Melinda Gates: Can Listening Change the World?

Melinda Gates
I’m Alan Alda, and this is C+V, conversations about connecting and communicating.
Melinda: 50:18 We believe in philanthropy that we want to try and show what’s possible. When we came into this field 20 years ago, so many people would say, “But it’s just an enormous problem. It’s a whole, nothing can be done.” No, you have to imagine a future you want and then start to work backwards to break down the problem into manageable pieces and to come up with solutions. And believe me, we do not always get it right. We’ve had so many mistakes and failures along the way, but we learn from those. And we tack, and we pivot, and we keep going towards our goals.
That’s Melinda Gates. She’s the Melinda in the Bill and Melinda Gates Foundation, the world’s largest philanthropy. When someone wants to make the world a better place – and actually has the means to do it – you wonder: How do they go about it? What are their guiding principles? What works and what doesn’t?
We linked up between Melinda’s offices in Seattle and our studio in New York, and I found her to be both candid and inspiring.
Alan: 01:17 Melinda, this is such a treat to be able to be talking with you today. Because on this show we talk a lot about relating, and communicating, and being aware of the person you’re communicating with. And I get the impression from everything I’ve seen and read about you and by you, that that’s sort of a fundamental concern of the way you work to help the world be a better place. To be personal, to gather information firsthand from the people you’re helping. Am I right about that?
Melinda: 01:49 Yes. Well first of all, thanks for having me on Alan. Yes, I think you have to speak with people and really, really listen. And listen carefully to both what they’re saying and how they’re saying it, what they’re trying to communicate. If you want to understand someone’s life and then try to help them lift themselves up. So I spent a lot of time in villages all over the world, in townships and cities, really talking to people to understand their lives.
(Alan: 02:25 How did you get to the idea that in order to raise it up, not only women, but their whole community, that family planning was a key issue?
Melinda: 02:37 Well, I would be out in some of the most remote places in different countries in Africa, or Northern India. And people living in very meager and sometimes dire circumstances. And I would often be there to talk with them about their children’s health and talk about vaccines. But when I stayed long enough and really listened. I would always turn the question and answer time back for them to be able to ask me questions. They kept bringing up family planning and contraceptives over, and over, and over again. And it became this rallying cry I couldn’t turn away from. I was one, surprised how much they knew about contraceptives. But two, they kept saying, “I used to be able to have access to them and now I can’t. Don’t you see? Don’t you see? It’s just not fair for my children, for me to have another child.”
Alan: 03:30 They can’t feed them. They can’t care for them. Right?
Melinda: 03:34 No, they can’t feed them. They can’t care for them. Much less educate them. Many of them know, men too will tell you they know a sister who died in childbirth. A man told me he had a wife who died in childbirth. This was his second wife. Because if you can’t plan and space the birth of your children, the woman is not as healthy and her body’s not ready to have another baby Or the baby comes prematurely, which then has all kinds of complications.
Alan: 04:03 And you it struck me reading through your stories, and your book is so full of vivid stories. That I get the impression you don’t just listen once. You have to keep listening and adapting to different versions of the same need.
Alan: 04:22 I’m thinking of that story where I think you were in India, and you were working with sex workers and wanting to get them contraceptives so that they wouldn’t get STDs and that kind of thing. And then they said, “No, that’s not what we need.”
Melinda: 04:39 Right. Yes. We had a goal, a shared gold with the Indian government of trying to make sure that HIV/AIDS didn’t spread into the majority of the population. It still at the time was really following the same way the epidemic had started in other countries. It was following the trucking route because the men as they would go out in the trucks to have jobs, they were seeing sex workers. And so we had this shared goal that if we could stop the epidemic along that truck worker line, that it wouldn’t break out into the general population.
Melinda: 05:12 So as we started to do this work, we thought in a certain way, it’s kind of a simple solution. Like Thailand has done in other countries, let’s make sure that the sex workers demand condoms in those situations. But as we talked with the sex workers and we met with them, they said, “Yes, that would be a nice thing to do. We would like to do that. But are you kidding? We’re in these violent situations. You have to first help us work through the violence and how we can bring that down, and we need ways to talk about it.”
Melinda: 05:44 So we ended up creating these very, very tiny community centers where the sex workers could come together and talk about solutions, talk about ways to bring down the violence, have their children with them. Because they weren’t working, they had to care for their children. So we had to do that first before we could ever get to the point where they felt like they could then demand condom use of their workers.
Alan: 06:07 It’s so interesting to me because you were using communication to find out what the real need was. And in most other cases, I get the impression that women would walk miles, 10 miles to get to a center and find out there were no condoms available, no contraceptives. Here, they had them available. But their biggest need was a form of communication that would allow them to cut down on the violence every time they suggested that one be used. So you had the communication teaching you and as also as a solution, it was very interesting.
Melinda: 06:43 Well, and as we learned and spoke with other women then in other countries where the epidemic had broken out into the widespread population and we would say to married women, “But why are you asking us about contraceptives? There are condoms available,” because the HIV/AIDS program. And the women finally would say, “Are you kidding? I can’t demand a condom when I’m having sexual intercourse with my husband. I’m either suggesting he’s been unfaithful, or him suggesting I’ve been unfaithful.”
Alan: 07:18 Right, it was just a misunderstood signal.
