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

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.