THE MOMENT OF LIFT

Co-chair of the Bill and Melinda Gates Foundation, the largest private foundation in the world, Melinda Gates has dedicated her life to achieving transformational improvements in the health and prosperity of families, communities, and societies. Core to her work is empowering women and girls to help them realize their full potential. In 2015, Melinda created Pivotal Ventures, an investment and incubation company that enables her to bring together other new and emerging strands of her advocacy and philanthropic work focused in the US. Melinda received a bachelor’s degree from Duke and an MBA from Duke’s Fuqua School. After joining Microsoft Corp. in 1987, she helped develop many of the company’s multimedia products. In 1996, Melinda left Microsoft to focus on her philanthropic work and family.

“The Moment of Lift is an urgent call to courage. It changed how I think about myself, my family, my work, and what’s possible in the world. Melinda weaves together vulnerable, brave storytelling and compelling data to make this one of those rare books that you carry in your heart and mind long after the last page.” —Brené Brown, Ph.D., author of the New York Times #1 bestseller Dare to Lead

“An inspirational look at the need to empower women to make change in the world.” —The Washington Post

“[The Moment of Lift] is a moral appeal, imploring each of us who reads it to look around — at our own families, our own workplaces, our own place in a gigantic, but highly connected, world — and get to work making it more equal.” – Chicago Tribune

“At a time when beneficial globalization is being threatened by nationalism, and women’s rights are in danger of being rolled back to nineteenth-century norms, Gates offers urgent reminders of why it’s necessary to help women everywhere achieve their full potential.”—Booklist, starred review

“Part memoir, part call to action, Gates’s compassionate narrative underscores her determination to leave a positive mark on this world. She inspires and emboldens in this eloquently argued work.”—Publishers Weekly

“This book is a beautiful and concise mission statement on what we need to do to move society forward–continue to empower women. At every level and in all places women are truly the bedrock supporting their communities.”—Trevor Noah

“Melinda Gates uplifts and inspires by weaving a narrative of fortitude and hope. She pushes us to challenge the status quo and never settle.” —Mellody Hobson

“The Moment of Lift is a gift to humanity. With concrete stories and examples, Melinda Gates helps us see and embrace the great truths – ‘The goal is for everyone to be connected. The goal is for everyone to belong. The goal is for everyone to be loved.’ Melinda’s message is so real, so personal, so intelligent, so needed. If only everyone would read it and know it, we would all rise up together!” –Richard Rohr

“The Moment of Lift is a book about gender equity and its golden thread is empathy. This book lifts up the voices of women and girls whose experiences have been entirely unlike Melinda’s own. They’ve taught her a great deal, and in this beautifully crafted and artful memoir, Melinda Gates invites the reader to learn from them too.” —Paul Farmer, M.D., co-founder of Partners In Health

“I think this is one of the best books I’ve ever read.” —Warren Buffett

1. In the Introduction, Melinda shares stories from her life—watching Apollo launches as a child, and, as a mom, taking off on airplanes with her family—that in part inspired the title of the book. How has she maintained the sense of wonder and curiosity she felt as a child in her work as a philanthropist? Can you recall any moments in your own life that elicited a similar feeling of grace and being “lifted like a scarf on the wind,” as Mark Nepo describes (2)?

2. Melinda explains that she has shared these women’s (and men’s) stories as a way to inspire us to lift each other up. In your experience, how does lift happen? Are there individuals in your life whom you feel you’ve helped to lift, in a big or small way? Who has helped lift you?

3. Each chapter of the book focuses on a central issue of gender equality, and yet taken as a whole they form a matrix of issues that support that idea that “there are no isolated problems” (16). Did you feel strongly that one issue or another was a “root” cause from which the others proliferated, or that you identified with one or two more than others? Which issue in the book is most relevant to your own life?

4. What are some of the taboos around women’s education cited in the book (e.g., Vicki Phillips in rural Kentucky) and from your own experience?

5. Melinda writes that “the most transforming force of education for women and girls is challenging the self-image of the girl who goes to school.” Did you have a teacher who helped change your self-image? How did he or she do it? What effect did it have on you?

6. Melinda speaks candidly of the way her relationship with her husband, Bill, has been impacted by her work with women internationally. Did reading about their communication give you any ideas for how you might open a dialogue between men and women in your home or workplace? What kind of education might men benefit from—Bill being an example of a man who “challenges people very hard . . . but listens and learns”—to understand how to lift up women (182)?

7. Consider the examples of women acting on instinct in spite of hierarchical or bureaucratic obstacles—such as Mama Rosa, who was able to instruct Hans to stop the vaccine car after a mother and baby died in childbirth; and Ruchi, who saved a baby by bringing him to her own skin. Can you recall a time where you acted in a similar way, or witnessed another woman “breaking the rules,” as it were? What helped overcome the fear of power, and how did the reactions to that event change the way people understood a woman’s power?

8. Gates cites shocking statistics about the time women spend doing unpaid work—an average of seven years more than men in a lifetime, or the equivalent of the time it would take to earn a bachelor’s and master’s degree education (118). Discuss your perspective on unpaid work done by women from your own life. Have you ever tried to reduce your unpaid work or redistribute it? What has worked for you?

9. Did you grow up with certain expectations of what was “women’s” work, and how it was valued compared to work done at an outside job? How does your current workplace and/or home value the tasks of taking care of a home and family, and where might you use your voice to make the two more compatible as Melinda describes?