Melinda: 07:18 Right? And so they were asking us for a different types of contraceptives, ones that they could use covertly from their husbands. And we needed to make sure that those supplies were available, which is a shot. Primarily women in Africa use a shot called Depo-Provera, but it had been out of stock for many, many years in many countries.)
Alan: 07:38 How long does the shot last?
Melinda: 07:41 It lasts for three months, and then a woman has to walk to the health clinic again and get it. And I will tell you it’s a very painful shot also, and there are side effects and the women don’t like the side effects.
Alan: 07:56 You know what has occurred to me, and I’m sure your organization, your foundation, which is so far flung in terms of the needs it meets. I’m sure you’ve considered this, but there’s this kind of tragic problem. It seems to me that the more lives you save, the more food you need to feed them. And the more clean water you need. Do you approach that problem directly?
Melinda: 08:26 Yes. So that’s an interesting myth that Bill and I also believed and were very concerned about when we came into this work. We said to ourselves, “My gosh, what if we save more babies with vaccinations or we offer family planning, what if we save more children, but then you have more children to feed?” Luckily, the converse is true.
Alan: 08:50 I’m glad to hear that. How does it work?
Melinda: 08:52 So a man or woman if they know that two or three of their children will survive into adulthood, they will naturally start to reduce the size of their family. They are basically running a calculus in their head that is an insurance policy. They have seen so much death in the developing world of children that they’re saying, “We want to make sure two or three of our children survive, so we better have five or six.”
Melinda: 09:18 I was in a village in India where there were probably, gosh, I don’t know, not quite 100 people there, and it was a group of women all sitting on mats with their children. And I said, “Everybody, would you raise a hand if you’ve ever seen someone die in childbirth or a baby that has died right after childhood birth?” Every single hand in the village went up. These villagers have seen death up close and personal, much of it.
Alan: 09:45 So to guard against, that they have a tendency to have more children. But then as the children are healthier, you find that they don’t go for that insurance policy, the women are spaced more? That’s interesting.
Melinda: 10:02 And we know that from around the world. If you look at contraceptive use throughout history, when contraceptives become widely available and there are different options for women because women use different types of contraceptives at different parts of their life or the reproductive cycle. Then all of a sudden within one generation, families start to reduce their size, the size of the family. So whether that’s in Europe, whether that’s in the United States, whether that’s Peru, whether it’s Bangladesh or a country in Africa. Families naturally start to bring down the number of children that they have.
Alan: 10:37 The pressure on women that you bring out in the book to do unpaid work is really phenomenal. And again, you tell a personal story that really strikes home when you were, let me see, where were you? In Africa I think. And you were living with a friend or colleague. And you did the work of the women in the family. 17 hour days were they?
Melinda: 11:08 Just about. Yeah, so my oldest-
Alan: 11:10 What was that like?
Melinda: 11:11 So my oldest daughter Jen, she was 15 at the time, and I went to live with a Maasai family in Tanzania. They were kind enough to have us in their home. And we said to the family going in, we were working with a community group that had been in this set of communities for over 30 years. So we went in with the community group and we said, we want to please live in your home. We said, “But don’t treat us as guests. We want to actually walk in the shoes of what [Ana 00:11:39],” was the wife’s name in the family. Ana, and her husband was [Sonary 00:11:42]. “We want to do the same chores Ana does every day.” And so we walked for miles to collect dirty water in a bucket. And I will tell you-
Alan: 11:53 Now tell me about this walking. You were wearing sneakers and they were wearing what?
Melinda: 11:57 I was wearing sneakers and Ana was wearing flip flops. And we had this old bucket that we collected the water in that might look like something you would put plaster on the walls in your home when the maintenance worker comes. Big, big bucket, put it on our heads. And we walked. It was not that hard to walk to what was the water pan. But walking home, once you had that bucket, you balanced it on your head, was so incredibly different. And believe me, I spend time working on my core in the gym. That didn’t even help.
Alan: 12:28 Can you do it without a lot of training. They’d been doing it all their lives. I imagine it puts a big stress on your neck.
Melinda: 12:37 It does. They have incredibly good posture, both when they work in the fields and when they cook. I watched Ana’s posture and how straight as a stick she keeps her back all the time. And it was funny because as my daughter Jen and I and Ana were walking back to her home, other women were coming out of their homes on the road to see us carrying this water. And they were all chuckling and laughing about how hard my daughter Jen and I were struggling. And these women are tough, and they’ve been doing it a long time.
Melinda: 13:07 So we collected water with Ana. We cooked. I cooked in the cooking at least five hours that day, which was a separate little hut as part of their Boma, their compound of tiny little mud huts.
Alan: 13:19 And what’s it like in the hut? Is it smoky or do they have enough ventilation?
Melinda: 13:23 Completely smoky. Luckily in Ana’s case, I’d been in other ones of these. She and her husband had built it in such a way that they knew to ventilate it out the back. But I’m still telling you when you’re there chopping onions, and chopping tomatoes, and boiling water, you’re getting a lot of smoke in your eyes even with decent ventilation. And it’s hot. And I followed her out to the field.
