When a sympathetic president, Benigno Aquino III, took office in 2010, Pia decided to push for the bill in the Senate, highlighting the tragedy of maternal death and saying, “No woman should die giving life.” She was told it was hopeless, that her colleagues would amend the bill till she didn’t recognize it, and she’d never get the votes to pass it anyway. Other senators heaped doubt on her statistics about mothers dying and downplayed the significance of the mothers’ deaths, saying that more men die at work, so women shouldn’t complain. Not one of her male colleagues would support her until one senator stood with her—her younger brother, Alan Cayetano.
When Alan joined the debate on the side of his sister, men began to acknowledge the hardship the current law created for the poor. As the bill gained momentum, the Catholic bishops intensified their opposition, and Pia and other supporters were targeted in personal ways.
One Catholic congregation hung a banner outside its church with the names of the legislators who voted for the reproductive health bill. The banner was headlined TEAM DEATH. In sermons, priests would mention Pia’s name on the list of people going to hell. She stopped taking her family to Mass so her children wouldn’t have to hear it.
At the same time, Pia told me, some Catholic leaders reached out to her, offering political guidance and building a bridge of quiet cooperation around common goals of supporting the poor and reducing the deaths of mothers and infants. With a lot of effort and delicate diplomacy, the bill passed—and was immediately challenged in court.
A year later, in May of 2013, I met Pia at the Women Deliver conference in Malaysia. She told me she had to put off a long-planned visit to the United States so she could be in the Philippines to make oral arguments at the Supreme Court. The following spring I saw Pia’s name in my inbox with a joyous message and a link to this news article:
MANILA, Philippines (UPDATED)—After earning the ire and ridicule of some male colleagues for defending the controversial reproductive health law, a beaming Senator Pia Cayetano hailed the Supreme Court decision upholding the legality of its key provisions.
“This is the first time I can honestly say I love my job!” she said.
“Many women who have questioned this, even men, are people who have access [to reproductive health], so this is for the poor, especially poor women, who do not have the ability to access their own information and services.”
It’s easy for me to connect very deeply with people doing this work, and I’ve always found it exciting to watch and applaud the success of people I admire, even when I have to do it from a distance. But I especially appreciate the chance to show my love and respect in person. When Pia came to the US for a conference in Seattle in 2014, I was able to give her a big hug, and it reminded me how much all of us in this work need one another. We give energy to one another. We lift each other up.
The United States
The work of Pia and others in the Philippines was a huge success. In another success, Great Britain has cut its teen pregnancy rate—once the highest in Western Europe—in half over the last two decades. The experts say success came from connecting young people to high-quality, nonjudgmental counseling.
The United States has also been successful in bringing down teen pregnancy rates. The country is at a historic low for teen pregnancy and a thirty-year low for unintended pregnancy. Progress is due largely to expanded use of contraceptives, which accelerated thanks to two initiatives begun in the prior administration—first, the Teen Pregnancy Prevention Program, which spends $100 million a year to reach low-income teens in communities across the United States; and second, the birth control benefit in the Affordable Care Act, which allows women to get contraceptives without paying for them out of pocket.
Unfortunately, that progress is in jeopardy—both the drop in unwanted pregnancies and the policies that helped make it happen. The current administration is working to dismantle programs that provide family planning and reproductive health services.
In 2018, the administration put out new guidelines for Title X, the national family planning program, which serves 4 million low-income women a year. The guidelines basically state which kinds of programs the government will fund, and this version does not mention any of the modern contraceptive methods approved by the Food and Drug Administration. Instead, it named only natural family planning, or the rhythm method, even though less than 1 percent of the low-income women who rely on this federal program use that method.
The administration also proposed eliminating the Teen Pregnancy Prevention Program, which would end a crucial supply of contraceptives for teens who need them. We’re talking about young people living in poor areas who have few options, like teens from the Choctaw Nation in Oklahoma and teens in foster care in Texas. In place of these services, the administration wants to offer abstinence-only programs.
Overall, its goal seems to be replacing programs proven to work with programs proven not to work, which, in effect, means that poor women in the US will have less access to effective contraceptives, and many poor women will have more children than they want to just because they’re poor.
Another dire threat to family planning in the United States comes in a policy the current administration has proposed but not yet finalized—one that would stop federal funds from going to healthcare providers that perform, or even refer for, abortions. This is similar to laws already enacted in Texas and Iowa, where the effect on women has been devastating. If this policy takes effect nationally, more than a million low-income women who now rely on Title X funding to get contraceptive services or cancer screenings or annual exams from Planned Parenthood will lose their healthcare provider. A half million women or more could be left with no provider at all; there are simply not enough community health clinics to serve the women who will be cut off by this policy. If you’re a woman with no economic means, you may have nowhere to go.