10. Melinda writes: “As soon as we began to spend more time understanding how people live their lives, we saw that so many of the barriers to advancement. . . can be traced to the limits put on the lives of women.” (50) Can you think of a barrier that women face in your community that keeps women or their children from education, income or economic opportunities?

11. The Bill & Melinda Gates Foundation was first interested in transforming agriculture through science alone—developing seeds that would help farmers grow more food—but ultimately discovered that gender bias would keep better seeds from reaching—or benefiting the people who plant them. The resistance of some team members to shift views leads Gates to question in the book, “How do you follow your plan and yet keep listening to new ideas? How can you hold your strategy lightly, so you’ll be able to hear the new idea that blows it up?” (185). Have you ever had to convince people in your work or family life to see things from a different perspective?

12. In describing her own journey with her Catholic faith, Melinda explains the importance of acting according to one’s conscience—that “Faith in action to me means going from the margins of society, seeking out those who are isolated, and bringing them back in” (73). Does this resonate with your experience with religion or spirituality?

13. Gates asks, “What gives me the right, as an outsider, to support efforts to change the culture of communities I’m not part of?”—a question that many Westerners have when looking for ways to help developing countries (172). How do the personal narratives in The Moment of Lift break down the barriers that encourage exclusion, which Melinda cites as a major cause of inequality and suffering? What threads did you trace among the stories that illustrate the importance of having a common purpose—such as all people wanting their babies to be healthy and safe, and the collective desire for love?

14. Gates’s friend Killian Noe, founder of the Recovery Café, explains this principle behind her work: “To be known without being loved is terrifying. To be loved without being known has no power to change us. But to be known and deeply loved transforms us” (149). Where do you see yourself on this spectrum of being deeply known and/or loved? Have you had experiences of being one or the other, neither or both, and what impact did that have on your ability to be “excited about living”?

15. We often hear about striving for a “work-life balance”—creating equal time for private life and professional life, but separating them to avoid burnout. In reading about the challenges of women in the book to achieve this in male-dominated environments, how did your view of work-life balance change, if at all? How might we reframe the conversation to not see them as discrete areas of life, but part of accepting each other as whole, multi-faceted beings? Consider how Melinda interacted with her colleague whose brother was ill, and her development of an unofficial paid family leave policy.

16. “A low self-image and oppressive social customs are inner and outer versions of the same force,” writes Melinda, as a way to illustrate why personal and cultural change are equally important in fighting inequality (112). Has reading this book given you new insights on how to improve your own and others’ self-image, and the culture around you? Which seems more difficult to achieve in your opinion?

17. After finishing the book, has your understanding of what it means to empower women changed, in terms of concept and execution? What are some of the ways Melinda suggested we can all—women and men—move out of this state of fear and into one of love and acceptance?

18. Visit Melinda’s website, Evoke.org, which is a hub for empowering stories by and about women making a difference in their communities and join the conversation with #MomentofLift on social media. Why do you believe equality can’t wait in your own life? Is there anything you plan to do differently to help accelerate progress towards gender equality in your own home, workplace and community?

Introduction

When I was little, space launches were a huge deal in my life. I grew up in Dallas, Texas, in a Catholic family with four kids, a stay-at-home mom, and an aerospace engineer dad who worked on the Apollo program.

On the day of a launch, we’d all pile into the car and drive to the home of one of my dad’s friends—another Apollo engineer—and watch the drama together. I can still feel in my bones the suspense of those countdowns. “Twenty seconds and counting, T minus fifteen seconds, guidance is internal, Twelve, Eleven, Ten, Nine, ignition sequence start, Six, Five, Four, Three, Two, One, Zero. All engines running. Liftoff! We have a liftoff!!!”

Those moments always gave me a thrill—especially that moment of lift when the engines ignite, the earth shakes, and the rocket starts to rise. I recently came across the phrase “moment of lift” in a book by Mark Nepo, one of my favorite spiritual writers. He uses the words to capture a moment of grace. Something was “lifted like a scarf on the wind,” he writes, and his grief went silent and he felt whole.

Mark’s image of lift is filled with wonder. And wonder has two meanings for me. It can mean awe, and it can mean curiosity. I have loads of awe—but just as much curiosity. I want to know how lift happens!

At one time or another, we’ve all been sitting on a plane at the end of a long takeoff run, waiting anxiously for the moment of lift. When the kids were little and we were on a plane ready to take off, I’d say to them “wheels, wheels, wheels,” and the moment the plane got off the ground I’d say “Wings!!” When the kids were a bit older, they would join me, and we all said it together for years. Once every so often, though, we’d say “wheels, wheels, wheels” more times than we expected, and I’d be thinking, Why is it taking so long to get off the ground!?

Why does it sometimes take so long? And why does it sometimes happen so fast? What takes us past the tipping point when the forces pushing us up overpower the forces pulling us down and we’re lifted from the earth and begin to fly?

As I’ve traveled the world for twenty years doing the work of the foundation I co-founded with my husband, Bill, I’ve wondered:

How can we summon a moment of lift for human beings—and especially for women? Because when you lift up women, you lift up humanity.

And how can we create a moment of lift in human hearts so that we all want to lift up women? Because sometimes all that’s needed to lift women up is to stop pulling them down.

