Melinda Gates: Making Change Through Cultural Lines

Right before the London Family Planning Summit this summer, I went to Niger in Senegal. And I went to Niger for a very specific reason. It's the highest fertility rate in the world in terms of number of babies had by women. It's the highest desired fertility rate in the world in terms of how many births men want their wives to have, and the highest desired fertility rate in the world in terms of what women, how many children they say they want to have. So I thought, okay, highest of all these things in the world. Super poor country. Is this even possible? Is this even remotely possible to be contraceptives? Because we know in society after society where contraceptives have come, whether you look at France or Germany or the US or Bangladesh, which has an amazing longitudinal study since 1970, that if you get contraceptives to women, it used to be two generations before you saw a sea change in terms of the number of children they have. It's now one generation. And. And it spreads not on socioeconomic lines, it spreads on cultural lines. So I thought, okay, Niger. Can we possibly get at this in Niger? Very polygamous society. So I sat down and talked with several women in their homes. I stood by the well. I was about an hour and a half outside of Niamey, which is the capital, out in the desert, the absolute desert. And when I was talking to women about contraceptives, I said to this one woman, she had six children and she was using contraceptives. And I said to her, well, you know, I was saying to her about having so many children. Are you going to have more children? She said, absolutely not. And I said, what are you doing? And she said, I go to this clinic. And she was angry. She said, why is it the clinic you were just at? I saw you there near my house. I can see it from my house. Why can't I get a contraceptive there? Which I had actually just been haranguing the officials about that, too. She said, I have to go essentially 7km and walk in the heat. And last time I went, I couldn't get the shot. She. She said, can't you see? Can't you see that we're starving here? She said, we are starving, starving, starving. She said, I can't feed my children, and you're not getting me this shot. You're not helping me. And when I said to her, well, okay, you know about contraceptives. And there actually were these village women, these health care workers who are starting to give contraceptive pills out, and they go through the dust and they hand you a little packet of pills, not in a little plastic case, just you get the pills. And so I said to her, okay, you know about contraceptives? Do sisters in the village know about it? And she said, yes. And she said, the good thing about women is we talk. And she said, we talk by the well. We talk when the children are born and we talk when we grind millet every day. And she said, and she said, so we're talking about contraceptives and more of us are using them. And I said to her, okay, so this is polygamous society. Her husband's not there. And I said, so what happens if another co wife comes in? And she got very somber. And she said, well, I just told you, I'm not going to have any more children. But she said, if another co wife comes in, I will have to have more children because it's a race between her and the other wife for who has the most children to then inherit the land. But then she stopped herself and she said, but there's nothing here. So she said, and in my culture, it's not if we have to say, it's not when it's if a woman comes in. But she said, there's nothing here. So why would another woman want to have a lot of children? But. So I had to meet. So in terms of getting cultural change there, what we have to do is we're setting up the country. Not when I say we, the global partnership, but the country is setting up husband schools to teach the husbands first because they're the power structure in a polygamous society about why having fewer children makes sense and that it is a decision. The women think there's no decision in this. It's just like if you'd gone to France many, many centuries ago, women didn't know there was a decision that they could make about their bodies. So. So we have to teach the husbands first, get them involved. I met with a whole group of the imam, the whole structure all the way up in the country of the imams. And they say, yes, the Quran says we can do family planning and we need to teach that to all the imams in the village. And we need to get them to spread the word. So that's the way in Niger to start cultural change is the husbands and the imams and then get the women talking and get the contraceptives in and let them make the decision. Then it.