Gates, who is a pracitising Catholic and with her husband, Bill – the founder of Microsoft – is one of the world's biggest players on development issues, predicted that women in Africa and Asia would soon be "voting with their feet", as women in the West have done, and would ignore the church's ban on "artificial" birth control.
Gates, who was a speaker at the London Summit on Family Planning organised by her foundation in conjunction with the UK government and the United Nations Population Fund (UNFPA), said that since she announced her new direction a few weeks ago she had been inundated with messages of support from Catholic women, including nuns.
"A church is made up of its members, and one of the things this campaign might do is help women speak out. I've had thousands of women come on to websites and say 'I'm a Catholic, but I believe in contraception'. It's going to be women voting with their feet."
Gates said that in the West the bishops said one thing, but ordinary Catholics did another. "In my country 82% of Catholics say contraception is morally acceptable. So let the women in Africa decide. The choice is up to them."
She admitted, though, that she had agonised over whether to speak out in defiance of the church hierarchy. "Of course I wrestled with this. As a Catholic I believe in this religion, there are amazing things about this religion, amazing moral teachings that I do believe in, but I also have to think about how we keep women alive. I believe in not letting women die, I believe in not letting babies die, and to me that's more important than arguing about what method of contraception [is right]."
It takes a woman
Being a woman and a mother were at the heart of her decision to focus on family planning, said Gates, who has three children aged 16, 13 and 10.
"It would have been nice to stay as a private citizen but part of the reason why I'm so public is that it does take a woman to speak out about these issues … Why have women not been at the heart of the global health agenda? It's because we've not had enough women speaking out. We need to give a voice to women all over the planet … This will be my life's work."
Wednesday's conference, which brings together 250 delegates from around the world including Jakaya Kikwete, the president of Tanzania, Chantal Compaoré, first lady of Burkina Faso, and the Bangladeshi minister of health, AFM Ruhal Haque, is the launch of what the Gates Foundation is billing "a groundbreaking effort to make affordable, lifesaving contraceptive, information, services and supplies available to an additional 120 million girls and women in the world's poorest countries by 2020".
Gates was due to announce on Wednesday the exact amount the foundation is pouring into improving birth control, but it is likely to be millions of US dollars – and the hope is that others will raise the fund to more than $4-billion. The UK government is pledging to double its efforts on family planning, up from its current £90-million a year to £180-million a year.
In her interview with the Guardian, Gates said the moment had now come to push contraception back to the top of the development agenda.
She said that when she and her husband first set up their foundation 18 years ago, they had originally focused on family planning but had then shifted their agenda to providing vaccines after realising that childhood mortality was the top issue, and that women would not choose to have fewer children until they were sure their children would survive childhood. "But once we saw that was happening, we could take family planning back on," she said.
It was meeting women in Africa and Asia on her travels through the developing world, said Gates, which made her determined to push contraception back on to the agenda. "Over and over again women have told me that all they want is to be able to put time between one child and another child. It's a universal thing to want to feed your children and to educate your children, and women know that the only way they can do that is not have so many. And this campaign could give them the tools to make sure they can do that."
The campaign would include research to look at developing better methods of contraception, said Gates – and these methods could, in time, benefit women in the West as well as women in Africa and Asia.
"What I'm most excited about is thinking about tools that will have fewer side effects and could be longer-lasting," she said. "Luckily for women in the West it's not a life-and-death situation, but for women in the developing countries it is, which is why I believe in putting them at the heart of it." – © Guardian News and Media 2012