Melinda: 13:45 We went and chopped firewood, Jen and I chopped fire with Ana and her other daughters, which is a woman’s work in the developing world. I am terrible chopping firewood. Terrible. And she was quite good at, believe me, she kept trying to show me how to look for the right wood, and chop. And again, you go and put it on the woodpile, and guess what? There’s a whole bunch of scorpions.
Melinda: 14:07 I remember my Jen saying to her, “Hey, does anybody ever get stung by a scorpion?” And she’s like, “Well, yeah.” And Jen said, “Well, what do you put on it?” She said, “Well, nothing. You just deal with it.” So women are tough in the developing world.
Alan: 14:21 And what about mealtime? Did the women eat with the men, or that other process where they wait?
Melinda: 14:30 In that culture in Tanzania, the women actually eat with the men. That is not true in many other cultures. Like, I’ve stayed in homestays in Malawi and that is not true. So the women eat with the family. And Ana in the Sonary, her husband, were luckily in a very loving mostly equal relationship except for kind of some societal norms. So we all ate together. But when dinner was over, the interesting thing was it was 10 at night, dark as can be out on the plains and Tanzania. Moon’s out. We’re out in the dust as a group of women, Ana and her daughters and her sister and my Jen and me, doing the dishes in the dust in the dark. And yet, one of the sets of children in the home were twins, twin boy and twin girl. And they were just switching from primary school to secondary school, and had to take their entrance exam. The family was incredibly worried about the daughter Grace. It was a male twin and then Grace. The male twin had passed his exam and was headed into secondary school. They were so worried about Grace.
Melinda: 15:30 And what I observed was that that young male at night could go study in the home under the one light bulb they had. But Grace was out doing dishes with us in the dark at 10 at night. And when my Jen came out of our little hut with a headlamp, Grace, who was a pretty shy adolescent, which is pretty typical at that age, she came right up to my Jen and the one thing she asked us for while we were there is, “May I have your headlamp when you go home so I can study at night?”
Alan: 15:58 After being up so late working all day?
Melinda: 16:01 Doing unpaid labor.
Alan: 16:03 Yeah. You remind me of that wonderful scene you draw in your own kitchen. I love it that you’re so personal that you’re brave enough to tell inside stories. When you said nobody leaves the kitchen. Tell me that story again. I love that.
Melinda: 16:19 Sure. So we have a tradition in our family that after dinner, we all do the dishes together. So we would divvy up the chores. And quite often I would kind of clear the table and load the dishwasher, Bill would clean the dishes, the kids would be tidying up. But finally, I started to realize when the kids were little at night that everybody would sort of melt away when the dishes were done and loaded in the dishwasher to go upstairs. [inaudible 00:16:45] the kids to go do whatever they were going to do, homework or a little TV. And there I was in the kitchen a good 10 or 15 minutes left after everybody else.
Melinda: 16:53 So one night in a fit of personality, I put my hands on my hips and I said, “Nobody leaves the kitchen until mom leaves the kitchen.” And it turns out there are all these little things that you do to finish the cleanup that we hadn’t divvied out that no one else was noticing. Well I want to tell you 15 minutes melted into five minutes really quick, because when everybody picked up the extra little chores, we all went upstairs at the same time and that’s what we still do. You’re not allowed in our house to melt away upstairs until the kitchen’s all done.
Alan: 17:21 It’s funny to me because that’s just a little bit of communication where you let them know something that they had conveniently not noticed that somebody was still in the kitchen doing work, and that didn’t know how long it was because they weren’t there.
Melinda: 17:35 And I think that’s the hidden key in this unpaid labor is that we need to look at all those places. All these assumptions were women assume about themselves because their moms did it or somebody else they saw did it, that we take on these roles or the family or society assumes we will take on certain roles. Instead of the whole family coming together and saying what else needs to be done here? Why do we assume mom will just do it? Or we don’t see it. So much of this labor is hidden labor that we don’t see and recognize for what it is.
Alan: 18:10 I’m trying to think of that group in India that has this built in problem. I think they’re more untouchable than the untouchables. And you work with them, and you’ve got these young women who wouldn’t even look people in the eye because they accepted the stereotype about them that they were not to be related to. And you brought them so far forward, you and the people who were your colleagues.
Melinda: 18:40 Yes. So in Northern India, there’s a group called the Musahar, which are the rat eaters. And they are considered the lowest of the low. They are considered the lowest of the untouchables. And the example I give in the book is there’s a beautiful woman I met. Her spirit is beautiful, Sister [Suda 00:18:59]. And she realized that the only way to transform a girl’s image of herself was to fight hate with love. And she said to say somebody is untouchable or is the lowest of the low. That’s just an unkind, hateful thing.
Melinda: 19:18 So she founded a school, a boarding school where she convinced parents of these villages around her to let the girls come to the boarding school. And slowly but surely, she started to educate the girls, help them learn. She was incredibly respectful to them. She touched them a lot, would hug them when you went into the school because they’d been told they were untouchable. They weren’t worth touching.
Alan: 19:44 So it’s meant literally you can’t touch them?
Melinda: 19:46 You don’t touch them. And they’re told even when they’re walking to the school, they’re spit upon, they’re teased. They’re told they’re nothing. And so she said to transform their image, you have to educate them. And so she started doing that and they started all of a sudden lifting their eyes, and they started seeing themselves differently. And then she realized that they were facing violence even as they would walk home on the holidays or back in their village. So she thought, “Well, I’ll bring someone in to teach them karate.” So she said, “You want to think of a girl knowing she’s strong is if she can actually use karate to take down a man.” So she taught them karate and they could protect themselves.
