s a hallmark for the world that we have 300 million women who have access to contraceptives now in the developing world. There are still 200 million women asking us for them, and so what we need to do is give them options, lots of different options. They might decide that for a time, they’re going to use a contraceptive that’s short-acting, or they might decide eventually they want an implant. Many young girls in our own country are starting to use implants in their arms. Those are becoming very popular in the developing world, but we need to deliver them so women understand them and they have access to them if they choose to use them.

What are you seeing on the ground that’s working in that part of the fight?

There are two pieces of this. Making sure that women have access, that we fill the supply chain with all the types of contraceptives we have in the United States. It’s like they’re begging me for them. I met a woman named Sadie in Niger who said, “Why is it that clinic right there used to have contraceptives and they don’t anymore? Why can’t I get them? Why do I have to walk 10 kilometers in the heat to get them?”

On the other hand, there are women who say, “I might know about contraceptives, but my husband won’t let me use them.” Or maybe it’s a new idea to them. I’ve met women drawing water from a village well in Niger who have never heard of contraceptives. I then talked to an older group of women who had been using contraceptives in the same village. I said to them, “Hey, there are these young women who don’t know about contraceptives. How are they ever going to get the message? They don’t even come out of their homes very much except to go collect water.” They said, “Don’t worry. We talk. Women talk. We talk at the birth of children, we talk when we grind millet. We talk when we get together to wash clothes. We’ll talk to them, and we’ll tell them we use them and why we use them.”

The way to reach those women is in very culturally sensitive ways. For instance, the government in Niger has set up something called a husband school, where they first teach the men why their children will be healthier if they can space their births, and why their women are less likely to die in childbirth. Then they are able to go in and talk to the women, and then it does become a husband-and-wife decision.

In this annual letter, Bill and I talk about self-help groups. In India, there are 75 million women in self-help groups. Each is usually about 30 women who get together. The group gets just a little bit of education about maybe contraceptives, or about a new seed they can grow on their farm, where they get more yield. They then take those new tools up with the original information they got, they start to learn about all kinds of other things, and suddenly these women have their voice, and they start to have agency. They’ll tell you the way my mother-in-law treats me in my home is different from yours. The way my husband treats me is different. The way my sons treat me is different. I’ve met these groups where they’ve been meeting over two years, and they’ll say to me, “Do you know what I did? We took to the government a rape case in our village that needs to be tried.” That’s what women’s empowerment is. If you help get these groups formed and you start them with little bits of education, they eventually take it over, and boy, do they empower all the women around them. Because women talk.

Access to mobile phones and other forms of technological innovation has really boosted women’s ability to participate in the financial sector. Where can the most gain be made?

The poor are not welcomed at banks. They’ll tell you, if they get on the train or the bus, they have to spend the money to get on the train or the bus. They’ve got to travel to this city—they get robbed on the way, and then they get to the bank and they’re not welcome. Yet, I’ll be in a remote village where you wouldn’t think there was a mobile phone, I’ll be talking to a woman, and chickens will be running around, and all of a sudden, the phone in her pocket rings. We’re finding that when men, and particularly women, have access to mobile banking on their phones, they can save a dollar a day, two dollars a day. When she can start to save into a bank account, and it’s not in a tin can under their bed where a relative can come ask them for it, or it doesn’t get eaten by rats, when it’s in a mobile money account, then when it comes time for the school fees, she’s got money to put her kid in school. When there’s a drought, which happens a lot in Africa, or a food shortage, she’s got money to go buy food at the market. It’s transformative in these women’s lives.

We’ve heard talk about rolling back women’s access to contraception in the U.S., women’s access to family planning, clinics worldwide that take U.S. aid money that will no longer be able to give advice on abortion, access to family planning ...

I believe in universal access to contraceptives. I’m very open about that. The way this policy is being talked about this time would actually affect clinics that also give out HIV/AIDS drugs, tuberculosis drugs, malaria drugs. The U.S. gives to something called the Global Fund, which is for AIDS, tuberculosis, and malaria. Twenty million people are alive because of that fund. When I visit these very small clinics that the U.S. and the U.K. and France and Germany have all helped set up, and think that they won’t be there in a community anymore because of the way we’re going to implement a policy—wow, that doesn’t sound to me like the Americans we are and the value we have for life. That just doesn’t make sense to me.

What could be done to make that advocacy more clear? Will you be even more public about this?

In the U.S., less than 1 percent of Americans know that poverty has been cut in half in the past 25 years. We’re trying to get the messages out about that, so people understand that these investments that we make, that we ask our government to make, are making a profound difference in the developing world. If we want peace and security in the United States, making these investments in the developing world is what allows people to stay where they are. They want a better life in their own community. I would say to people, “If you care about these issues, call your senator and say, ‘I care about these foreign aid dollars continuing to be spent in the same way they have been in the past.’ ”

You and Bill have seen children die as you do this work. How are you able to compartmentalize that and keep looking at the broader picture? How does that experience affect you?