In my travels, I’ve learned about hundreds of millions of women who want to decide for themselves whether and when to have children, but they can’t. They have no access to contraceptives. And there are many other rights and privileges that women and girls are denied: The right to decide whether and when and whom to marry. The right to go to school. Earn an income. Work outside the home. Walk outside the home. Spend their own money. Shape their budget. Start a business. Get a loan. Own property. Divorce a husband. See a doctor. Run for office. Ride a bike. Drive a car. Go to college. Study computers. Find investors. All these rights are denied to women in some parts of the world. Sometimes these rights are denied under law, but even when they’re allowed by law, they’re still often denied by cultural bias against women.

My journey as a public advocate began with family planning. Later I started to speak up about other issues as well. But I quickly realized—because I was quickly told—that it wasn’t enough to speak up for family planning, or even for each of the issues I’ve just named. I had to speak up for women. And I soon saw that if we are going to take our place as equals with men, it won’t come from winning our rights one by one or step by step; we’ll win our rights in waves as we become empowered.

These are lessons I’ve learned from the extraordinary people I want you to meet. Some will make your heart break. Others will make your heart soar. These heroes have built schools, saved lives, ended wars, empowered girls, and changed cultures. I think they’ll inspire you. They’ve inspired me.

They’ve shown me the difference it makes when women are lifted up, and I want everyone to see it. They’ve shown me what people can do to make an impact, and I want everyone to know it. That is why I wrote this book: to share the stories of people who have given focus and urgency to my life. I want us to see the ways we can help each other flourish. The engines are igniting; the earth is shaking; we are rising. More than at any time in the past, we have the knowledge and energy and moral insight to crack the patterns of history. We need the help of every advocate now. Women and men. No one should be left out. Everyone should be brought in. Our call is to lift women up—and when we come together in this cause, we are the lift.

CHAPTER ONE

The Lift of a Great Idea

Let me start with some background. I attended Ursuline Academy, an all-girls Catholic high school in Dallas. In my senior year, I took a campus tour of Duke University and was awed by its computer science department. That decided it for me. I enrolled at Duke and graduated five years later with a bachelor’s degree in computer science and a master’s in business. Then I got a job offer from IBM, where I had worked for several summers, but I turned it down to take a job at a smallish software company called Microsoft. I spent nine years there in various positions, eventually becoming general manager of information products. Today I work in philanthropy, spending most of my time searching for ways to improve people’s lives—and often worrying about the people I will fail if I don’t get it right. I’m also the wife of Bill Gates. We got married on New Year’s Day in 1994. We have three children.

That’s the background. Now let me tell you a longer story—about my path to women’s empowerment and how, as I’ve worked to empower others, others have empowered me.

* * *

In the fall of 1995, after Bill and I had been married nearly two years and were about to leave on a trip to China, I discovered I was pregnant. This China trip was a huge deal for us. Bill rarely took time off from Microsoft, and we were going with other couples as well. I didn’t want to mess up the trip, so I considered not telling Bill I was pregnant until we came back. For a day and a half, I thought, I’ll just save the news. Then I realized, No, I’ve got to tell him because what if something goes wrong? And, more basically, I’ve got to tell him because it’s his baby, too.

When I sat Bill down for the baby talk one morning before work, he had two reactions. He was thrilled about the baby, and then he said, “You considered not telling me? Are you kidding?”

It hadn’t taken me long to come up with my first bad parenting idea.

We went to China and had a fantastic trip. My pregnancy didn’t affect things except for one moment when we were in an old museum in Western China and the curator opened an ancient mummy case; the smell sent me hurtling outside to avoid a rush of morning sickness—which I learned can come at any time of day! One of my girlfriends who saw me race out said to herself, “Melinda’s pregnant.”

On the way home from China, Bill and I split off from the group to get some time alone. During one of our talks, I shocked Bill when I said, “Look, I’m not going to keep working after I have this baby. I’m not going back.” He was stunned. “What do you mean, you’re not going back?” And I said, “We’re lucky enough not to need my income. So this is about how we want to raise a family. You’re not going to downshift at work, and I don’t see how I can put in the hours I need to do a great job at work and raise a family at the same time.”

I’m offering you a candid account of this exchange with Bill to make an important point at the very start: When I first confronted the questions and challenges of being a working woman and a mother, I had some growing up to do. My personal model back then—and I don’t think it was a very conscious model—was that when couples had children, men worked and women stayed home. Frankly, I think it’s great if women want to stay home. But it should be a choice, not something we do because we think we have no choice. I don’t regret my decision. I’d make it again. At the time, though, I just assumed that’s what women do.

In fact, the first time I was asked if I was a feminist, I didn’t know what to say because I didn’t think of myself as a feminist. I’m not sure I knew then what a feminist was. That was when our daughter Jenn was a little less than a year old.

Twenty-two years later, I am an ardent feminist. To me, it’s very simple. Being a feminist means believing that every woman should be able to use her voice and pursue her potential, and that women and men should all work together to take down the barriers and end the biases that still hold women back.

This isn’t something I could have said with total conviction even ten years ago. It came to me only after many years of listening to women—often women in extreme hardship whose stories taught me what leads to inequity and how human beings flourish.

But those insights came to me later. Back in 1996, I was seeing everything through the lens of the gender roles I knew, and I told Bill, “I’m not going back.”

