The “global gag rule” imposed by Donald Trump, blocking US funds to any organisation involved in abortion advice and care overseas, could impact millions of women and girls, endangering their lives and those of their babies, Bill and Melinda Gates have warned.



The changes are expected to result in funding from the world’s biggest donor to family planning and women’s health programmes in the developing world being slashed. It could, Bill Gates told the Guardian, “create a void that even a foundation like ours can’t fill”.

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Gates and his wife spoke out as they published a progress letter to Warren Buffett, the businessman who 10 years ago invested a large part of his fortune in the couple’s foundation, which has at its centre the mission to save children’s lives. Empowering women and girls, the couple said, was central to that aim.

Trump signed an executive order reimposing the Mexico City policy, also known as the global gag rule, on his first full day in office. Republican presidents since Ronald Reagan in 1984 have imposed the policy, while their Democrat counterparts have lifted it. The rule strips funds from any organisation that “performs or actively promotes abortion as a method of family planning” overseas.

But Trump’s order goes further and applies to any organisation that receives funding from US Aid , not just those involved in family planning. That expansion, said Melinda Gates, was a surprise.



“We’re concerned that this shift could impact millions of women and girls around the world,” she said. “It’s likely to have a negative effect on a broad range of health programs that provide lifesaving treatment and prevention options to those most in need.



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“This includes programmes that prevent and treat HIV, TB and malaria, and provide healthcare to women and children around the world. Enabling women to time and space their pregnancies and providing access to treatment and prevention of infectious diseases is lifesaving work. It saves moms’ lives and it saves babies’ lives, and that has long had wide support in the United States.”

Bill Gates said their foundation would not be able to bridge the potential funding gap. “The US is the No 1 donor in the work that we do. Government aid can’t be replaced by philanthropy. When government leaves an area like that, it can’t be offset, there isn’t a real alternative. This expansion of this policy, depending on how it’s implemented, could create a void that even a foundation like ours can’t fill.”

He had an early phone call with Trump in November and then a meeting in December with the president-elect in New York, he told the Guardian. They talked about the eradication of polio, which Gates hopes could come as early as this year, and the research his foundation is supporting towards an Aids vaccine and ways to protect people from pandemics such as Ebola in west Africa.

“So that was a good discussion – the fact that he was interested in having me talk about the Foundation’s work – I was pleased,” said Gates.

But the philanthropist did not anticipate the scope of the executive order affecting family planning, an issue at the centre of the foundation’s work, that Trump was to sign.

Facebook Twitter Pinterest Bill and Melinda Gates with investment veteran Warren Buffett (R) in 2006. Photograph: Nicholas Roberts/AFP/Getty Images

The letter to Buffett is an assessment of the progress the Gates Foundation has made since 2006, when he pledged 10m shares in his company Berkshire Hathaway in annual instalments worth a total of $31bn at the time. The couple write of the progress that has been made in saving children’s lives, particularly through immunisation and vaccine development, and the work that lies ahead in making childbirth safer and tackling malnutrition.

Their letter makes clear what is at stake with Trump’s move to reimpose the global gag rule, arguing that women and maternal health are key to so many global health issues.



Empowering women is a key theme of the letter in which the couple argue that enabling women to access contraceptives control over the number of pregnancies they have is crucial. When women have a gap of at least three years between births, their children are more likely to survive and be healthy and well educated, the couple say. “Like vaccines, contraceptives are one of the greatest lifesaving innovations in history,” writes Bill Gates in the letter.

Since they set up their foundation its focus has shift from the hunt for technological solutions towards social change. The attention to women’s empowerment came from the evidence, the couple say.

“You cannot go out and be in the developing world and then come back and look at the data and turn away from the importance of women in the developing world,” said Melinda Gates.

Whether they breastfeed and take their children to be vaccinated makes a profound difference to how the child grows and his or her life chances, and men are not always there, she added. “So you have to look at the woman’s role and when you look at it you realise it can be an accelerator to every single thing you want to have happen in the world for global health and global development and social change.”

In their letter, Bill Gates says that poverty is sexist, a phrase he first heard from the U2 frontman Bono.

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“The poorer the society, the less power women have. Men decide if a woman is allowed to go outside, talk to other women, earn income. Men decide if it’s acceptable to strike a woman. The male dominance in the poorest societies is mind-blowing.”

In the letter, Melinda Gates adds: “It’s also crippling. Limiting women’s power keeps everyone poor.”

She and her husband tell of their visits to sex workers in India whom the couple say they encouraged to form self-help groups, thinking the women would help each other insisting their clients wore condoms to protect themselves from HIV. That vision, said Bill Gates, “was way too narrow”. The sex workers began to support each other in every aspect of their lives.

“Warren, if Melinda and I could take you anywhere in the world so you could see your investment at work, we probably would take you to meet sex workers. I met with a group in Bangalore, and when they talked about their lives, they had me in tears,” writes Bill Gates.

“One woman told us she turned to sex work after her husband left her – it was the only way to feed her children. When people in the community found out, they forced her daughter out of school, which made the girl turn against her mother and threaten to commit suicide.

“That mother faced the scorn of society, the resentment of her daughter, the risks of sex work, and the humiliation of going to the hospital for an HIV test and finding that no one would look at her, touch her, or talk to her. Yet there she was, telling me her story with dignity.”

Facebook Twitter Pinterest Bill and Melinda Gates receive medals from Obama at presidential medal of freedom ceremony in November 2016. Photograph: Carlos Barria/Reuters

There have been setbacks, such as the failure yet to end polio, but the couple emphasise the enormous progress that has been made in the last couple of decades in global health and speak in the letter of their optimism for the future.



“Polio will soon be history. In our lifetimes, malaria will end. No one will die from AIDS. Few people will get TB. Children everywhere will be well nourished. And the death of a child in the developing world will be just as rare as the death of a child in the rich world.

“We can’t put a date on these events, and we don’t know the sequence, but we’re confident of one thing: The future will surprise the pessimists.”