When her book “The Moment of Lift: How Empowering Women Changes the World” came out in April 2019, Melinda Gates could not have imagined how important the ideas in it would become in the wake of the COVID-19 outbreak. The pandemic cast systemic inequities facing women and people of color into newly sharp relief, as parents struggled to manage both full-time child care and full-time work, and women of color left the workforce in staggering numbers.

Gates wrote the book in what feels more and more like a very different world, but the ideas she raises in it provide a practical road map for rebuilding when the pandemic is over — and responding to the problems it has amplified. Here’s what she had to say about gaining back the progress COVID-19 has stunted, through policies that acknowledge the needs of women and their families. (This conversation has been edited for length.)

One of the things you map out in the book is that women are often doubling up on paid and unpaid labor, and work environments are often unsupportive of working parents, and as the pandemic has progressed, we’ve only seen this exacerbated. What are some of the things that you would like to see happen on a policy level that would improve these disparities?

Since I wrote the original book in 2019, we thought we were on our way in terms of gender equality in the world, but the pandemic has absolutely set that back in country after country, and in our own country. I’m sure you saw the jobs report in December — of the 140,000 jobs lost, they were all women’s jobs, and the majority were women of color, and so women have lost a million more jobs in the United States than men have [during the pandemic], and that’s really for two reasons. One, they are the ones who predominantly are in the low-wage jobs, those service jobs that have been shed from the economy with people not going out and getting the services they were using before.

And No. 2 is because of the burden of child care, and we’re finally seeing it in our homes; the pandemic has exposed it, so it’s right there in front of us. It’s always been there, though, as I say in my book, this burden of unpaid labor. And so to address it, we absolutely need at the federal level a paid family medical leave policy. We’re the only industrialized nation that doesn’t have it. Twenty-one percent of women have paid maternity leave in this country. That’s all — 21%. So it is well past time that we pass a paid family medical leave policy. I think now that legislators are seeing it in their own homes, now that we have more women in Congress, I think we have a far better chance than we did before.

And then during the pandemic, we need things like paid sick days, so that when somebody gets sick or their child gets sick, or a family member, they can take the time off from work, they can actually quarantine for 10 to 14 days. That has to be part of the next stimulus package. It was part of some of the early ones, but was not part of the latter ones. And to be frank, we need to deal with the elder care that’s going on in this country. We’ve got 800,000 elderly people sitting on the Medicare rolls who cannot find an elder care facility. And that’s got to be taken care of, too, because who’s taking care of not just the young but the old? It’s women. And it’s pushing them out of the labor force.

Another thing this connects to is your discussion about family planning and birth control. In your book, you described the attacks on birth control access that have happened in the United States. What kinds of policies would you like to see to restore that access?

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Around the world, there are over 200 million women that are asking us for contraceptives that don’t have access. Two hundred million. So I would like to see President-elect Biden’s administration rescind the Mexico [City Policy] that has gotten put back into place in the Republican administration, so that our foreign aid can flow more freely to contraceptives around the world. Because of the lack of contraceptives and the supply chains being broken during the pandemic, we’re forecasting 15 million unplanned pregnancies this year around the world. Every one of those pregnancies is a woman that then gets stuck in a cycle of poverty if she’s in a low-income country. And these women will tell you when you meet them, “I can’t have another child, I can’t feed the three or four that I’ve got, much less educate them.” So this is actually an emergency for those women.

One of your major philanthropic focuses is the need to make lifesaving vaccines available to children in developing countries. That’s something that’s going to be especially important with the implementation of the COVID-19 vaccine. What do you think should be considered as the vaccine is implemented among women and families in developing countries?

Well, I think in every country around the world, you start with health care workers everywhere, because they take care of everybody else. And worldwide, 70% of the health care workers are women. So you start there. And then you’ve got to get it out to the most vulnerable populations. But you do have to do special things to make sure that women know the vaccine is available. The good news is that in many of these low-income countries, women are used to taking their children for vaccines. In fact, we talk about vaccine hesitancy in our country, but when you go stand in a health care clinic line, and you talk to women, they’ll say to you, “I’ve got my child with me, it’s vaccine day,” and if you ask them why they’re getting vaccines, they look at you like there must be something wrong with you. They’re like, “Well, because my child will stay alive because they get these vaccines.”

In the book, you describe coming to the discovery that gender equity could be used as a strategy for fighting poverty in the developing world, and you acknowledge the pitfalls of global philanthropy more broadly. What are the things that you’ve learned about what helps and what hurts coming in as a Westerner?

First of all, there isn’t a single thing that a philanthropic organization is going to do that they won’t do in concert. If you’re going to do work and do it at scale, you have to do it within the ecosystem of understanding you’re just one player, and that it takes government to scale up things — big solutions. It takes the private sector — business — to come up with new innovations. Often they have to be stimulated to do that, because there isn’t a market there. And it takes civil society to call out what is right and what needs to get done.

I’ve also learned that we as Westerners can’t go in and tell someone, “This is the right tool for your country, or your community or your family or your body.” Nobody wants to hear that from somebody from another country. We have to go in with local partners who have the trust of those communities, understand the cultural context, are listening to the locals on what they need and want and build up trust, and when you do that, then people are willing to take up new information, just as we learn here in the United States about things, then we’re willing to take up new behavior changes or new policies. We change what we eat, we don’t smoke anymore in the rates that we used to, we put our kids in car seats because it’s safer, we wear seat belts.

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Do you have an example of a time when you’ve seen all of those pieces come together successfully?

I would say honestly it’s around vaccines, because around the time that we started the foundation and then began to get involved in vaccine systems, it was taking 20 to 25 years from when a vaccine would come out in the United States or in Europe until it would get to a country like Kenya or Tanzania or Bangladesh, and quite often by the time it got there, it didn’t have the right strains of what was needed in those countries. Now that time lag is down to one to one and a half years, and the right strains are in the vaccine.

As well, new vaccines have come out where there wasn’t a market before. The biggest predominant killer of children in the developing world was diarrhea and pneumonia, and we now have vaccines for rotavirus, which is the biggest diarrheal disease, and pneumococcus, which is the biggest pneumonia killer for children. And those vaccines have the right strains, and as soon as they come out in a place like the United States, they’re getting out [to other countries] very quickly. So that’s a success story. But it took the entire ecosystem working together.

And look, you’re seeing it with a COVID-19 vaccine. This vaccine has been created in rapid time, but it’s going through great regulatory systems called the FDA or the EU in Europe. And then it’s getting out in the U.S. Yes, it’s bumpy right now. But it’ll get better in the next 45 days. And hopefully in a year, you’ll start to see a lot more vaccine out in low- and middle-income countries as well.