I try actually not to compartmentalize it. Out in Nigeria, I saw a young girl, Fatima, 3½ and very, very sick. Her mom was there with a 1-year-old in her arms. The dad was there. They’d taken out a loan to even get her to this clinic I was in. I had a few doctors traveling with me, and it looked to us that they’d given her the wrong diagnosis, but they were going to move her up to the next level of health care, which was the right thing to do. But the family was going to have to take out another loan to get her to this next clinic, if they could, and so her outlook was quite bleak.

I try to take time somewhere, before I come home and back to my busy life with three kids in Seattle, and process what I’ve seen, and realize the outlook for that little girl is very, very bleak. You have to take that in, as hard as it is, and you have to feel how heartbreaking it is. And then I try to use that in other places to fuel the work that we do, or to talk about a story like Fatima’s, so people know what I actually see and experience. There’s a thing we sometimes forget—that this care that we have for our children in the U.S. is exactly how people feel all over the world. Their child dying is as tragic to them as it would be to me if my child died, and we need to connect with that, because I think it’s in that connection that we then decide to take action.

The foundation has committed $80 million to collecting and analyzing data on women and girls. What are your ambitions in terms of harnessing big data to look at the gender gap?

What we don’t measure, we don’t work on. We haven’t measured women. A lot of the surveys we do, the great household surveys that are done across Africa every five years, they’re inadvertently biased against women. I’ll give you an example: They start by asking the man and woman who has income in the household, and as soon as he answers, they don’t even ask if there’s secondary income in the household. In Uganda, when they asked the woman, “Do you have income?” it turned out it added $700 million to their economy. They didn’t even know that women had this amount of money and were working.

Once we start to understand these things about women, then we will actually know how and where to act. Without good data, it’s very hard to act and to go and say to another government or a philanthropist, “Hey, we’ve put money into this issue for women. Do we know if we’re getting a return? I’m not certain.” If I can say to them, “I absolutely know I’ve gotten this many women signed up on mobile phones with this many bank accounts, and I’ve lifted this many women out of poverty,” then they say, “Wow. We want to invest in that, too.”

Photograph: Victoria Hely-Hutchinson for Bloomberg Businessweek

Are you surprised there’s still this absence of data about women and girls’ lives, not just in developing countries?

It always surprises me when we bump up against it. Even in the United States. A great example is women in technology. I have a computer science degree. At the time I graduated, in the 1980s, 37 percent of computer science degrees went to women. At the same time, in the late 1980s, law degrees and medical degrees were about the same. Now they’ve gone up. They’re almost at parity with men now, or slightly above. Women are now down to 18 percent of computer science degrees.

We know there’s this leaky pipeline. We lose young women and girls all the way from kindergarten through college and into the workforce, but nobody knows why, because we actually haven’t collected the data to even understand the problem.

We’re just now starting to collect that data to learn what can we actually do about it. That’s just in the United States, and yet if only 18 percent of computer science degrees are women, and even fewer minorities—blacks and Latinos—holy smokes, we don’t have a very diverse team at the table developing this technology that we’re all using. That’s a problem, and that’s a measurement problem.

Why do you think it’s gone from 37 percent to 18 percent?

Nobody knows for certain why it’s gone down, but I do think it was right around the time that games became very male-centric. The games changed, and all of a sudden women started dropping out of computer science in droves. When you start to get where women are dropping out, then it sort of propels itself, because the fewer women that are in, then when you go to university, there are very few role models. There are very few female professors or associate professors. You don’t look up now in the industry and say, “Wow, there are 50 women, I can tick off their names, who are doing great apps, or running this tech company, or doing that thing.” Without role models to look up to, women say, “Ooh, I’m not sure that’s for me.” We have a lot of pieces to fix, both telling girls at a young age that you can be great at math and science and computer science. And we have a lot of things to fix, I think, in high school and in college, but then, also, this role modeling.

You have these dropout points, these loss points everywhere along the way. One thing we know, for even young kids and middle schoolers—let’s say you send girls off to a computer camp, to coding camp, in the summer. They’re excited. They’re interested to go. They go. But if all the posters on the walls are males, and you ask girls after the camp how they felt about how they performed in camp, you get a much lower rating than if the posters on the wall are half female, half male, or if all the posters on the wall are female.

A girl doesn’t perceive she did as well if all she sees are male role models on the wall, so that’s just this one little thing that we can change.

You come from Dallas, a middle-class family. Your father worked quite hard to put four kids through college. You worked hard. How do you identify with people in this country who feel they’ve been left behind, that there’s this disconnect, that they don’t feel optimistic?

I think there absolutely is poverty in the U.S. We need to acknowledge that, and we need to acknowledge that some of these amazing government programs have helped, but we probably need to do more. Bill and I were out in rural Appalachia, in Kentucky, last year getting to talk to communities about poverty and what causes them to not have hope and what causes hope. We were in this amazing public school called Betsy Lane. The leaders in that school were telling those kids, “You can go to college.” And they were not only telling them, they were showing them how.