This threw Bill for a loop. Me being at Microsoft was a huge part of our life together. Bill co-founded the company in 1975. I joined Microsoft in 1987, the only woman in the first class of MBAs. We met shortly afterward, at a company event. I was on a trip to New York for Microsoft, and my roommate (we doubled up back then to save money) told me to come to a dinner I hadn’t known about. I showed up late, and all the tables were filled except one, which still had two empty chairs side by side. I sat in one of them. A few minutes later, Bill arrived and sat in the other.

We talked over dinner that evening, and I sensed that he was interested, but I didn’t hear from him for a while. Then one Saturday afternoon we ran into each other in the company parking lot. He struck up a conversation and asked me out for two weeks from Friday. I laughed and said, “That’s not spontaneous enough for me. Ask me out closer to the date,” and I gave him my number. Two hours later, he called me at home and invited me out for that evening. “Is this spontaneous enough for you?” he asked.

We found we had a lot in common. We both love puzzles, and we both love to compete. So we had puzzle contests and played math games. I think he got intrigued when I beat him at a math game and won the first time we played Clue, the board game where you figure out who did the murder in what room with what weapon. He urged me to read The Great Gatsby, his favorite novel, and I already had, twice. Maybe that’s when he knew he’d met his match. His romantic match, he would say. I knew I’d met my match when I saw his music collection—lots of Frank Sinatra and Dionne Warwick. When we got engaged, someone asked Bill, “How does Melinda make you feel?” and he answered, “Amazingly, she makes me feel like getting married.”

Bill and I also shared a belief in the power and importance of software. We knew that writing software for personal computers would give individuals the computing power that institutions had, and democratizing computing would change the world. That’s why we were so excited to be at Microsoft every day—going 120 miles an hour building software.

But our conversations about the baby made it clear that the days of our both working at Microsoft were ending—that even after the children were older, I would likely never go back there. I had wrestled with the idea before I was pregnant, talking with female friends and colleagues about it, but once Jenn was on the way, I had made up my mind. He didn’t try to talk me out of it. He just kept asking, “Really?!”

As Jenn’s birth approached, Bill started asking me, “Then what are you going to do?” I loved working so much that he couldn’t imagine me giving up that part of my life. He was expecting me to get started on something new as soon as we had Jenn.

He wasn’t wrong. I was soon searching for the right creative outlet, and the cause I was most passionate about when I left Microsoft was how you get girls and women involved in technology, because technology had done so much for me in high school, college, and beyond.

My teachers at Ursuline taught us the values of social justice and pushed us hard academically—but the school hadn’t conquered the gender biases that were dominant then and prominent today. To give you a picture: There was a Catholic boys high school nearby, Jesuit Dallas, and we were considered brother-sister schools. We girls went to Jesuit to take calculus and physics, and the boys came to Ursuline to take typing.

Before I started my senior year, my math teacher, Mrs. Bauer, saw Apple II+ computers at a mathematics conference in Austin, returned to our school, and said, “We need to get these for the girls.” The principal, Sister Rachel, asked, “What are we going to do with them if nobody knows how to use them?” Mrs. Bauer replied, “If you buy them, I’ll learn how to teach them.” So the school reached deep into the budget and made its first purchase of personal computers—five of them for the whole school of six hundred girls, and one thermal printer.

Mrs. Bauer spent her own time and money to drive to North Texas State University to study computer science at night so she could teach us in the morning. She ended up with a master’s degree, and we had a blast. We created programs to solve math problems, converted numbers to different bases, and created primitive animated graphics. In one project, I programmed a square smiley face that moved around the screen in time to the Disney song “It’s a Small World.” It was rudimentary—computers couldn’t do much with graphics back then—but I didn’t know it was rudimentary. I was proud of it!

That’s how I learned that I loved computers—through luck and the devotion of a great teacher who said, “We need to get these for the girls.” She was the first advocate for women in tech I ever knew, and the coming years would show me how many more we need. College for me was coding with guys. My entering MBA class at Microsoft was all guys. When I went to Microsoft for my hiring interviews, all but one of the managers were guys. That didn’t feel right to me.

I wanted women to get their share of these opportunities, and that became the focus of the first philanthropic work I got involved in—not long after Jenn was born. I thought the obvious way to get girls exposed to computers was to work with people in the local school district to help bring computers into public schools. I got deeply involved in several schools, getting them computerized. But the more I got into it, the more it became clear that it would be hugely expensive to try to expand access to computers by wiring every school in the country.

Bill believes passionately that technology should be for everyone, and at that time Microsoft was working on a small-scale project to give people access to the internet by donating computers to libraries. When Microsoft completed the project, they scheduled a meeting to present the results to Bill, and he said to me, “Hey, you should come learn about this. This is something we both might be interested in.” After we heard the numbers, Bill and I said to each other, “Wow, maybe we should do this nationwide. What do you think?”

Our foundation was just a small endowment and an idea back then. We believed that all lives had equal value, but we saw that the world didn’t act that way, that poverty and disease afflicted some places far more than others. We wanted to create a foundation to fight those inequities, but we didn’t have anyone to lead it. I couldn’t run it, because I wasn’t going to go back to a full work schedule while I had little kids. At that time, though, Patty Stonesifer, the top woman executive at Microsoft and someone Bill and I both respected and admired, was leaving her job, and we had the temerity to approach her at her farewell party and ask her if she would run this project. She said yes and became the first foundation employee, working for free in a tiny office above a pizza parlor.

