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.
CHAPTER TWO
Empowering Mothers
Maternal and Newborn Health
In 2016 on a trip to Europe, I made a special visit to Sweden to say good-bye to one of my heroes.
Hans Rosling, who died in 2017, was a trailblazing professor of international health who became famous for teaching experts facts they should already know. He became well known for his unforgettable TED Talks (more than 25 million views and counting); for his book Factfulness, written with his son and daughter-in-law, which shows us that the world
is better than we think it is; and for their Gapminder Foundation, whose original work with data and graphics has helped people see the world as it is. For me personally, Hans was a wise mentor whose stories helped me see poverty through the eyes of the poor.
I want to tell you a story Hans shared with me that helped me see the impact of extreme poverty—and how empowering women can play the central role in ending it.
First, though, I should let you know that Hans Rosling was less taken with me than I was with him, at least at the start. In 2007, before we knew each other, he came to an event where I was going to speak. He was skeptical, he later told me. He was thinking, American billionaires giving away money will mess everything up! (He wasn’t wrong to be worried. More on that later.)
I won him over, he said, because in my remarks I didn’t talk about sitting back in Seattle reading data and developing theories. Instead, I tried to share what I’d learned from the midwives, nurses, and mothers I had met during my trips to Africa and South Asia. I told stories about women farmers who left their fields to walk for miles to a health clinic and endured a long, hot wait in line only to be told that contraceptives were out of stock. I talked about midwives who said their pay was low, their training slight, and they had no ambulances. I purposely didn’t go into these visits with fixed views; I tried to go with curiosity and a desire to learn. So did Hans, it turns out, and he started much earlier than I did and with greater intensity.
When Hans was a young doctor, he and his wife, Agneta—who was a distinguished healthcare professional in her own right—moved to Mozambique, where Hans practiced medicine in a poor region far from the capital. He was one of two doctors responsible for 300,000 people. They were all his patients, in his view, even if he never saw them—and usually he didn’t. His district had 15,000 births a year and more than 3,000 childhood deaths. Every day in his district, ten children died. Hans treated diarrhea, malaria, cholera, pneumonia, and problem births. When there are two doctors for 300,000 people, you treat everything.
This experience shaped who he was and defined what he taught me. After we met, Hans and I never attended the same event without getting time with each other, even if it was only a few minutes in the hallway between sessions. In our visits—some long, some short—he became my teacher. Hans not only helped me learn about extreme poverty; he helped me look back and better understand what I had already seen. “Extreme poverty produces diseases,” he said. “Evil forces hide there. It’s where Ebola starts. It’s where Boko Haram hides girls.” It took me a long time to learn what he knew, even when I had the advantage of learning it from him.
Nearly 750 million people are living in extreme poverty now, down from 1.85 billion people in 1990. According to the policymakers, people in extreme poverty are those living on the equivalent of $1.90 a day. But those numbers don’t capture the desperation of their lives. What extreme poverty really means is that no matter how hard you work, you’re trapped. You can’t get out. Your efforts barely matter. You’ve been left behind by those who could lift you up. That’s what Hans helped me understand.
Over the course of our friendship, he would always say, “Melinda, you have to be about the people on the margins.” So we tried together to see life through the eyes of the people we hoped to serve. I told him about my first foundation trip and how I came away with so much respect for the people I saw because I knew their daily reality would ruin me.
I had visited the slum of a large city, and what shocked me was not little kids coming up to the car and begging. I expected that. It was seeing little kids fending for themselves. It shouldn’t have surprised me; it’s the obvious consequence of poor mothers having no choice but to go off to work. It’s a matter of survival in the city. But whom do they leave the baby with? I saw children walking around with infants. I saw a 5-year-old running with his friends in the street, carrying a baby who was still in the wobbly-headed stage. I saw kids playing near electrical wires on a rooftop and running near sewage that was streaming down the edge of the street. I saw children playing near pots of boiling water where vendors were cooking the food they were selling. The danger was part of the kids’ day and part of their reality. It couldn’t be changed by a mother making a better choice—the mothers had no better choice to make. They had to work, and they were doing the best anyone could do in that situation to take care of their kids. I had so much regard for them, for their ability to keep on doing what they had to do to feed their children. I talked many times with Hans about what I saw, and I think it prompted him to tell me what he saw. The story Hans shared with me a few months before he died was, he told me, the one that he thought best captured the essence of poverty.
When Hans was a doctor in Mozambique in the early 1980s, there was a cholera epidemic in the district where he worked. Each day he would go out with his small staff in his health service jeep to find the people with cholera rather than wait for them to come to him.
