The Moment of Lift: How Empowering Women Changes the World

Nonfiction | Autobiography / Memoir | Adult | Published in 2019

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Summary

Chapter Summaries & Analyses

Introduction and Chapter 1

Chapters 2-3

Chapters 4-6

Chapters 7-8

Chapter 9 and Epilogue

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Chapters 2-3Chapter Summaries & Analyses

Chapter 2 Summary: “Empowering Mothers: Maternal and Newborn Health”

Chapter 2 describes the early health initiatives of the Bill & Melinda Gates Foundation. It begins with a discussion of Dr. Hans Rosling (d. 2017), one of Melinda Gates’s mentors. Dr. Rosling’s emphasis on seeing life through the eyes of those he wanted to serve resonated with Gates. Helping people demands understanding their needs, desires, and beliefs. This kind of understanding can only come from direct interaction. Gates traveled extensively and spoke to women in different countries; through these conversations, she came to realize that she could attack poverty and empower women by helping mothers protect their children. The foundation’s first global initiative aimed to save children under the age of five by expanding vaccine distribution and supporting programs that improved maternal and newborn heath. Gates then traveled to Shivgarh in Uttar Pradesh, a state in northern India known as the epicenter of maternal and newborn deaths, to discuss newborn care with a group of villagers. She met the family of a young boy who nearly died of hypothermia shortly after his birth. Only the quick actions of a healthcare worker trained and deployed using funds from the foundation saved the infant’s life.

Their Cup is Not Empty

This section stresses the importance of dialogue and cultural awareness in saving lives. Gates discusses delivery systems—mechanisms for delivering tools and encouraging their use to those who need them. Barriers to delivering help include distance, ignorance, poverty, religion, stigma, and gender bias. Before implementing maternal and childhood health programs, workers at the Bill & Melinda Gates Foundation strove to understand community beliefs and practices around childbirth. Gently questioning traditional, ineffective practices is one way to deliver life-saving information; seeking help from influential community members is also important. Transparency is key, as is building trust, encouraging science, and allowing locals to take the lead.

Midwife in Every Village

This section emphasizes the importance of delivery systems using two examples: Indonesia and Rwanda. In 1989, the government of Indonesia launched a program called “Midwife in Every Village” to lower the country’s high maternal and infant mortality rates. The government trained 60,000 midwives and deployed them in rural communities—but these workers were not well received because Indonesian villagers tend to distrust outsiders. Only after spending time with villagers were the midwives able to help. The government of Rwanda’s efforts to rebuild the medical field after their 1994 genocide relied on forging close connections as well. Rather than bring in outsiders, the health minister spearheaded a medical program that tasked every village in the country with electing three healthcare workers, one of whom focused solely on maternal health. The program dramatically improved the lives of mothers and infants. As Indonesia and Rwanda demonstrate, alleviating poverty requires making offers of help appealing, trustworthy. Learning why people are poor and understanding the barriers to delivering aid are crucial parts of this process (i.e., by consulting those experiencing hardships such as poverty).

Chapter 3 Summary: “Every Good Thing: Family Planning”

Chapter 3 focuses on combatting poverty, improving women’s health, and lowering childhood mortality rates through family planning. Family planning clinics in developing countries are crucial tools in the fight against poverty. In Malawi, women travel long distances on foot for injectable contraceptives—but clinics are often understocked, resulting in unplanned pregnancies. These unplanned pregnancies devastate families, who do not have the time or resources to care for more children. Much of Gates’s work at the foundation centers on family planning. In 2012, she helped organize an international family planning summit in London, an event that drew criticism from the Catholic Church.

The Old Conversation—That Left Women Out

Contraception is a divisive issue with a complex history. The first modern contraceptives were met with misogyny-fueled opposition as a woman’s sexuality was seen as immoral when divorced from childbearing. Nineteenth-century lawmakers codified these views, not only outlawing contraceptives, but making it illegal for doctors to discuss them. In their eyes, women were not humans with equal rights to education, advancement, and pleasure. A woman’s role was to marry, serve her husband, and bear his children. But in 1936, the Second Circuit Court ruled that doctors could prescribe contraceptives. In 1965, the Supreme Court lifted contraceptive restrictions, but only for married couples. The Church remains resistant to contraceptives, to the detriment of the poor. The 2012 summit organized by the Bill & Melinda Gates foundation aimed to spark new conversations about family planning by amplifying women’s voices.

After the Summit—a Bit of the Old Conversation

The summit received pledges of support from governments and nonprofit organizations around the world. However, it was not without critics. The Vatican Newspaper, L’Osservatore Romano, framed Gates as confused, dismissive of “natural family planning” (71), and being manipulated by drug companies who stood to make a fortune from expanded access to contraceptives. Gates’s stance on contraceptives put her at odds with the institution of the Church, but not with the idea of “loving thy neighbor.” For her, this meant lifting women and children out of poverty by expanding access to contraceptives.

The New Conversation—Under Way in Nairobi

The London summit aimed to give 120 million women in 69 poor countries access to contraceptives by 2020. By 2016, the campaign only reached 30 million women (19 million short of its halfway goal). To address this setback, Gates travelled to Kenya, one of the few places already ahead of its goal. She spoke with resident enumerators who gathered data on the demand for contraceptives, the types of contraceptives locals preferred, and cultural norms around sexuality, fertility, and family (by going door-to-door with cell phones). Sometimes they were sent away by controlling men opposed to family planning. Other challenges included inflexible data systems that left out important information that impacted family planning, such as domestic violence.