That’s how we got started in philanthropy. I had the time to get involved when I was still at home with Jenn because we didn’t have our son, Rory, until Jenn was 3 years old.

I realize in looking back that I faced a life-forming question in those early years: “Do you want to have a career or do you want to be a stay-at-home mom?” And my answer was “Yes!” First career, then stay-at-home mom, then a mix of the two, then back to career. I had an opportunity to have two careers and the family of my dreams—because we were in the fortunate position of not needing my income. There was also another reason whose full significance wouldn’t become clear to me for years: I had the benefit of a small pill that allowed me to time and space my pregnancies.

It’s a bit ironic, I think, that when Bill and I later began searching for ways to make a difference, I never drew a clear connection between our efforts to support the poorest people in the world and the contraceptives I was using to make the most of our family life. Family planning became part of our early giving, but we had a narrow understanding of its value, and I had no idea it was the cause that would bring me into public life.

Obviously, though, I understood the value of contraceptives for my own family. It’s no accident that I didn’t get pregnant until I had worked nearly a decade at Microsoft and Bill and I were ready to have children. It’s no accident that Rory was born three years after Jenn, and our daughter Phoebe was born three years after Rory. It was my decision and Bill’s to do it this way. Of course, there was luck involved, too. I was fortunate to be able to get pregnant when I wanted to. But I also had the ability to not get pregnant when I didn’t want to. And that allowed us to have the life and family we wanted.

Searching for a Huge Missed Idea

Bill and I formally set up the Bill & Melinda Gates Foundation in 2000. It was a merger of the Gates Learning Foundation and the William H. Gates Foundation. We named the foundation for both of us because I was going to have a big role in running it—more than Bill at the time, because he was still fully engaged at Microsoft and would be for the next eight years. At that point, we had two kids—Jenn was 4 and had started nursery school, and Rory was just 1—but I was excited to take on more work. I made it clear, however, that I wanted to work behind the scenes. I wanted to study the issues, take learning trips, and talk strategy—but for a long time I chose not to take a public role at the foundation. I saw what it was like for Bill to be out in the world and be well known, and that wasn’t appealing to me. More important, though, I didn’t want to spend more time away from the kids; I wanted to give them as normal an upbringing as possible. That was hugely important to me, and I knew that if I gave up my own privacy, it would be harder to protect the children’s privacy. (When the kids started in school, we enrolled them with my family name, French, so they would have some anonymity.) Finally, I wanted to stay out of the public work because I’m a perfectionist. I’ve always felt I need to have an answer for every question, and I didn’t feel I knew enough at that point to be a public voice for the foundation. So I made it clear I wouldn’t make speeches or give interviews. That was Bill’s job, at least at the start.

From the beginning, we were looking for problems that governments and markets weren’t addressing or solutions they weren’t trying. We wanted to discover the huge missed ideas that would allow a small investment to spark massive improvement. Our education began during our trip to Africa in 1993, the year before we were married. We hadn’t established a foundation at that point, and we didn’t have any idea how to invest money to improve people’s lives.

But we saw scenes that stayed with us. I remember driving outside one of the towns and seeing a mother who was carrying a baby in her belly, another baby on her back, and a pile of sticks on her head. She had clearly been walking a long distance with no shoes, while the men I saw were wearing flip-flops and smoking cigarettes with no sticks on their heads or kids at their sides. As we drove on, I saw more women carrying heavy burdens, and I wanted to understand more about their lives.

After we returned from Africa, Bill and I hosted a small dinner at our home for Nan Keohane, then president of Duke University. I almost never hosted that kind of event back then, but I was glad I did. One researcher at the dinner told us about the huge number of children in poor countries who were dying from diarrhea and how oral rehydration salts could save their lives. Sometime after that, a colleague suggested we read World Development Report 1993. It showed that a huge number of deaths could be prevented with low-cost interventions, but the interventions weren’t getting to people. Nobody felt it was their assignment. Then Bill and I read a heartbreaking article by Nicholas Kristof in The New York Times about diarrhea causing millions of childhood deaths in developing countries. Everything we heard and read had the same theme: Children in poor countries were dying from conditions that no kids died from in the United States.

Sometimes new facts and insights don’t register until you hear them from several sources, and then everything starts coming together. As we kept reading about children who were dying whose lives could be saved, Bill and I began to think, Maybe we can do something about this.

The most bewildering thing to us was how little attention this got. In his speeches, Bill used the example of a plane crash. If a plane crashes, three hundred people die, and it’s tragic for the families, and there’s an article in every newspaper. But on the same day, thirty thousand children die, and that’s tragic for the families, and there’s no article in any newspaper. We didn’t know about these children’s deaths because they were happening in poor countries, and what’s happening in poor countries doesn’t get much attention in rich countries. That was the biggest shock to my conscience: Millions of children were dying because they were poor, and we weren’t hearing about it because they were poor. That’s when the work in global health started for us. We began to see how we could make an impact.

Saving children’s lives was the goal that launched our global work, and our first big investment came in vaccines. We were horrified to learn that vaccines developed in the United States would take fifteen to twenty years to reach poor children in the developing world, and diseases that were killing kids in the developing world were not on the agenda of vaccine researchers back here. It was the first time we saw clearly what happens when there’s no market incentive to serve poor children. Millions of kids die.