One day they drove into a remote village at sunset. There were about fifty houses there, all made of mud blocks. The people had cassava fields and some cashew nut trees but no donkeys, cows, or horses—and no transportation to get their produce to market.
As Hans’s team arrived, a crowd peered inside his jeep and began saying, “Doutor Comprido, Doutor Comprido,” which in Portuguese means “Doctor Tall, Doctor Tall.” That’s how Hans was known—never “Doctor Rosling” or “Doctor Hans,” just “Doctor Tall.” Most of the villagers had never seen him before, but they had heard of him. Now Doctor Tall had come to their village, and as he got out of the car, he asked the village leaders, “Fala português?” Do you speak Portuguese? “Poco, poco,” they answered. A little. “Bem vindo, Doutor Comprido.” Welcome, Doctor Tall.
So Hans asked, “How do you know me?”
“Oh, you are very well known in this village.”
“But I’ve never been here before.”
“No, you’ve never been here. That’s why we are so happy you’ve come. We are very happy.” Others joined in: “He is welcome, he is welcome, Doctor Tall.”
More and more people gathered, joining the crowd softly. Soon there were fifty people around, smiling and looking at Doctor Tall.
“But there are very few people from this village who come to my hospital,” Hans said.
“No, we very seldom go to hospital.”
“So how come you know me?”
“Oh, you are respected. You are so respected.”
“I am respected? But I’ve never been here.”
“No, you’ve never been here. And yes, very few go to your hospital, but one woman came to your hospital, and you treated her. So you are very respected.”
“Ah! One woman from this village?”
“Yes, one of our women.”
“Why did she come?”
“Problem with childbirth.”
“So she came to be treated?”
“Yes, and you are so respected because you treated her.”
Hans started feeling a bit of pride, and asked, “Can I see her?”
“No,” everyone said. “No, you cannot see her.”
“Why not? Where is she?”
“She’s dead.”
“Oh, I’m sorry. She died?”
“Yes, she died when you treated her.”
“You said this woman had a problem giving birth?”
“Yes.”
“And who took her to the hospital?”
“Her brothers.”
“And she came to the hospital?”
“Yes.”
“And I treated her?”
“Yes.”
“And then she died?”
“Yes, she died on the table where you treated her.”
Hans began to get nervous. Did they think he’d blundered? Were they about to unleash their grief on him? He glanced to see if his driver was in the car so he could make a getaway. He saw it was impossible to run so he began to talk slowly and softly.
“So, what illness did the w
oman have? I don’t remember her.”
“Oh, you must remember her, you must remember her, because the arm of the child came out. The midwife tried to drag the child out by the arm, but it was impossible.”
(This, Hans explained to me, is called an arm presentation. It blocks the chance of getting the child out because of the position of the baby’s head.)
At that point, Hans remembered everything. The child was dead when they arrived. He had to remove the child to save the life of the mother. A C-section was never an option; Hans didn’t have the setting for surgery. So he attempted a fetotomy (bringing out the dead infant in pieces), and the uterus ruptured and the mother bled to death on the operating table. Hans couldn’t stop it.
“Yes, it was very sad,” Hans said. “Very sad. I tried to save her by cutting off the baby’s arm.”
“Yes, you cut off the arm.”
“Yes, I cut off the arm. I tried to take the body out in pieces.”
“Yes, you tried to take it out in pieces. That’s what you told the brothers.”
“I’m very, very sorry that she died.”
“Yes, so are we. We are very sorry, she was a good woman,” they said.
Hans exchanged courtesies with them, and when there wasn’t much else to say, he asked—because he is curious and courageous—“But how can I be respected when I didn’t save the woman’s life?”
“Oh, we knew it was difficult. We know that most women who have the arm coming out will die. We knew that it was difficult.”
“But why did you respect me?”
“Because of what you did afterward.”
“What was that?”
“You went out of the room into your yard. You stopped the vaccination car from leaving. You ran to catch up with it, you made the car come back, you took out boxes from the car, and you arranged for the woman from our village to be wrapped in a white sheet. You provided the sheet, and you even provided a small sheet for the pieces of the baby. Then you arranged for the woman’s body to be put into that jeep, and you made one of your staff get out so there would be room for the brothers to go with her. So after that tragedy, she was back home the same day while the sun was still shining. We had the funeral that evening, and her whole family, everyone was here. We never expected anyone to show such respect for us poor farmers here in the forest. You are deeply respected for what you do. Thank you very much. You will always be in our memory.”
The Moment of Lift Page 3