Let’s Plan

This section focuses on the “Tupange” (Let’s Plan) program in Kenya. The program successfully boosted contraceptive use in three of the country’s largest cities. Program organizers focused on community outreach to share information about family planning. In addition to door-to-door visits, public fairs were used to destigmatize the issue—especially among men who needed convincing of family planning’s effectiveness in making children healthier and more intelligent. Organizers recruited men to speak to other men in order to accomplish this. Building healthy communities requires tackling stigmas around women’s reproductive health. Tupange workers openly challenged stigmas with respect, eventually changing attitudes toward contraceptives.

When Stigma is Law

This section focuses on the Philippines. In the early 2000s, the Philippines did not legally guarantee access to contraceptives. Some localities required a prescription for condoms, while others banned contraceptives altogether. A national bill to legalize contraceptives was stalled for over 10 years due to opposition from the Church; the maternal death rate rose, even as it fell worldwide. A new president and a motivated lawmaker renewed efforts to pass the bill in 2010. The bill gained momentum thanks to male allies and was passed in 2012.

The United States

Chapter 3 ends with a brief discussion of the US. Widespread contraceptive use resulted in the lowest teen pregnancy rates in the country’s history, as well as low rates of unplanned pregnancies. The Teen Pregnancy Prevention Program serves low-income girls nationwide, while the Affordable Care Act makes birth control accessible at no cost. The administration of President Donald J. Trump, however, sought to defund or eliminate such programs—most notably, Planned Parenthood (as they perform abortions). Trump also proposed stopping all contributions to the UN Population Fund, using “morality” to justify his actions.

Chapters 2-3 Analysis

Gates stresses the Catholic faith throughout her memoir as it is one of the primary factors driving her philanthropy: “Faith in action to me means going to the margins of society, seeking out those who are isolated, and bringing them back in” (73). In Chapter 3, she describes being moved by lyrics she heard in church and at daily Mass in Catholic school: “The Lord hears the cry of the poor” (65). The nuns instilled in students a sense of responsibility, telling them it was the role of the faithful to respond to these cries. Gates takes this responsibility to heart, describing the cries of women around the world: “They are far apart in time and place, but alike in their struggle to be heard and in the reluctance of their communities to listen” (65).

Being driven by faith does not mean Gates’s views always align with those of the Catholic Church. Her promotion of family planning in particular put her at odds with the Vatican. The Church historically opposed the use of modern contraceptives such as birth control pills, condoms, diaphragms, and injections. According to the Church, contraception goes against ‘natural’ law (i.e., it promotes immorality, undermines the institution of marriage). Although Gates is Catholic, she rejected the Church’s teachings and devoted herself to improving the lives of families.

Gates’s decision to lead her foundation’s family planning efforts also grew out of her encounters with women whose lives were devastated by unplanned pregnancies. In Malawi, she met a desperate young woman who tried to give up her newborn and two-year-old son: “‘The only hope I have for this child’s future,’ she said, ‘is if you’ll take him home with you’” (56). Gates was so upset by the encounter that it colored the rest of her trip. She realized that the foundation was falling short by focusing solely on clinics: “We weren’t seeing the whole picture. […] My visit to Malawi opened my eyes to women who knew about contraceptives and wanted contraceptives but couldn’t get them” (58). Listening to women led her to devise and implement more effective family programs.

Despite pushback from the Church, Gates chose to follow her conscience and support women her own way:

I don’t see my actions as putting me at odds with the Church; I feel I am following the higher teaching of the Church. I have felt strong support in this from priests, nuns, and laypeople who’ve told me that I am on solid moral ground when I speak up for women in the developing world who need contraceptives to save their children’s lives (74).

Despite numerous studies detailing the benefits of contraceptive use in developing countries, the Church spoke for abstinence and against the London summit—one publication even accusing Gates of spreading false information. Gates received negative attention online, with netizens referring to her as “former Catholic Melinda Gates” and “so-called Catholic Melinda Gates” (72). The comments stung, but she remained steadfast in her commitment, putting the needs of other women before her own.

Gates continues to balance personal and scientific stories to keep readers engaged and stress the urgency of her philanthropy. At the start of Chapter 2, she relays studies in which almost 750 million people live in extreme poverty worldwide (31). Statistics, however, do not capture the desperation of the world’s poor. Gates pairs statistics with stories about women and children she met during her travels, effectively putting faces to the issue of global poverty. She describes visiting a slum outside of a large African city and seeing children left to fend for themselves. Without adult supervision, danger was a daily part of these children’s lives: “I saw kids playing near electrical wires on a rooftop and running near sewage […] I saw children playing near pots of boiling water where vendors were cooking the food they were selling” (32). In sharing such anecdotes, Gates evokes empathy from her audience—a strategy that likely came in handy when receiving pledges.

Some of Gates’s anecdotes seem designed to shock readers. In Chapter 2, she recounts a conversation with Dr. Rosling about his time in Mozambique during the cholera epidemic of the 1980s. In one village, he was met with instant respect as he previously treated a member of their community, who died in childbirth. The circumstances of her death were gruesome: “He had to remove the child to save the life of the mother. [...] 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” (35). This conversation is jarring but serves a broader purpose. Dr. Rosling firmly believed in seeing life—no matter how painful—through the eyes of those he wanted to serve. After the woman’s death, a local nurse arranged to have her and the infant’s bodies wrapped and sent back to the village. This event taught Dr. Rosling the importance of understanding the beliefs and needs of his patients. Gates embraced this approach, traveling around the world to speak directly to women about their health and families.