That was a crucial lesson for us, so we joined governments and other organizations to set up GAVI, the Vaccine Alliance, to use market mechanisms to help get vaccines to every child in the world. Another lesson we kept learning is that the problems of poverty and disease are always connected to each other. There are no isolated problems.

* * *

On one of my early trips for the foundation, I went to Malawi and was deeply moved to see so many mothers standing in long lines in the heat to get shots for their kids. When I talked to the women, they’d tell me the long distances they’d walked. Many had come ten or fifteen miles. They’d brought their food for the day. They’d had to bring not only the child who was getting vaccinated but their other children as well. It was a hard day for women whose whole lives were already hard. But it was a trip we were trying to make easier and shorter, and a trip we were urging more mothers to take.

I remember seeing a young mother with small kids and asking her, “Are you taking these beautiful children to get their shots?”

She answered, “What about my shot? Why do I have to walk twenty kilometers in this heat to get my shot?” She wasn’t talking about a vaccination. She was talking about Depo-Provera, a long-acting birth control injection that could keep her from getting pregnant.

She already had more children than she could feed. She was afraid of having even more. But the prospect of spending a day walking with her children to a far-off clinic where her shot might not be in stock was deeply frustrating to her. She was just one of the many mothers I met during my early trips who switched the topic of our conversation from children’s vaccines to family planning.

I remember traveling to a village in Niger and visiting a mother named Sadi Seyni whose six children were competing for her attention as we talked. She said the same thing I heard from so many mothers: “It wouldn’t be fair for me to have another child. I can’t afford to feed the ones I have now!”

In a large and very poor neighborhood of Nairobi named Korogocho I met Mary, a young mother who sold backpacks made from scraps of blue jean fabric. She invited me into her home, where she was sewing and watching her two small children. She used contraceptives because, she said, “Life is tough.” I asked if her husband supported her decision. She said, “He knows life is tough, too.”

Increasingly on my trips, no matter what their purpose, I began to hear and see the need for contraceptives. I visited communities where every mother had lost a child and everyone knew a mother who had died in childbirth. I met more mothers who were desperate not to get pregnant because they couldn’t take care of the kids they already had. I began to understand why, even though I wasn’t there to talk about contraceptives, women kept bringing them up anyway.

The women were experiencing in their lives what I was reading in the data.

In 2012, in the world’s sixty-nine poorest countries, 260 million women were using contraceptives. Over 200 million more women in these nations wanted to use contraceptives—and couldn’t get them. That meant millions of women in the developing world were getting pregnant too early, too late, and too often for their bodies to handle. When women in developing countries space their births by at least three years, each baby is almost twice as likely to survive their first year—and 35 percent more likely to see their fifth birthday. That’s justification enough to expand access to contraceptives, but child survival is just one reason.

One of the longest-running public health studies dates from the 1970s, when half of the families in a number of villages in Bangladesh were given contraceptives and the other half were not. Twenty years later, the mothers who took contraceptives were healthier. Their children were better nourished. Their families had more wealth. The women had higher wages. Their sons and daughters had more schooling.

The reasons are simple: When the women were able to time and space their pregnancies, they were more likely to advance their education, earn an income, raise healthy children, and have the time and money to give each child the food, care, and education needed to thrive. When children reach their potential, they don’t end up poor. This is how families and countries get out of poverty. In fact, no country in the last fifty years has emerged from poverty without expanding access to contraceptives.

We made contraception part of the early giving of our foundation, but our investment was not proportional to the benefits. It took us years to learn that contraceptives are the greatest life-saving, poverty-ending, women-empowering innovation ever created. When we saw the full power of family planning, we knew that contraceptives had to be a higher priority for us.

It wasn’t just a matter of writing bigger checks, either. We needed to fund new contraceptives that would have fewer side effects, last longer, and cost less, and that a woman could get in her own village or take by herself in her home. We needed a worldwide effort that included governments, global agencies, and drug companies working with local partners to deliver family planning to women where they lived. We needed a lot more voices speaking up for women who weren’t being heard. By that time I had met many impressive people who had been working in the family planning movement for decades. I talked to as many as I could and asked them how our foundation could help, what I could do to amplify their voices.

Everyone I approached seemed to become awkwardly silent, as if the answer was obvious and I didn’t see it. Finally, a few people told me, “The best way for you to support the public advocates is to become one. You need to join us.”

That wasn’t the answer I was looking for.

I am a private person—in certain ways, a bit shy. I was the girl in school who raised her hand to speak in class while other kids bellowed their answers from the back row. I like to work offstage. I want to study the data, go see the work, meet people, develop a strategy, and solve problems. By then, I was accustomed to making speeches and giving interviews. But suddenly friends, colleagues, and activists were pressing me to become a public advocate for family planning, and that alarmed me.

I thought, Wow, am I going to step publicly into something as political as family planning, with my church and many conservatives so opposed to it? When Patty Stonesifer was our foundation’s CEO, she warned me, “Melinda, if the foundation ever steps into this space in a big way, you’re going to be at the center of the controversy because you’re Catholic. The questions will all be coming to you.”