Melinda: 20:21 Well low and behold, she decided to raise some money and take them to a local competition. They went to a competition and they won. Then they went to a regional competition and she raised the money for the bus fare. They won. Eventually, she raised the money and they went to Japan. And they went to a society that didn’t see them anything like they saw themselves. And they realized oh my gosh, that is just a message we got from society. And they won that competition. And her point is that if you want to fight hate, you fight it with love, and you fight it with education
Alan: 20:58 And the loving touch of karate when necessary.
Melinda: 20:59 And the loving touch of karate, that’ll set a man back.


Alan: 21:06 It’s really amazing the reach you have. We’ve been associated, you have such a large organization, you may not know that the Alda Center for Communicating Science has done workshops with some of your groups in the grand challenges.
Melinda: 21:25 Oh, sure. Yeah, I didn’t know that. But yeah, it would make sense to that group. Fabulous.
Alan: 21:30 It’s so great. You’ve got that sense of communication. Did you have to work on that or did you find you had it always and you could tap into it?
Melinda: 21:43 I think I’ve pretty much always had it, and I’ve just learned to hone the skill over time. I think I’ve learned how important communication is. And I’ve lived in worlds where people didn’t really value communication. Like when I was in computer science, and I came to know that communication is vitally important for anything that you want to do. So I’ve just tried to really hone that skill over time and to take feedback, and to work on my communication skills. And that’s a lifelong thing that I will continue to work.
Alan: 22:17 It is for me, a lifelong thing too. Once you get hooked into the idea that you can make contact with people and become aware of what they’re going through as you try to present your ideas, your thoughts, your feelings to them. You never can get to the bottom of that. We’re social animals and yet there’s this gulf between us and we’re always trying to bridge the gulf.
Alan: 22:42 The idea that you were mentioning before, I interrupted myself with my own soliloquy there. I know what I was thinking of. When you’re at work in a culture where something is not helping the people you’re working with because it’s a cultural attribute. In a way, how stuck are you? Because you want to respect the culture to be able to make contact with them. You don’t want to go in and say this thing you do because of your culture is a hurtful or damaging thing. And yet there’s some underlying need to change that practice. How do you handle that?
Melinda: 23:39 I think you have to go in and you have to constantly, we have to constantly our western world view hat off and really listen to what’s going on and why certain people do things that they do. And you have to do your very best not to judge. So again, if you have a goal let’s say of trying to save children’s lives or make sure that women don’t die in childbirth, you have to have your eye on the goal all the time. But you have to constantly tack, just like if you were in a sailboat race or if you’re in business, you tack on your strategy.
Melinda: 24:16 So when you hear these things, you have to think about what’s another way to go through that? Who’s another person in this culture that might see things differently and that can help me? I’ll give you an example.
Melinda: 24:28 In the villages in Senegal, the Imam, the village chief and the Imam, the local religious leader are the two most powerful people in the village. And they are men. But yet, and so often they will tell women that the Qur’an doesn’t allow for family planning. But if you meet with the senior leadership in Senegal of the Imams, they will tell you actually that’s a false notion. People mistakenly think that the Qur’an doesn’t allow for family planning. It does.
Melinda: 24:59 So if you say to them, “Well, would you all help us with this?” They’ll say yes. And when I started to ask them why said, “Why would you help us get this message out?” And they said, because one of them said, “My sister died in childbirth.” Another said, “My first wife died in childbirth. We don’t want our women to die. We love our wives and our sisters. So we need to help you. We know there’s this problem. We need to help get the message out. And there’s ways we can do that through our network.” So you find like-minded individuals who understand the culture, understand the context, and then you ask them respectfully for that help and that change.
Alan: 25:37 What about a difficult problem like genital cutting? That sounds so entrenched, as mandatory in the culture as foot binding was in China, it seems to me. How do you work against that? Is it a religious attribute, or is it purely cultural, to the extent you can separate those two ideas?
Melinda: 26:00 Yes. It’s something that has just been around for a long time. I’ve asked that question in many settings, and it’s just what they know it. Many places, I’ll give you an example of Senegal. In Senegal, they use a euphemism for it in the villages. They call it the tradition. And they just know it happened to them, it happened to their mothers, it happened to their grandmothers. And what they believe is that they are protecting the girl’s honor and her virginity, and that they’re protecting the family’s reputation. But it is something you do, the tradition.
Melinda: 26:36 So instead of coming in and blaming, and judging, and saying how horrific this is, you have to work with them on the ground with people who are living and working with them to start to introduce new ideas in ways that they can hear and listen.
Melinda: 26:52 So they may have a goal for instance, of cleaning up the water because they know that people are getting sick because there’s dirty water around and they want clean water. You help work on that first. But as you’re doing that, you start to have conversations of, “What else would you like to change? Have you ever thought of this?” You can introduce ideas like contraceptives. Eventually with enough time and trust, you can introduce the idea of do you know that not all women in the world practice that tradition? And as women then start to talk about what’s happening and why it’s done, it just starts to open their eyes. Just like the Sister Suda story from India. They start to think of things in new ways. Then you get the village to come together and men and women to talk about it. Then eventually the women and the men have to commit that they’re going to change this cultural practice. But then somebody, and it usually takes the village chief, needs to go talk to all the villages around. Because they can’t marry those girls in the other villages if the other villages expect their girls to be cut, there will be nowhere for them to be married.
