CARE 2011 Keynote Address

March 9, 2011
Prepared remarks by Melinda French Gates, co-chair and trustee

Thank you, Helene.

Helene brought her special blend of expertise and enthusiasm to the Gates Foundation when we were just getting started. Bill and I couldn’t have asked for a more inspiring teacher.

In the last few years, Helene has enriched the wonderful partnership we’ve always had with CARE. CARE is a pillar of the women’s health community. The fact that all of you are here today is proof of that.

It’s moving to see so many advocates gathered in one place. There is no place I’d rather celebrate the one hundredth International Women’s Day than at CARE’s national conference with all of you.

But I have to tell you that I wish I could choose a different year to celebrate. A lingering economic crisis and a painful budget season are not the ideal backdrop for this historic occasion.

Our celebration is mixed with sympathy for those who are struggling—here in the United States, where unemployment has been too high for too long; and around the world, where a growing number of families don’t have enough food to eat.

Our celebration is also mixed with anxiety. Many of the programs on which poor women and children depend for their survival are at risk of losing support in the halls of government.

In the back-and-forth of the budget debate, members of every imaginable interest group pay a visit to their representatives—to fight for funding, to be heard. Women in poor countries can’t be here to engage in the democratic process. But they can be heard. They do have a voice. It is your voice.

One hundred years ago, on the first International Women’s Day, women around the world marched in the streets to demand the right to an education, the right to vote and hold office, the right to fair and equal wages.

We celebrate those pioneers by remembering all that they accomplished. And we honor them by carrying on their work. Right now, carrying on their work means making the case for women’s and children’s health when it’s under attack.

I met recently with a group of mothers in a slum outside of Nairobi called Korogocho. They were talking about their health and the health of their children, and one woman said, “I want to bring every good thing to one child before I have another.”

It’s hard to imagine what it’s like to raise a child in Korogocho, where the chances that your daughter will die are higher than the chances that she will be left-handed. But there is not a soul on earth who doesn’t know exactly what that mother is talking about when she says she wants “every good thing” for her children.

Mothers everywhere work every day of their lives to give every child “every good thing.”

They work for hours and hours in the fields growing the food their families will eat. They nurse their children back to health when they get sick. They save every penny to pay school fees.

Mothers invest in life-saving health care and life-making education for their children. When the world also invests in those things, we are reducing the burdens and sorrows of motherhood. We are empowering women to create the future they want for themselves, for their sons, and for their daughters.

An investment in women is an investment in children.

An investment in children is an investment in women.

And an investment in women and children is an investment in the future we all share together.

As advocates, we have an amazing story to tell. It is the revolutionary story of child survival.

Fifty years ago, in 1960, the number of children who died before their fifth birthday was 20 million. Then, the world learned how to grow more food and treat more disease, and the number went down. Way down. By 1975, the number of children under 5 who died was 15 million. That was an amazing story.

Then the world learned how to deliver more medicines and vaccines, and the number went down again, to 12 million. Then it was 10 million. Last year, 8.1 million.

So when we advocate, we must remember to tell our story. We’re not just haggling over a line item in the budget. The money governments spend on foreign aid has already saved millions upon millions of lives.

We have an amazing story to tell. And here’s the most fantastic part: We know exactly what to do next. Right now, at precisely this moment, there are proven and simple ways to save millions more children.

The question is not, can the world save these precious lives? The only question is, will the world choose to save them?

Will the world hear our story? Will governments spend the relatively small amount of money it takes to strengthen families and build thriving societies?

We cut child mortality in half in 50 years. How long before we cut it in half again?

Vaccines

One of the smartest investments we can make in women and children is vaccines. We know that vaccines are a miracle. They are inexpensive, easy to deliver, and just a few doses protect a child from debilitating and deadly disease for a lifetime.

Vaccines made it possible to wipe smallpox off the face of this planet. Vaccines have cut the number of polio cases by 99 percent in just 20 years. Now, we are on the brink of eradicating polio once and for all. And when we do, it will be thanks to the financial commitment of donors, an impressive logistical effort in poor countries, and a 13-cent vaccine swallowed by billions of children.

There used to be a lag of a decade or more between when vaccines were developed and when they were given to children in poor countries. The hepatitis B vaccine was developed in 1981, but it wasn’t standard in most poor countries until the mid-2000s.

But now the lag is just a year or two. This year, a vaccine for pneumonia is being introduced at almost simultaneously in the developing and the developed world. That is an incredible milestone for global equity. If we can save the life of a child who is sick in one country, we should do it in every single country. That is the principle that led Bill and me to start our foundation, and we are elated to see the world living by that principle.

Pneumonia is the biggest killer of children in the world. Guyana, Kenya, Sierra Leone, and Yemen have just introduced the brand new vaccine for pneumonia.

The second biggest killer of children is diarrhea. Nicaragua recently introduced a new vaccine for diarrhea.

There’s a very good chance that, in just a few years, vaccines will protect most of the children in the world from the two biggest killers of today.

That is the amazing story we get to tell.

Newborn Health

Let me tell you another story. Like the vaccines story, it starts out sad but it gets better.

In the first 28 days of life, babies are especially vulnerable. In poor countries, many of the complications that arise during childbirth can be fatal. Millions of newborns die because they’re born premature, because they can’t breathe adequately, or because they get an infection.

We haven’t always known how to prevent these deaths. For years, the first 28 days were one of the most frustrating puzzles in global health—and one of the most terrifying periods in a mother’s life. But that is changing, fast. A series of recent studies have proved beyond a shadow of a doubt that we can dramatically reduce the risk of the first few weeks of life.