I knew this would be a huge shift for me. But it was clear the world had to do more on family planning. Despite decades of efforts by passionate advocates, progress had largely stalled. Family planning had fallen off as a global health priority. This was partly because it had become so politicized in the United States, and also because the AIDS epidemic and vaccine campaigns had drawn funding and attention away from contraceptives globally. (It is true that the AIDS epidemic did lead to widespread efforts to distribute condoms, but for reasons I’ll explain later, condoms were not a helpful contraceptive tool for many women.)

I knew that my becoming an advocate for family planning would expose me to criticism I wasn’t used to and would take time and energy from other foundation activities. But I began to feel that if anything was worth those costs, it was this. I felt it in a visceral, personal way. Family planning was indispensable to our ability to have a family. It allowed me to work and have the time to take care of each child. It was simple, cheap, safe, and powerful—no woman I knew went without it, but hundreds of millions of women around the world wanted it and couldn’t get it. This unequal access was simply unjust. I couldn’t look the other way as women and children were dying for want of a widely available tool that could save their lives.

I also considered my duty to my children. I had a chance to stand up for women who didn’t have a voice. If I turned it down, what values was I role modeling for my kids? Would I want them to turn down difficult tasks in the future and then tell me that they were following my example?

And my own mother had a powerful influence on my choice, though she might not have known it. She always said to me as I was growing up, “If you don’t set your own agenda, somebody else will.” If I didn’t fill my schedule with things I felt were important, other people would fill my schedule with things they felt were important.

Finally, I have always carried in my head images of the women I’ve met, and I keep photographs of the ones who have moved me the most. What was the point of their opening their hearts and telling me about their lives if I wasn’t going to help them when I had the chance?

That clinched it for me. I decided to face my fears and speak out publicly for family planning.

I accepted an invitation from the UK government to cosponsor a family planning summit in London with as many heads of state, experts, and activists as we could attract. We decided we would double our foundation’s commitment to family planning and make it a priority. We wanted to revive the global commitment that all women worldwide must have access to contraceptives, so that we can decide for ourselves whether and when to have a child.

But I still had to figure out what my role would be and what the foundation needed to do. It wouldn’t be enough just to convene a global summit, talk about contraceptives, sign a declaration, and go home. We had to set goals and form a strategy.

We joined the UK government in a sprint to hold the summit in London in July of 2012, two weeks before everyone’s attention turned to the opening of the London Olympics at the end of the month.

The approach of the summit triggered a wave of media stories that highlighted the life-saving value of family planning. The British medical journal The Lancet published a study funded by the UK government and our foundation showing that access to contraception would cut the number of mothers who die in childbirth by a third. A report by Save the Children said a million teenage girls die or are injured in childbirth every year, which makes pregnancy the number one cause of death for teen girls. These findings and others helped set a tone of urgency for the conference.

There was a big crowd at the summit, including many heads of state. The speeches went well, and I was pleased with that. But I knew the test of success would be who stepped up and how much money we raised. What if national leaders didn’t support the initiative? What if governments didn’t increase their funding? Those worries had been giving me a sick feeling for months—not very different from the fear of throwing a party where no one shows up, but in this case, the media would show up to report on the failure.

I won’t say that I shouldn’t have worried. My worries make me work harder. But the funding and support were greater than my highest hopes. The United Kingdom doubled its commitment to family planning. The presidents of Tanzania, Rwanda, Uganda, and Burkina Faso and the vice president of Malawi were present at the conference and played a key role in raising the $2 billion committed by developing countries. That included Senegal, which doubled its commitment, and Kenya, which increased its national budget for family planning by a third. Together we pledged to make contraceptives available to 120 million more women by the end of the decade in a movement we called FP 2020. It was by far the largest sum of money ever pledged to support access to contraceptives.

Just the Beginning

After the conference, my best friend from high school, Mary Lehman, who had traveled with me to London, joined me for dinner with some influential women who also attended the conference. We were all having a glass of wine and enjoying a sense of satisfaction, and I was personally relieved to be done. After many months of planning and worrying, I felt I could finally relax.

That’s when these women all said to me, “Melinda, don’t you see? Family planning is just the first step for women! We have to move on to a much bigger agenda!!”

I was the only one at the table naïve enough to be surprised—and I was overwhelmed. I didn’t want to hear it. Talking to Mary in the car after dinner, I said over and over, “Mary, they’ve got to be kidding.” I was near tears and kept thinking, No way. I’m already doing my part and it’s more than I can handle, and there is already a ton of work ahead on family planning alone to meet the goals we just declared—never mind a wider women’s agenda.

The call for “more” was especially hard to hear after an emotional visit I’d had a few days earlier in Senegal. I was sitting in a small hut with a group of women talking about female genital cutting. They had all been cut themselves. Many had held their daughters down to be cut. As they were telling me about it, my colleague Molly Melching, who’s worked in Senegal for decades and was acting as my translator that day, said, “Melinda, some of this I’m not going to translate for you because I don’t think you could take it.” (At some point I have to summon the guts to ask her what she was holding back.)

Those women told me that they had all turned against the practice. When they were younger, they were afraid if they didn’t have their daughters cut, the girls could never be married. When their daughters hemorrhaged to death, they believed it was evil spirits. But they had come to see these views as lies and had banned cutting in their village.

They believed they were telling me a story of progress, and they were. But to understand in what sense it was progress required an understanding of how cruel and widespread this practice still was. They were telling me how far they had come, and were also revealing to me how awful things still were for girls in their country. The story was horrifying to me—and I just shut down. I saw the effort as hopeless and endless, beyond my stamina and resources, and I said to myself, “I quit.”