For women outside the United States, the administration has proposed cutting its contribution for international family planning in half and cutting its contributions to the UN Population Fund to zero—even though there are still more than 200 million women in the developing world who want contraceptives but can’t get them. Congress has so far stood up for poor women and largely maintained previous levels of international family planning funding. But the world needs the US administration to be a leader for women’s rights, not an opponent of them.
The administration’s new policies are not trying to help women meet their needs. There isn’t any reliable research that says women benefit when they have children they don’t feel ready to raise. The evidence says the opposite. When women can decide whether and when to have children, it saves lives, promotes health, expands education, and creates prosperity—no matter what country in the world you’re talking about.
The US is doing the opposite of what the Philippines and the UK did. It is using policy to shrink the conversation, suppress voices, and allow the powerful to impose their will on the poor.
Most of the work I do lifts me up, some of it breaks my heart, but this just makes me angry. These policies pick on poor women. Mothers struggling in poverty need the time, money, and energy to take care of each child. They need to be able to delay their pregnancies, time and space their births, and earn an income as they raise their children. Each one of these steps is advanced by contraceptives, and each one is jeopardized by these policies.
Women who are well off won’t be harmed, and women with a stable income have options. But poor women are trapped. They will suffer the most from these changes and can do the least to stop them. When politicians target people who can’t fight back, that’s bullying.
It’s especially galling that some of the people who want to cut funding for contraceptives cite morality. In my view, there is no morality without empathy, and there is certainly no empathy in this policy. Morality is loving your neighbor as yourself, which comes from seeing your neighbor as yourself, which means trying to ease your neighbor’s burdens—not add to them.
The people who push these policies often try to use the Church’s teaching on family planning for moral cover, but they have none of the Church’s compassion or commitment to the poor. Instead, many push to block access to contraceptives and cut funds for the poor. They bring to mind the words of Christ in the Gospel of Luke: “And you experts in the law, woe to you, because you load people down with burdens they can hardly carry, and you yourselves will not lift one finger to help them.”
It’s the mark of a backward society—or a society moving backward—when decisions are made for women by men. That’s what’s happening right now in the US. These are not policies that would be in place if women were making decisions for themselves. That’s why it’s heartening to see the surge of women activists across the country who are spending their time knocking on doors, supporting family planning, and changing their lives by running for office.
Perhaps a big push for women’s rights has been triggered by these recent efforts to take rights away. I hope that’s what’s happening now, and that the fire that drives this defense of family planning fuels a campaign to advance all rights of women, all around the world—so that in the future, in country after country, more and more women will be in the room, sitting at the table, leading the conversation when the policies that affect our lives are made.
CHAPTER FOUR
Lifting Their Eyes
Girls in Schools
When Meena asked me to take her children home with me, I realized we had to do more than help mothers give birth safely. We had to see the big picture. That’s why we expanded our foundation’s work in family planning. But every time I’ve thought, Okay, now we’re seeing the big picture, I’d meet another woman or girl who would show me a bigger picture. And my most important teachers were not the experts we would meet with in Seattle. They were women and girls who met us in their towns and talked about their dreams.
One of our teachers was Sona, a 10-year-old girl who came from a very poor community in a village called Kanpur, home to one of the lowest castes in India. The people there lived in about six feet of trash because of the work they did. They would go gather the garbage from other areas, bring it to their village, pick out whatever had value, and sell it—leaving whatever they couldn’t sell strewn on the ground around them. That’s how they earned a living.
Gary Darmstadt, my foundation colleague, met Sona on a visit he made to Kanpur in 2011 to talk about family planning. On the morning of his visit, he greeted our partners from the Urban Health Initiative, and they all walked through the village till they came to a place where meetings were held. As soon as the group stopped, a cluster of women gathered around them, and Sona—the only girl among them—walked up to Gary and handed him a toy parrot. She had found the raw material in the trash, bent and carved it into the form of a bird, and now offered it as a gift. When Gary thanked her, Sona looked him in the eyes and said, “I want a teacher.”
Gary was a bit thrown by this. He had come to Kanpur to discuss family planning with the women of the village, not to start a school. For the moment he left aside Sona’s comment and began talking with the mothers. It turned out they were very happy with the program. For the first time, they felt they were beginning to gain some control over their lives. It’s always gratifying to hear good news. But throughout the conversation, Gary could see Sona standing around waiting, and as soon as there was a pause, she would say to Gary, “I want a teacher. You can help me.” Over the course of three hours, probably fifty times she looked at Gary and said, “I want a teacher.”