For example, simply teaching mothers to hold their babies against their skin makes a huge difference. It’s called kangaroo care, and it helps regulate the body temperature, heartbeat, and breathing of babies who are in distress. It also helps promote breastfeeding, which is one of the most important things we can do to protect infants from infections.

Can you believe that kangaroo care can save half the pre-term infants who are currently dying?

Saving newborns is not technologically complicated. We are learning how to deliver simple tools and messages, and it is saving lives.

We have an amazing story to tell.

Family Planning

There is one more proven way to save a huge number of lives, and that is giving mothers and fathers the ability to decide how many children they will have, and when they will have them.

My ability to plan my family is something I took for granted as a woman living in the United States. When Bill and I got married, we didn’t have to guess about children. We planned, and we had access to contraceptive tools that helped us follow through on our plans.

For women in poor places where it’s hard to get food or clean water or basic health care, it may be even more important to plan.

I met another young mother in Korogocho. She had a business making and selling backpacks from scraps of blue jean fabric. She invited me into her home, where she was sewing and watching her two small children. She used contraception because, she said, “Life is tough.”

I asked if her husband supported her decision. She said, “He knows life is tough, too.”

When life is tough, your best chance to make life better for yourself and for your children is to have some control over how you grow your family.

There is a lot of controversy in this country about reproductive health because of the issue of abortion. And it’s appropriate to continue that dialogue. There are strong feelings on both sides.

But the thing we must remember is that there has long been a broad, bipartisan consensus on the need to give all women access to the contraceptives that women in rich countries use every day. It is vital to maintain that consensus.

Right now, more than 200 million women in the world who don’t want to have a child but are not using contraceptives. This is a problem we should be able to solve. I believe in people’s good faith, and I am optimistic we can work together to give women the lifesaving tools they deserve.

When I meet women in poor countries, contraceptives are what they want the most. It is almost always the first thing they bring up. They tell me exactly why they want to plan their families, and they usually know precisely which kind of contraceptive they prefer. Unfortunately, they also say the clinic is routinely out of stock.

There are many excellent contraceptive tools available. There are condoms. There is an injection that costs $1 and lasts for three months. There is an implant that costs $8 and lasts for four years. I observed a woman getting an implant at a health facility in Nairobi. It was painless, it took about six minutes, and it was going to fundamentally change her family’s future.

When we can get contraceptives to all the women who ask for them, we will have an amazing story to tell.

Frontline Workers

I’ve seen all these approaches work—vaccination, newborn care, and contraception. Last year, I visited Malawi. It’s one of the poorest countries in the world. But Malawi has visionary leaders, and it has built a strong health system around more than 10,000 frontline health workers called Health Surveillance Assistants. Most of these assistants are women. They spend one week a month in the health care facility and three weeks in villages, giving health care to people in their homes.

Because of the work these women are doing, vaccination is up, newborn deaths are down, and family planning is more readily available. Malawi is on track to meet Millennium Development Goal 4—to reduce the child mortality rate by two-thirds. They’re now taking aim at Millennium Development Goal 5—to reduce the maternal mortality ratio by three-quarters.

If it can be done in Malawi, a country that has every disadvantage, then it can be done anywhere.

And it is being done. India is deploying frontline workers. So is Pakistan. And Ethiopia. And they are doing it at a huge scale. There are millions of health workers—mostly women—on the front lines in countries around the world. As long as we give them the proper equipment and training, they will have an amazing story to tell.

Conclusion

One of the main reasons I went to Kenya was to learn about the new pneumonia vaccine.

I started at a hospital that looked like most hospitals I visit in the developing world—crowded. There were four children to a bed, and half of them were suffering from pneumonia.

A doctor showed me into the intensive care unit. It’s really hard to watch a child struggling for breath. They’re fighting for their lives every time they inhale. I’m not an expert, but I could tell some of them were going to lose the fight.

The babies in intensive care were on oxygen, but the hospital only had one oxygen tank. The doctors and nurses had rigged an ingenious system to divide the oxygen using urinary catheter tubes. It wasn’t the ideal delivery mechanism, but it was better than the alternative.

I tried to avoid eye contact with the mothers who were standing beside their sick children. Their hearts were breaking, and I had nothing to offer.

Then I went to a different facility, the Westlands Clinic, and I sat with a young mother while her child was getting one of the first pneumonia shots ever given in Kenya.

It was a joy to talk to this woman. I like to ask mothers what they dream for their children’s future, and the answer is almost always the same. They want to be able to feed them so they grow up healthy. They want to be able to send them to school. The mothers waiting to get the pneumonia vaccine knew they were giving their children the chance to achieve their dream.

To a child, the pneumonia vaccine is a reason to cry for a few minutes. But to a mother, it’s the difference between a vigil over your dying baby and the beauty of a lifetime.

We have an amazing story to tell.

And so I urge you to go tell it.

Donors and governments need to hear the real story of aid. They need to hear the stories of women and children who are alive because of it. They need to hear the stories of frontline workers who are bringing good health into remote villages. They need to hear the stories of mothers who can provide for their families because they are able to plan for them.

They need to know that they have already been part of a movement to save millions upon millions of children. They have already made poor women’s lives healthier and happier.

And they need to know that there are proven and simple ways to build on the progress they have already made.

Let us celebrate International Women’s Day by telling our story.

Let us make people hear it. Because we have an amazing story to tell.

Thank you.