I suspect most of us, at one time or another, say “I quit.” And we often find that “quitting” is just a painful step on the way to a deeper commitment. But I was still stuck in my private “I quit” from Senegal when the women at the table in London told me how much more had to be done. So I said my second “I quit” to myself in one week. I looked into the abyss between what needed to be done and what I was able to do and I just said “No!”

Even though I said it only to myself, I meant it. But later, when I began to drop my defenses, I realized that my “No!” was only a moment of rebellion before my surrender. I had to accept that the wounds of those girls in Senegal and the needs of women around the world were beyond anything I could heal. I had to accept that my job is to do my part, let my heart break for all the women we can’t help, and stay optimistic.

Over time, I came to “Yes,” and that allowed me to see what the women in London were telling me. Family planning was a first step, but that first step wasn’t only gaining access to contraceptives; it was a step toward empowerment. Family planning means more than getting the right to decide whether and when to have children; it is the key to breaking through all kinds of barriers that have held women back for so long.

My Huge Missed Idea: Invest in Women

Some years ago in India, I visited women’s self-help groups and realized that I was seeing women empower each other. I was seeing women lifting each other up. And I saw that it all begins when women start talking to each other.

Over the years, the foundation has funded women’s self-help groups with a number of different aims: to prevent the spread of HIV, to help women farmers buy better seeds, to help women get loans. There’s a whole range of reasons to form groups. But no matter what the original focus, when women get information, tools, funding, and a sense of our power, women lift off and take the group where they want it to go.

In India, I met with women farmers in a self-help group who had purchased new seeds and were planting more crops and getting better yields on their farms—and they told me about it in the most personal ways. “Melinda, I used to live in a separate room in the house. I wasn’t even allowed to be in the house with my mother-in-law. I had a room off the back, and I didn’t have any soap. So I washed with ashes. But now I have money, so I can buy soap. And my sari is clean, and my mother-in-law respects me more. So she lets me in the house now. And I have more money now, and I bought my son a bike.”

You want to talk about being respected by your mother-in-law? Buy your son a bike.

Why does this win respect? Not because of a local custom. It’s universal. The mother-in-law respects the daughter-in-law because her income has improved the life of the family. When we women can use our talent and energy, we begin to speak in our own voices for our own values, and that makes everybody’s life better.

As women gain rights, families flourish, and so do societies. That connection is built on a simple truth: Whenever you include a group that’s been excluded, you benefit everyone. And when you’re working globally to include women and girls, who are half of every population, you’re working to benefit all members of every community. Gender equity lifts everyone.

From high rates of education, employment, and economic growth to low rates of teen births, domestic violence, and crime—the inclusion and elevation of women correlate with the signs of a healthy society. Women’s rights and society’s health and wealth rise together. Countries that are dominated by men suffer not only because they don’t use the talent of their women but because they are run by men who have a need to exclude. Until they change their leadership or the views of their leaders, those countries will not flourish.

Understanding this link between women’s empowerment and the wealth and health of societies is crucial for humanity. As much as any insight we’ve gained in our work over the past twenty years, this was our huge missed idea. My huge missed idea. If you want to lift up humanity, empower women. It is the most comprehensive, pervasive, high-leverage investment you can make in human beings.

I wish I could tell you the moment this insight came to me. I can’t. It was like a slow-rising sun, gradually dawning on me—part of an awakening shared and accelerated by others, all of us coming to the same understanding and building momentum for change in the world.

One of my best friends, Killian Noe, has founded an organization called Recovery Café that serves people suffering from homelessness, addiction, and mental health challenges, and helps them build lives they’re excited about living. Killian inspires me to explore things more deeply, and she has a question she’s made famous among her friends: “What do you know now in a deeper way than you knew it before?” I love this question because it honors how we learn and grow. Wisdom isn’t about accumulating more facts; it’s about understanding big truths in a deeper way. Year by year, with the support and insight of friends and partners and people who have gone before me, I see more clearly that the primary causes of poverty and illness are the cultural, financial, and legal restrictions that block what women can do—and think they can do—for themselves and their children.

That’s how women and girls became for me a point of leverage and a place to intervene across the range of barriers that keep people poor. The issues that make up the chapters in this book all have a gender focus: maternal and newborn health, family planning, women’s and girls’ education, unpaid work, child marriage, women in agriculture, women in the workplace. Each of these issues is shaped by barriers that block women’s progress. When these barriers are broken, opportunities open up that not only lift women out of poverty, but can elevate women to equality with men in every culture and every level of society. No other single change can do more to improve the state of the world.

The correlation is as nearly perfect as any you will find in the world of data. If you search for poverty, you will find women who don’t have power. If you explore prosperity, you will find women who do have power and use it.

When women can decide whether and when to have children; when women can decide whether and when and whom to marry; when women have access to healthcare, do only our fair share of unpaid labor, get the education we want, make the financial decisions we need, are treated with respect at work, enjoy the same rights as men, and rise up with the help of other women and men who train us in leadership and sponsor us for high positions—then women flourish … and our families and communities flourish with us.

We can look at each of these issues as a wall or a door. I think I already know which way we see it. In the hearts and minds of empowered women today, “every wall is a door.”

Let’s break down the walls and walk through the doors together.

Copyright © 2019 by Melinda Gates