After the group had finished its talk, Gary paused and asked one of the mothers about Sona. The woman said, “You know, we’ve told you how family planning has helped us. It’s had a tremendous impact on our lives. But the truth is, unless our kids get an education they’re going to be right back here living in trash like us. It’s good to be able to control the size of my family, but I’m still poor, and I’m still picking trash. Our kids are going to have the same life unless they can go to school.”
It takes courage to ask for what you want—especially when it’s more than people think you should have. Sona had a magical combination of courage and self-regard that allowed her to ask for a teacher even though she was a low-caste girl whose parents picked trash for a living. She probably didn’t even know how bold she was being. But the women around her knew it—and they didn’t tell her to be quiet, which in a way made Sona the spokeswoman for the group, saying what the mothers believed but didn’t quite have the nerve to say.
Sona had no leverage over anyone. She had only the innocence of a child speaking her truth and the moral power of a girl saying “Please help me grow.” That power guided her in the right direction, because more than almost anything else society and government provide, education determines who thrives.
Education is a vital step on the path to empowerment for women—a path that starts with good health, nutrition, and family planning and prepares you to earn an income, run a business, form an organization, and lead. In this chapter, I want to introduce you to some heroes of mine, people who have opened up opportunities for students who were treated like outsiders undeserving of an education.
But first, let me tell you what happened to Sona. Our partners who met with Gary to talk about family planning knew the area and its laws well. When they heard Sona saying “I want a teacher” and listened to a mother talking to Gary about education, they got together and developed a plan. The land Sona lived on with her family was not registered with the government. In fact, they had no legal right to be there. So our partners went to the local government and did all the work needed to get Sona and her neighbors registered as inhabitants, which was an amazing thing; the government officials could have found all kinds of tricks to block the change, but instead they supported it. When the people were declared legal inhabitants of that land, the families were then entitled to a full range of government services—including schools. Sure enough, Sona got a teacher. She got books. She got a uniform. She got an education. And not just Sona, but every kid in the village, and it was all triggered by one small child with courage looking a visitor in the eyes, offering him a gift, and saying over and over again, “I want a teacher.”
The Incomparable Lift of School
The lift that comes from sending girls like Sona to school is stunning—for the girls, their families, and their communities. When you send a girl to school, the good deed never dies. It goes on for generations advancing every public good, from health to economic gain to gender equity and national prosperity. Here are just a few of the things we know from the research.
Sending girls to school leads to greater literacy, higher wages, faster income growth, and more productive farming. It reduces premarital sex, lowers the chance of early marriage, delays first births, and helps mothers plan how many children to have and when. Mothers who have had an education do a better job learning about nutrition, vaccination, and other behaviors necessary for raising healthy children.
Half of the gains in child survival in the past two decades can be attributed to gains in mothers having gone to school. And mothers who have gone to school are more than twice as likely to send their own children to school.
Girls’ education can have transformative effects on the health, empowerment, and economic advancement of women. But we still don’t have detailed knowledge about why. What happens in the minds and lives of girls that leads to these benefits? Are the changes triggered by literacy, role modeling, the practice of learning, or just getting out of the house?
Many of the principal claims I’ve heard make strong intuitive sense: Women who can read and write can do better navigating the health system. School helps girls learn how to tell the stories of their families’ health issues to health providers. Learning from teachers helps mothers learn how to teach their own children. Also, when girls are in the classroom and see how they can learn, they begin seeing themselves differently, and that gives them a sense of their own power.
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This last idea is especially exciting to me—it means that women can use the skills they learn in school to dismantle the rules that keep them down. When I visit schools and talk to students, this is where I feel the power of the work. It goes back to high school for me, when I volunteered in a crowded public school tutoring kids in math and English. When kids learn something new, they see they can grow; that can lift their sense of self and change their future.
People who’ve been treated like outsiders often come to school thinking that they don’t deserve more and should never demand it because they won’t get it. Good schools change that view. They instill in their students an audacious sense of who they are and what they can do. These high expectations are in direct conflict with society’s low expectations for these kids, and that’s the point. Schools that empower students on the margins are subversive organizations. They foster a self-image in the students that is a direct rebuke to the social contempt that tries to keep them in their place.
You can see this socially defiant mission in good schools everywhere—in the United States, South Asia, or sub-Saharan Africa. These schools change the lives of students who’ve been led to believe that they don’t matter, that they don’t deserve a full chance.
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