INTERVIEW By United Nations
United Nations Secretary-General Ban Ki-moon calls the efforts to achieve ‘Millennium Development Goals’ over the last 15 years “the most successful anti-poverty movement in history’. The final report on the goals says the number of people living in extreme poverty has declined by more than half, as has the death rate of children under five years old. Deaths of mothers in pregnancy and childbirth has dropped almost as much – by 45 percent. School enrollment is up. Gender inequality has diminished. But millions still live in poverty and hunger and die from preventable causes. Last week the UN General Assembly adopted ambitious new targets for the next 15 years – the Sustainable Development Goals – aimed at eliminating poverty and its ills.
Malaria is a good example of both a successful effort and the challenges still ahead. According to the United Nations, 6.2 million lives have been saved and 663 million cases prevented since 2000, with half the world’s countries now malaria free. But children still die from malaria at the rate of one a minute. What is required to completely eliminate the disease is the topic of a new report released by Bill Gates, Co-chair of the Bill & Melinda Gates Foundation, and Ray Chambers, the UN Secretary-General’s Special Envoy for Financing the Health Millennium Development Goals and for Malaria. The report says achieving a malaria-free world by 2020 would save 11 million lives and provide $2 trillion in economic benefits. Before traveling to New York for events connected with the UN General Assembly and the new global goals, Melinda Gates spoke to AllAfrica by phone from Seattle, where she is co-chair of the Bill & Melinda Gates Foundation. Acknowledging that more funding and greater commitment is needed, she gave examples of how and where progress can be accelerated and said, “One of the reasons I’m so optimistic about what can be done is because we have learned so much.”
We know that if a woman goes to a clinic with a skilled birth attendant to deliver her baby, her chances of surviving are so much higher. Her baby’s chances of surviving are much higher. We can decrease the number of newborn deaths – we think by three million! – just by having women come into facilities where there is a well-trained birth attendant.
There are still things we need to know [but] we know many, many things to do to save women and children, and we can apply those lessons. You take the mother’s blood pressure, for instance, so that she doesn’t suffer from hypertension as she goes through the birth process – basic things that we do all over the world in a good facility. We’re starting to see the number of facility births increase across all income groups. I’m particularly excited about that. That’s why we’re seeing progress.
The right food
Undernourished mothers are much more likely to give birth to underweight babies. Underweight babies are 25 percent more likely to die before the age of five. Making sure that pregnant women are properly nourished, that babies are fed properly; breastfeeding for the first six months before you start introducing other foods – these are things that can be taken up in communities, whether it is Bangladesh or Ethiopia or Malawi. We’re seeing childhood mortality drop and nutrition improve in places like Rwanda because they’re taking up the right things.
The great thing is that if you’re a nourished child, your chance of actually learning in school, your cognitive development goes up. Then your chance of participating in a job goes up. It has a ripple effect throughout the economy. That’s why you’re seeing not just health ministers, but finance ministers and prime ministers talking about how we make the right investments in nutrition.
If a mother has a child and is well nourished, when the child gets to school it is well nourished. We can raise their cognitive development, their capacity, significantly. Then, their earning potential goes up about 22 percent. When you go into schools, you can actually see which children are stunted quite often – the ones that are low weight to height. You just know those children are struggling more than the other ones in the school, the ones who are vibrant and able to pay attention and stay in their seat.
We care in the developed world about making sure our children eat a healthy breakfast before they go to school. There’s a reason for that, right? It’s because they do better. The same is true in the developing world.
A Magic Bullet
The number one cause of death for women ages fifteen through nineteen is pregnancy. If a woman can just delay the first birth – or if she’s in a place where she is culturally expected to give birth right away like Africa or India – if she can at least delay the second birth, her chances of surviving childbirth and her baby’s chances of surviving and growing up healthy and thriving are much, much higher. That is why, for me, family planning is such an important piece of all of this when we talk about maternal and child health.
We talk about what are the magic bullets when you’re trying to solve a problem. Family planning is a magic bullet. Women want to bring down the size of their families because they want their children to grow up healthy. If they only have two, they can feed them and get them into school.