Education is the key. That is what we know lifts families up. My father was the first to go to college in his family. He was an engineer. He left New Orleans, went to Georgia, went to California, and eventually settled in Dallas. He thought that his four children should be college-going, and I got that message as young as I can remember. For all of my siblings and me, we had that vision and hope. And so around the United States, we need to make sure kids have great elementary schools, great high schools, and great options for college, whether it’s university or community college.

Is our education system equipped to prepare children for the modern workforce and for the jobs of the future?

The public school system in the United States is failing two-thirds of the kids. We know that only a third of the kids who go through our K-12 public education system are actually prepared to go on for a career and for life. Many of the kids get into college, but then so many of them drop out in freshman year, because they get into these remedial classes—they don’t have good enough algebra, they don’t have good enough writing skills—and they get discouraged. No, our system is not working properly to educate kids, even for the jobs of today, much less the jobs of 10 years from now. We should do something about that.

The foundation has had many successes. It’s also had struggles and failures. How frustrating are those challenges, and how much do they motivate you?

We’re trying to do very ambitious things. We’ve only ever eradicated one human disease, smallpox, and we’re trying to eradicate polio. Last year we thought we were on our way. It takes three years to certify [a place as] polio-free, and there were a few more cases in Nigeria in those very tough, remote areas, where there’s a lot of violence. And so that was a very sad day for us at the foundation, for Bill and for me, those sort of 72 hours you’re taking that in, and you think, “Oh, we thought we were there.”

We know how hard it is on the partners. They’re the ones who do that hard work in the field, the vaccinators who want it to be done, the villages who want it to be done. Then you pick yourself up, and you say, “OK, we’re going to lead on this, and it can be done.” We know it can. We know why these outbreaks happen. We’ve learned from that; we’ve learned from that setback. We learned what we have to do next. And so you pick yourself up, and then you lead. We’re still confident we’re going to get polio, and I think we’re hopeful, knock on wood somewhere, that this will be the last year with a case of polio.

We don’t have polio in the United States anymore. It’s crazy that a child living in the developing world still gets that disease. That shouldn’t be.

Some people would say that bringing it down to just 32 cases worldwide, as it was last year, would be enough—let’s divert this money elsewhere.

Let’s say we left it at, oh, 30 children a year, only 30 are going to get polio. What happens is polio spreads. So it would be 600 the next year, and it would be 8,000 the next year, and then we’d be back up at 20,000. I think you have to say even of the 30, it’s tragic for any one child to get that disease when it’s a needless disease, but it would spread. Disease spreads. The other thing is, yes, it’s costing a lot to get down to these last-to-zero cases, but eventually we will get to the place where we won’t have to spend on polio at all anymore.

You were a rising star at Microsoft before you got married. You left to raise your three children, and over the past 15 years you’ve taken an increasingly public profile in fighting for the causes you believe in. How much of a learning curve has it been for you?

I was dating Bill, so I certainly knew what a public life he had to live. I knew what that looked like, but then to actually live it was kind of a different thing. I think where it really hit me, though, was once we had children, because I had to really think about how to have a private family life where I could allow our values to be instilled in our children, and for them to grow up as normally as they possibly could, given the circumstances of the wealth. I spent a lot of years where I was purposely not out in public, because that was my chance to take them to an activity, get to know other parents, be in their school, where I’m just another mom.

Then as they grew older, and I started to really think about the values I was teaching them—and particularly talking to my girls—to use their voice in the world and to be strong women, I realized, well, I need to role model that. They saw me role modeling, working hard at the foundation; they saw me role modeling, doing lots of trips to the developing world. They knew I cared deeply about issues, because I would talk about them, we would talk about them as a family, with Bill and our son and our two daughters around the dinner table.

I think they’re old enough now, and they’re far enough along in their own lives, that I can take a more public role. And I should, because I started to realize that I could give voice to issues for women in the developing world that I was seeing and for whatever reason no one else was. I made a very conscious decision that I would start to be more public.

How much of your always pushing yourself comes from your upbringing?

I knew coming out of high school that I wanted to make a difference in the world. I really had this belief already, and maybe it had been instilled in me, I think, both by my parents and the nuns, these pretty liberal nuns who taught us in high school. I had this belief that one person could change the world, that any one act actually had a ripple effect. You don’t know how many people you touch. Yes, I was ambitious, and my parents gave me all the hope in the world that I could be anybody I wanted to be. They always said, “If you can get into a great college, you can light any dream you have. We see your potential.”

I certainly never thought this was the path it was going to take, but I like to go out and talk. I still talk to groups of young girls in middle school or high school, or sometimes in all-women’s groups, sometimes in mixed men and women’s groups, but to try and inspire people and have them realize that no matter how they give back, whether it’s in their own community, whether it’s working in a homeless shelter, they make a difference in somebody’s life. That helps give meaning to our lives.

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