Gender & Sexuality Law Blog

Yesterday at the Women Deliver global conference, Melinda Gates announced that the Gates Foundation will invest $1.5 billion

Melinda Gates, courtesy of Haraz N. Ghanbari/AP

over the next five years in programs promoting maternal and child health, family planning, and nutrition in developing countries.  Fantastic.  Yet, one of Women Deliver’s key goals – safe and legal abortions as one of the tools that would help combat maternal death – is explicitly excluded from the Gates maternal health initiative.

When asked about this omission by NPR’s Michele Norris last night, here’s what Gate said:

The Foundation specifically doesn’t take a stance on abortion … we don’t want to be part of the controversy or stem that controversy.  We’re much more trying to work ‘upstream’ on reproductive rights.

What did she mean by using this riparian metaphor in relation to reproductive rights?  Well, as she explained:

If you say to a woman: Would you like to have an injection and come in once a month or an implant where you came in once every three years, and you give them the choices of the different tools, then you don’t even have to get into the issue of abortion downstream.

You can listen to the full interview here:

Gates’ riparian parry makes sense if and only if all sex that might result in a pregnancy takes place in contexts that are voluntary and planned for.  But as we know, this is not always the case.  It’s fine to take the position that abortion should be an option not of first resort (as has Hilary Clinton’s position, for instance), but the need for safe and legal abortion is not obviated by accessible and affordable birth control technology as Gates maintains.  Girls who do not plan on having sexual intercourse and thus are unlikely to have addressed their fertility in the structural ways Gates describes frequently find themselves pregnant either because they changed their minds and had sex with a boy or their pregnancies result from unconsented to intercourse. So too, adult women who may want to have more control of their fertility than Depo Provera or Noristerat would allow (the former is administered every 3 months and the latter every 8 weeks) may also have need for abortion services due to rape.  Nevermind the women who wish to terminate a pregnancy for reasons of their own health or the health of the fetus.

Substantial research has shown that women in developing countries who are most interested in the kind of long-term contraception that Gates’ touts are women who are older and have already had several children.  They use Depo Provera or Noristerat in order to control their family size.  Younger women who have not yet reached their ideal family size were less interested in longer-term contraception that patches and implants provide.  One study showed that “few women accepted Norplant before delivery of three or more children.”  Thus, women who wish to regulate their fertility in a more nimble manner than patches and implants afford remain susceptible to unwanted pregnancies for multiple reasons, and the availability of contraception would not eliminate the need for safe abortion services.

An estimated one in seven maternal deaths are the result of unsafe abortions.  Unfortunately, access to long-term contraception may minimize but will not fully address this enduring tragedy of women’s health.