Melinda: 27:55 So you have to give this time for this idea to percolate and spread, and people work through it to then to get them to commit. “We are not going to do this anymore.” And I think that’s probably the only way you get through female genital cutting.
Alan: 28:09 Sounds like there are two important elements. From what you just said, it sounds to me like you have to have a lot of staying power and you have to have the trust of the community, both of which take a lot of time and commitment from the person working.
Alan: 28:29 I’m reminded of a woman who wanted to be helpful at births as a midwife, but was not allowed, wasn’t trusted because she was western. Didn’t she help out with water first for a long time? Something unrelated to birthing.
Melinda: 28:50 Exactly. And I tell them her story in my book. She was in India. She was already helping in the village with other issues like water. But then they didn’t want her to help with births because they were used to the traditional midwife, but they were allowing her to attend births. She was in this emergency situation where she sees a newborn delivered, but the baby is blue. And she knows that the baby is getting chilled too quickly, too fast, and that child is extremely likely to dying, get pneumonia and die. So even though it was completely culturally inappropriate and was taboo, she scooped the baby up, and put it on her chest, and wrapped it in her Sari.
Alan: 29:35 [inaudible 00:29:35] to touch the baby at that point? Why was that?
Melinda: 29:38 Because the belief that perhaps the baby has an evil spirit inside of it and that evil spirit may rise up and kill all of us.
Alan: 29:49 Because if the baby is dying, it might be because of the evil spirit? That’s the idea?
Melinda: 29:54 That’s been cast into it from somewhere. Right.
Alan: 29:56 I see. So she put the baby on her chest and then what?
Melinda: 30:00 And then the baby started all of a sudden turning pink, and warming up, and breathing, and cooing, and crying. And the villagers, it was almost like you brought this child to life that they didn’t know could be alive. So all of a sudden the villagers started to realize that this practice, this woman from another part of India had been talking about and trying to teach them about, that it actually worked.
Melinda: 30:24 So the concept spread like wildfire throughout the villages. And then they started to take up this practice of what we call kangaroo care, keeping the baby warm immediately after birth, putting it on the mother’s chest. And guess what? They started to then realize hey, that wasn’t an evil spirit that was killing that child. That child was just getting too cold after birth because we had birth practices that as soon as the baby’s born, they would tend to the mom first, and then the child.
Melinda: 30:53 So if you go throughout time and history all over the world, when we can’t explain certain things about death, or about diseases, or about health, we tend to come up with other stories that our mind of what might be going on to explain it. And then we pass those stories down throughout history. You need to actually interrupt that chain and say, “No, here’s what’s actually going on, and we can actually solve this.”
Alan: 31:23 And interestingly, as true as that was, she wouldn’t have been in the position probably to help the baby in an emergency if she hadn’t had their trust, or at least that trust must have helped them pick up on the story.
Melinda: 31:37 They wouldn’t even had let her attend the birth if she didn’t have their trust. But because she’d been there so long helping them with other issues, and they were seeing her help make some progress, they at least said, “Okay, well you can at least attend some of these births and be with us.”
Melinda has been doing enormously insightful work to raise up the lives of women around the world. When we come back, our conversation turns to the status of women in our own country. Right after this short break.

This is Clear + Vivid—and now back to my conversation with Melinda Gates.
You reminded me a minute ago when you were talking about women and science. I’ve wondered, you’re doing this incredibly useful work around the world, helping to raise the status of women to what it ought to be. How about in our culture, the status of women in science, STEM? We do a lot of workshops to try to make sure that women have the tools they need, the communication tools to push back on problems that they get. Have you come across problems and solutions that we should know about?
Melinda: 32:38 Absolutely. So one of the things that I am passionate about is making sure that women get to be the top positions at an equal level, women and people of color in all professions. And one of the places that women are not as far along quite honestly are the STEM fields. It’s getting better in some areas and not as much in other. But let me give you a specific example of how this shows up and where it matters.
Melinda: 33:04 The contraceptive I talked about earlier that’s predominantly used in Africa, Depo-Provera, this intermuscular shot that’s painful, side effects. You get it once a quarter, you walk to your clinic. Do you know that in the United States, which is where a lot of the great science and new healthcare innovation comes from, that we have not been putting money into contraceptives, new forms of contraceptives in over 30 years. Because, our politicians and policymakers assume that problem is solved for women. Women here predominantly use the birth control pill. They’re pretty much happy with it. No. If you had new forms of contraceptives, women in the United States would take them up and women in Africa would take them up.
Melinda: 33:47 So you have to look at the problem in a different way. We just don’t fund certain scientific discoveries or data to collect data about women to then be able to know and go and fund. So guess what? One of the things we’re actually doing is funding new contraceptive technology. The contraceptive I talked about earlier that’s predominantly used in Africa, Depo-Provera, this intermuscular shot that’s painful, side effects. You get it once a quarter, you walk to your clinic. It turns out that intramuscular shot can be given subcutaneously, which is a tiny little shot under the skin. We’re trying to work on a six month formulation of it with less side effects, that a woman doesn’t have to walk to a clinic. She could eventually take it home and give it to herself. That’s an innovation. But unless you fund that issue, it’s just not going to change.
