Empowering women, reducing poverty and improving the overall health and well-being of women and children are noble goals. As with all great visions, however, the devil is in the details. Melinda Gates claims that the key to reducing poverty is to flood the developing world with contraceptives and abortifacients.
A cornerstone of this effort is the development of a new injectable contraceptive that would be analogous to the currently available medroxyprogesterone acetate, also known as DMPA, or by its brand name Depo-Provera. Unlike Depo Provera, which requires an intramuscular injection and must be administered by a medical professional, this new form is a self-administered subcutaneous injection. Ms. Gates hopes that her efforts will bring contraception to at least an additional 120 million women worldwide, with the primary focus being in sub-Saharan African and South Asia.
But what exactly is Ms. Gates offering these women? Her “solution” will result in the death of countless newly conceived children, it may double the transmission rates of HIV and it will certainly increase the risks for breast cancer. In addition, progestin-only contraceptives are associated with a significant risk for blood clots and strokes.
There are two mechanisms of action for injectable contraceptives like Depo Provera to prevent pregnancy. The first is to prevent ovulation so that conception does not occur. However, if this mechanism is unsuccessful and conception does occur, Depo Provera keeps the lining of the uterus so thin that implantation will not occur. The result is that the newly conceived life is aborted.
In promoting her cause, Ms. Gates links her efforts to expand contraceptive use to the fight against HIV/AIDS. However, use of an injectable contraception offers no protection against HIV transmission. In fact, researchers from the University of Washington studied women in Africa and found that the use of DMPA doubled the transmission rates of HIV. They cited three mechanisms to account for this increase. First, the hormonal contraceptives cause the vaginal lining to thin and develop small tears that increase the exposure to HIV during sex. Secondly, the hormonal contraceptives weaken the immune system and reduce a woman’s ability to repel HIV infection. Finally, women who are HIV positive and take hormonal contraceptives shed more HIV virus, making them more infectious.
Clearly, increased use of an injectable hormonal contraceptive is not going to help the fight against AIDS.
Hormonal contraceptives are also associated with a significantly increased risk of breast cancer. In a 2012 study published in the Journal of Cancer Research, researchers from the Fred Hutchinson Cancer Research Center looked specifically at DMPA and found that it doubled the risk of breast cancer. Pushing for expanded use of a drug that doubles the breast cancer risk in developing countries with limited capacity for routine screening for breast cancer is illogical and borders on reckless.
So why would the Gates Foundation advocate such a medically risky solution to the poverty of developing countries? The strategy overview offered by the Bill & Melinda Gates foundation provides some insight into their motivation:
By 2050, the global population is expected to grow to over 9 billion people, an increase of more than 50 percent over 2005 levels. This growth will only exacerbate the current health inequities for women and children, put pressure on social services and resources, and contribute significantly to the global burden of disease, environmental degradation, poverty, and conflict. Family planning is one of the best investments a country can make in its future.
This effort is just another iteration of the Malthusian principles that have been around since the nineteenth century. Concerns about overpopulation lead to efforts to limit the fertility of those deemed “undesirable.” Planned Parenthood founder Margaret Sanger pushed contraception on African-American communities to limit their growth. Likewise, the Gates Foundation sees contraception as way to limit the population of the impoverished people of Africa and Asia.
Improving the health and well-being of women does not depend on increased availability and use of contraception. No professional medical association recommends the routine use of hormonal contraceptives in healthy women as a means of preventing disease or maintaining good health because of the significant risks associated with their use.
On the other hand, women are empowered when they are educated. A longitudinal review of women in Chile over a fifty-year period found that the most critical factor in improving maternal health and in reducing both maternal and infant mortality was better education, not contraceptives.
The answer to poverty must be grounded in respecting the dignity of impoverished peoples - not in eliminating them. Both men and women need to be educated in order to contribute to the public discussion and formulation of social policy, and this should include education in the harmful effects of the drugs Ms. Gates is proposing be used to lower fertility in the developing world. Motherhood should be considered a valuable vocation and not a drain on society. Only then can the real roots of poverty be addressed.