Putting Women and Girls at the Center of Development

It is well-recognized that gender inequalities exist around the world. Evidence has also mounted showing that the marginalization and neglect of the needs, roles and potential of women and girls are key factors limiting advances in human health and development outcomes for all -- women, men, boys and girls.

Moreover, strong associations have been identified between addressing inequalities and enhancing women and girls' empowerment and agency, and improved health and development outcomes across sectors ranging from agriculture to family planning and maternal newborn and child health and nutrition. Investing in women's and girls' empowerment is a smart investment for overall development as well as a matter of social justice. And many global health organizations are recognizing these facts and acting on them to magnify the impact they are able to achieve.

In this week's issue of the prestigious magazine Science , Melinda Gates weaves together her personal experience and journey of learning that has resulted in her call for our foundation to address gender issues more intentionally in our work. Drawing from the latest evidence as well as extensive observations and conversations with women in low and middle countries, she recognizes that it is a matter of social justice when women -- half of the world's population -- are marginalized, lacking in agency and voice, and unable to share in control of income or assets or influence decisions in their homes and communities.

Addressing gender inequalities is the right thing to do, as a fundamental right of women and girls to equal opportunity to live a healthy and productive life. She also argues that gender equality is key for achieving impact across multiple health and development sectors. It is the smart thing to do too.

It's important to measure the impact of health and development programs, not only on sector outcomes such as modern contraceptive prevalence rate, prevalence of stunting, immunization rates, or access to digital financial services, but also on gender outcomes -- things such as equitable decision-making power, personal safety, mobility, and equitable interpersonal relations in the home which promote women's individual dignity and safety. These outcomes reflect empowerment of women and girls not only as a fundamentally important end in and of themselves. They also are the ingredients that enable women and girls to be engines of change in their communities, thus creating a virtuous cycle of enhanced gender equality and women's empowerment and improved health and economic and social development for households, communities and nations. Thus, to ignore gender in health and development programming -- to be blind to gender inequalities and therefore to do nothing intentional to address them -- leads to missed opportunities to enhance the lives and potential of women and girls as well as men and boys, and leads to lost health and development impact as well. It's poor stewardship. What's more, being gender blind or unintentional is a roll of the dice. Impact of health and development programs may be lost, but women and girls could also be harmed. The potential for gender-based violence is real, for example, when women begin to gain access to financial resources through increased agricultural productivity, or family planning services, or, as highlighted by Malala, when girls gain access to education.

As a learning organization, Melinda Gates calls upon our programs to move beyond the existing evidence to help accelerate discovery of how to most effectively and intentionally identify and address gender inequalities. We also need to do more to develop better measures of the impact of interventions to enhance women's and girls' empowerment and agency. Combining interventions in health and development (for example, improved supply chain logistics for contraceptives) with interventions that address an existing gender gap (e.g., facilitating conversations between men and women, leading to more collaborative decision-making about family planning) might lead to enhanced sector outcomes (for example increased modern contraceptive prevalence rate) and gender outcomes. These actions may improve outcomes in other sectors too, for example improved child nutritional status. Aspects of agency such as equitable influence and control over assets and decision-making power have positive associations with outcomes across multiple sectors. Many organizations have worked for years to identify effective ways to address gender inequalities and empower women and girls. It's time for the foundation to join forces with these important and ground-breaking efforts, be more intentional about addressing gender inequalities, and scale up approaches that we know work, in context-relevant ways, within existing health and development programs.

Additional research and rigorous evaluation are also needed to investigate how addressing gender inequalities and promoting women's and girls' empowerment will enhance the ability to achieve impact in different sectors, and how sector and gender outcomes can influence each other. Furthermore, there is a gap in our knowledge of the existence and measurement of gender inequalities and the cost-effectiveness of approaches to address them in different contexts. Innovation, integration and better data and measurement are needed in this space. We don't have all the answers today but we have a plan and call to action to get smarter about each of these issues over time.

This is the journey of learning that Melinda Gates is calling the foundation to, and CEO Sue Desmond-Hellmann will be leading going forward. This is what we intend to deliver. Many of our program teams have been working intentionally to address gender issues, but we recognize that we can do more. We will be making additional investments in the near future, for example in a new Grand Challenge that will be launched in early October. It's an exciting evolution in our organization. Most importantly, it's a change that will position us to more effectively engage with partner organizations working to enable women and girls around the globe to improve their well-being and that of their families, societies and our world.