Melinda: 34:24 So I look at fields like law and medicine. The time I was in school late 1980s, there was a big gap between men, women graduating in those fields. Today we have basically parody in medicine, in law, if not slightly more women graduating in those fields. But in computer science, the field I was in, we were on the way up. We’d gotten to about 37% of graduates of computer science being women. But now it took a precipitous drop in the next 10 years. And guess what? We’re not down at something like 19% of women graduated with a computer science degree.
Alan: 35:01 What happened? Why would that take place?
Melinda: 35:03 Because the early personal computers, originally the Atari, the games were, they were very neutral. It was like Pac-Man, Pac-Woman, Breakout. Eventually when the IBM PC came out, they started marketing the computer to boys as a boys gaming device. And so guess what? All the game makers made games for boys, shoot ’em up games. So girls were saying, “Not interested in that.” So the boys go into it, the boys start coding, and the girls back out.
Alan: 35:31 So we have a vicious cycle.
Melinda: 35:35 We have a vicious cycle. And also when you think about the difference technology and computers have made in our society, they are changing society by leaps and droves. Think about a decade ago you didn’t have a cell phone in your pocket with apps on it. So we have to have women and people of color with a seat at the table in technology to create our future. Otherwise, we’re actually biasing, we already know we’re biasing our technology.
Alan: 36:01 It sounds like the same problem has developing new contraceptives. Unless you have women in a high echelons of policymaking or deciding which direction the research will going, there’s a blind spot that’s built into the person who’s directing the progress. And here you have the same thing. You need women in positions that can direct new forms of products that women and girls will go for.
Melinda: 36:35 Right. Because today if you want to create say a new application, a new piece of technology, generally you start by creating it and getting funding. You get venture capital funding. Well in United States, less than 2% of venture capital funding goes to a woman’s business. Less than 1% goes to a person of color. So right there, there’s already a big barrier gate put down in a woman’s face. And there are many reasons for that, but we have to break through that. We have to start funding ideas, women’s ideas for business. Because guess what? They have ideas that sometimes men quite often don’t see. So there are whole gaps and markets where men have their blinders on. Men don’t predominantly take care of the children. And yet there could be fabulous care giving apps that help a woman find a last minute babysitter. If she has a child who has dyslexia, go online and find resources for that. Go and find somebody that can help her. But we don’t fund those types of businesses because men don’t understand that part of the market very well. And they fund what they’re used to knowing can be successful. So they fund other male led businesses.
Alan: 37:47 So what do you think is the, I don’t know. I don’t know the word that would best describe. What do you think is the entry point that would be most successful to remedy this? Is it communication? Do they need to shell their ideas more forcefully?
Alan: 38:04 One of the things that you talk about in the book, every once in a while you talk about the importance of male allies. Not that, your effort is not to replace men, but to work side by side with them. And that kind of thing. Do we need more male allies? What’s the entry point you think that will be most effective?
Melinda: 38:31 I think we need several things. Absolutely male allies are a part of this. The only way we’re going to change society is for the enlightened men, I know many of them. You probably know many yourself. The enlightened men to help women more, to use their voice. To stop another man if he’s bullying a woman. To stop a man if he’s re-explaining her point in a meeting. And to sponsor and lift women up. We know that men in companies have a huge network. And at a 70% rate, they get sponsored in a business by another man. Inside the corporation, the women have very few sponsors. So that alone is one thing a man could do right then is decide I’m going to sponsor some women for jobs. And not just mentor, sponsor.
Melinda: 39:18 We need to in computer science, do several things. In venture capital community, we just have to break the lock. And that means actually moving money. Having funds that will fund women led businesses. So we have mentored women until the cows come home about how to present their ideas in venture capital space. And they’re still not getting funding.
Melinda: 39:38 So we just finally have to move money. So we’re starting to see funds raise up that expect a really good return, but they over index for women led businesses. And when we start doing that and men start seeing that money is left on the table, these businesses are successful, they’ll start to move in that direction. So money. Then even in computer science, we need to stop thinking about it as being what they call a pipeline, one way into computer science. No, we have to create lots of pathways for young women to come into computer science. It makes a huge difference if that freshmen entry computer science course in college, if it has real world problems versus theoretical problems. It makes a big difference if you take the guys who’ve coated for four years of high school, and move them out of the class, and let young women and entry level men start together and have role models in the classroom of who’s teaching up front. Those things alone are part of the solution of what will change.
Alan: 40:37 I’m not sure I understand the idea behind what you just said. It sounded a little like you were saying that women might have a different way of learning.
Melinda: 40:47 They have a different way of looking at the world. They are often less interested in spending time going through a very theoretical math problem on the computer. They are much more interested in practical solutions that are real world.