Everywhere I go in the developing world, I ask people, “What are your dreams for your family?” They tell me, “Educating their kids.” Literally, every time they tell me that. I ask them, “What’s holding you back?” They say, “I have too many. I can’t feed them,” or “I can’t pay the tuition for my five kids to go to school.”
We take for granted that in a place like the United States it was contraceptives that allowed young women to reduce the size of their families, also to go out in the work force. Women [without access to contraception] say, ” I can’t go work. I have five children. I’m in charge of them.” The economic means is key for them.
Malaria, other diseases, exact huge toll
Every time someone deals with a bout of malaria, they are knocked out of the workforce or their farm for days. It used to be longer, but the drugs have gotten better. So you’re not locked out for that long if – and that’s a big ‘if’ – you have access to drugs.
You lose earning potential for the days you are out. If you have a child with malaria, we’re often talking about a life and death situation, particularly if they’re under the age of five, until their immune system gets used to malaria. Then you’re dealing with an extremely sick child. You’re using your families resources to get them into a health clinic to get them drugs. Also, the mom or the dad, whomever is taking the child to the health clinic, they’re gone for two weeks, sometimes longer. They’re constantly dealing with this crisis in the family, and it drains the economic means of the family. Something like malaria takes a huge toll.
Can malaria be eliminated?
Definitely. The fact that we’ve reduced malaria by about half since the start of the Millennium Development Goals [eight international development targets, called the MDGs, goals agreed at the United Nations in 2000] means that we’re not only making progress, but we’re learning what it takes, and we’re finding the tools. Bill and I actually spend a lot of time with the malaria team, internally [in the Foundation] and with our partners. We can eliminate malaria in certain areas. Now I think we know the tools we need to get eradication.
I’m optimistic that in the next thirty years, we will get malaria. It’s going to take some scientific breakthroughs in terms of malaria medicines, and it’s going to take a huge commitment. But it’s possible. We have things today, such as incredible mapping tools and mathematical models.
That’s what’s helped polio with this final push [towards elimination]. We know the science of the disease; we can model it, monitor it, get reports about it. The same is true with malaria. We have the technology to track it. We know right now where it’s possible to get local eliminations – where we can shrink the malaria map. When the right biological tools come along, we can actually deal with the hot spots, so malaria can stop spreading.
Bed nets work
The big thing that we used to talk about was: ‘If we get bed nets, will people sleep under them?’ Sure, you get some slippage where people don’t sleep under them, but now when I go out to the developing world, moms talk about who gets to sleep under the bed net. They know what season it is, when they need to sleep under it. It’s very, very different than a decade ago, because they know it saves lives.
Consult the people
You have to let the women speak about what they want – what’s useful and not useful to them. If you want a program to be relevant and sustainable so that the community believes in it and takes it up, there has to be local designing.
The developing world is riddled with pilot projects that failed. Sometimes it’s not that the piece of technology that was being brought in was bad; it’s the placement of it, or not thinking about how the family would use it, or if they had access – or if they had time.
There’s huge ‘time poverty’ in the developing world, right? Women are busy – fetching water and wood and cooking and taking care of the kids. If you want something sustainable, you better darn well get people involved in it, and make sure it’s designed for them. That’s when they’ll take it up and it will be sustainable. We’re seeing that.
It’s just like product design like in a place like the United States. You don’t do it in a vacuum, inside a building. You go out and talk to people who are going to use it, ask how they want to use it, and how they want it designed.
The development community has really woken up to that in the last ten or five years. Women are the center of the family, and quite honestly, the ones bringing in a lot of income to the family. We have to put women in the center if we want to make huge progress. We have to design for them. We have to listen to them. We have to make sure that we are reaching out to them and don’t have unintended consequences for them. Putting women at the center is what’s going to help us to get at these big goals – the new Sustainable Development Goals.
Will the resources to eliminate extreme poverty be found?
That’s what the world has got to do. Bill and I spend a lot of time calling on high-income governments, and middle income and low income ones. We all have to make the investments – particularly around women, we have to make the investments.
In 2012 we as a world made huge investments for family planning for women. It was the first time that that amount of money had been raised for a specific women’s issue. When the HIV community now comes together with resources around HIV programming, believe me,[you can see] the importance of young women in the fight against HIV.
I’m optimistic that the world will step up, because we’ve got to.