Melinda: 41:04 So if you literally take a math problem in an opening computer science class and you make the math problem just very theoretical, so they have to go code against that. Versus you take the exact same math problem, but you couch it in. And this will help in this hospital, in this way, saving this number of lives. And then will help the doctors be able to analyze this and follow up with the patient, etc. So you couch it in a real world problem. The woman is far more likely to want to go after that computer science class and say, “Yeah, I want to do that real world thing that helps people in a health healthcare setting.” And she’s still going to solve the problem. She’s going to solve the same math problem she would’ve done if it was theoretical. But she’s more interested in it, and she’s going to persist in it longer. And once she gets the first computer science class under her belt and sees that she’s been successful, because so often society has given her a message. If you’re not a white guy in a hoodie, you’re not going to be successful here. Once she sees she can be successful, she persists and keeps going.

Alan: 42:02 Yeah. That’s so interesting. It’s clear, you really look to ways to break down the problem and not take what first appears to be an obvious solution. There’s usually a complex system at work that you have to chop up and find out what the parts are. I get that impression from the way you talk, and you do that.
Alan: 42:27 But what’s interesting is you seem to have a very clear vision that it’s not just metrics, however important metrics are. You got to find out the humanity under the metrics. It’s a little bit like what you were just saying about seeing the math problem as a human problem. It gives you different insight. My guess is from reading your book, that you get insight into what you think are the solutions you can deliver by learning more about the people you’re delivering them to?
Melinda: 43:05 For me, the way I learn is to sit with people and talk with them, and really listen and hear. And when I hear a problem over and over again or I see it …
Alan: 43:21 Excuse me. Can you hear what’s coming on?
Melinda: 43:23 Mm-hmm (affirmative).
Alan: 43:25 We can both hear you. Okay. Okay, sorry.
Melinda: 43:34 Yeah. So the way I learn is I sit and listen, and try to listen very deeply to what’s going on and what the real world problems are that people face. And then by hearing that and hearing it repeatedly or seeing it in different settings around the world, I come back and look for the data that matches what I’ve learned to see if they actually match.
Melinda: 43:57 But what I have learned is that so often the data doesn’t exist. So like for instance, when women were telling me over and over again, “I used to have access to contraceptives, why don’t I have it now?” And I’m sharing this in village, after village, after village around the world. I came back and looked at the data. Well the data at the highest level will tell you there are contraceptives. They’re stocked in. But not until I dug down in the data. The data is very thin about what we’ve collected. But when I dug down, it’s like I found out condoms are available because of HIV/AIDS. But I already knew from talking to the women, as I told you earlier, they can’t negotiate a condom in their marriage.
Melinda: 44:32 And what I have come to learn is that we have actually collected very, very little data about women’s lives. We’ve collected a little bit of data about deaths and births, and a little bit of data about their reproductive life. But that’s about it. And again, it’s because society didn’t see that as important. Even in the science, the health sciences of men and women, we thought that drugs, the way they move through a man’s system, they move the same way through a woman’s system.
Melinda: 45:05 So we’ve recently learned in the last five years that you can’t just say that a woman is half the weight of a man, or X weight, that her body is just like a man’s essentially except for her reproductive organs and her weight. That is just not true. The way drugs move through her system move differently than through his system. And yet all the trials were basically for so long tested on men, and even male mice.
Alan: 45:33 Even male mice.
Melinda: 45:35 Even male mice. So we didn’t even, because we didn’t have women in these positions of power to say, “Could it move through differently through a woman’s bodies? Should we test it on a woman’s body?” So we both have not funded things about women’s health. We haven’t collected data at scale about women’s lives. And some of the data we do have, what I’ve come to learn is biased, inadvertently. And that is highly important to change all of those things< or we will not make decisions, good decisions on behalf of women all over the world. And yet women are not only 50% of society. They are the center of the families, and they are the ones in the developing world who lift their families up, who are expected to take care of the children's health, and feed them, and get them into school. So we have to look at this other half with finesse and collect data about their lives, and fund data, and fund research if we're going to really change society. Alan: 46:36 When you were talking before, and by the way that's beautifully said. When we were talking before about vaccines, I remember ... when we were talking before about vaccines, I was thinking of something I heard years ago, and I wonder if it's still true. That it's not just a question of making the vaccine available, but refrigeration is often a problem. And so many other elements in the supply chain that have not been perfected in some cases. Is that still a problem? Melinda: 47:14 It is a problem. It has gotten better over time. When we first got into this work about 20 years ago, one of the things bill and I was that there had been what they call cold chain, a supply chain that had been built up in the past. But it had crumbled. And what that meant was that let's say a new vaccine came out here for childhood disease in the US or in Europe. It meant that when that vaccine came out, because the cold chain was no longer working in the developing world, it was taking somewhere between 15 and 20 years for that vaccine to make it out to a country like Kenya or Tanzania. And even when it got there, it didn't have the right strains for those children. So one of the things we have worked on with our partners over time is making sure that cold chain actually works all the way down to the last mile, and making sure that the research and science is done up front so that when you create a vaccine, it's not created just for the rich world market, just for the strains of a disease that a child in the US or Europe has. But that you put the strains in right away for the kids in Kenya, and India, and Tanzania. Melinda: 48:30 So now when a new vaccine comes out say in the United States against a diarrheal disease, which is the biggest killer of children around the world, or pneumonia and diarrhea. When that comes out, it's basically now takes about 12 months, so a year to maximum 18 months for that vaccine to get delivered in Kenya. And when it shows up, it automatically has the right strains. Alan: 48:52 The problem is so complex and so enormous. It just amazes me that you've been so effective in taking it on, because people think of the Gates Foundation as having a huge source of money, but you've got a huge source of compassionate intellect at work as well. It's really, really nice to see that. Melinda: 49:18 I think one thing, if I could just add to that. I think one of the unexpected things to Bill and me after we started the foundation is we underestimated how much our business thinking from having worked, both of us worked at Microsoft and in that private sector. You always have a strategy. We were in that industry trying to create brand new products that had never been there before. So we had to imagine the future. And then you have a strategy but you keep, as I said, tacking on it and finding different ways. And that sort of business minded thinking with as you say, compassion and mixing the data and analytics, and where we don't have data going and getting it. And the stories, it's the mix of those skills with our partners that I think allows us to see the future we can imagine, which is a better world for everybody. But then to constantly break the problem down into smaller and smaller chunks and work on it, and tack against your strategy when things don't work. Melinda: 50:18 And we believe in philanthropy that we want to try and show what's possible. When we came into this field 20 years ago, so many people would say, "But it's just an enormous problem. It's a whole, nothing can be done." No, you have to imagine a future you want and then start to work backwards to break down the problem into manageable pieces and to come up with solutions. And believe me, we do not always get it right. We've had so many mistakes and failures along the way, but we learn from those. And we tack, and we pivot, and we keep going towards our goals. Alan: 50:53 Sounds like good advice for all of us, no matter what we're doing. We've sort of run out of time. I wish we didn't because I'm enjoying this so much. But before we go, we always with your good nature. willing to do this, I hope. We ask seven quick questions that invite seven quick answers. You game? Melinda: 51:16 Great. Oh, of course. Alan: 51:17 Okay. What's the hardest thing you've ever tried to explain to someone? Melinda: 51:22 How a computer actually works with the zeros and ones inside. Alan: 51:28 Oh, that's good. How do you handle a nosy person? Melinda: 51:35 I set up very clear boundaries, and I try and move them out of my life. Alan: 51:40 What would be a boundary? That sounds so interesting. "It's none of your business." That's sort of the big one. Melinda: 51:50 Yeah. "I'm living my life true to my values." Alan: 51:53 Yeah. Yeah. Okay, number three. How do you tell someone that they have their facts wrong? Melinda: 52:01 Very gently. Alan: 52:04 Yeah. Okay. Good. Melinda: 52:05 People don't like to be told that they're wrong, so you have to do it in a very gentle, kind way. And you don't do it in front of other people where you will embarrass them, or you'll get their back up and they'll never hear you. Alan: 52:16 Yeah. Good technique. A couple of our old favorite questions. What's the strangest question anyone's ever asked you? Melinda: 52:25 What I ate for breakfast. I'm like, "Do you care?" Alan: 52:29 People ask you that? Melinda: 52:30 Yeah. It's strange in an interview, like do you really care? Alan: 52:35 Sometimes they say that just to make you test the mic out. Melinda: 52:38 Yeah, that's true. I don't mind doing it for that purpose. Alan: 52:40 Yeah, as long as you know what it's for. How do you stop a compulsive talker? Melinda: 52:50 It's a technique I actually learned from Bill's dad, which is to say, "Wait just a minute." And I'll try and do it in a really friendly tone, and I'll just do a really gentle interrupt. Or I'll say if they're compulsively talking, "Just a second. I'd like to also hear what this person has to say." So I'll kind of use my hands to kind of stop them and then I'll gesture at the person that I'm hoping maybe can get in on the conversation. Alan: 53:13 Yeah, that's a thoughtful approach. How do you like to start up a real conversation with someone who you don't know at a dinner party? Melinda: 53:25 Yeah, I hate small talk to be frank. I really hate it. So I will try and ask them something about their day. Or if they have a family, ask them about their family. Getting them to talk about something that's very real to them. And then I might offer something about my family that feels a little unexpected or a little bit vulnerable, or a way that I can relate to them. Alan: 53:53 That's interesting, to show your own vulnerability. Probably invites people in. Melinda: 53:58 Absolutely. Alan: 53:59 Last question. This really interests me because I'm always interested in what all kinds of people say about this. What gives you confidence? Melinda: 54:12 Other women and men at my side where it's almost like we're in a rowboat, all pulling the oars together. And I sometimes can see their weaknesses and I'm sure they can see mine. But we're all trying to do the same thing together. And when I know they believe in that cause and I believe in it with laser focus too, I know we can get it done. So having other like-minded men and women around me, that's been hugely helpful to me. Alan: 54:39 That's great. I've had such a good time talking with you. Thank you so much. Melinda: 54:44 Thank you so much for this, Alan. I really, really enjoyed it. CREDITS Melinda Gates is an extraordinary human being, with a visionary’s mind. Her experiences have all taught her to understand that data is power. And she means this in a whole new way. To use her exact words – “data supports smarter decisions and better policies. It enables advocacy and accountability. It helps us understand each other better—who we are, what we need, how we can help.” Melinda’s recent book is called, “The Moment of Lift: How Empowering Women Changes the World.” And she hosts an online site called Evoke, which is made up of a community of optimists. You can join her community and find out more about the book and the big ideas that have been a result of her advocacy by going to: – that’s E V O K E (dot) org.