Q&A: The woman tasked with bringing gender to the center of the Gates Foundation

SACRAMENTO — Dr. Anita Zaidi, the first president of Gender Equality at the Bill & Melinda Gates Foundation, says growing up in Pakistan had a major influence on the trajectory of her career.

“I’ve thought a lot about how we design systems of care that don’t work for women, and how global health actually doesn’t work for women,” she said.

After training as a pediatric infectious disease physician in the United States, Zaidi returned to Pakistan, where she worked to improve access to care for women and children before being recruited to join the Gates Foundation in 2014.

While she joined the foundation as the director of Enteric and Diarrheal Diseases, and went on to lead Vaccine Development & Surveillance, she took on side projects focused on advancing progress for women and girls.

In June, the foundation announced that she would oversee the Gender Equality program team and Gender Program Advocacy and Communications team, while also leading the foundation’s broader gender integration agenda.

Zaidi assumed the role in November, and while she said she is still “in listening and learning mode,” she spoke with Devex about some of her emerging priorities.

This conversation has been edited for length and clarity.

During a particularly exciting time for your work on vaccines, what appealed to you about this opportunity to promote gender equality and ensure gender is incorporated throughout the work of the Gates Foundation?

When Mark Suzman became CEO earlier this year, we were of course working on women's issues and maternal and newborn child health, but we had not been as intentional as was possible across all of our work in the foundation to embed gender in the design of all of our programs.

So that was a thing we felt there was a huge opportunity to do. That's where the idea of the division came from. It’s fundamental to our core belief — everyone deserves a chance to live a healthy and productive life, and women and girls deserve a chance to live a healthy and productive life. How do we then, across the work of the foundation, bring gender to the center of everything we do?

That’s one part of it, and the second is raising the visibility of gender in the foundation’s work. I directly report to the CEO, I’m a member of the executive team, and I have access to Bill and Melinda and I can directly report to them. And so it just builds a lot of accountability into our work for gender.

The Gates Foundation has outlined a few specific areas of focus in its gender equality strategy overview. But what are some examples of missed opportunities for the foundation to embed gender in the design of its programs?

I can give you a long list. Let me start with one I have a real bee in my bonnet about, which is nutrition.

So, nutrition and anemia. Anemia is mainly a problem of women and girls because women lose blood every month during menstruation. We have never had a gender lens to nutrition, not just at the foundation, but globally. We know that anemia has huge consequences for health, for work, for energy, for pregnancies, for childbirth, loss of life. One of the big causes of obstetric hemorrhage is severe anemia. It’s such an obvious thing, and I just don't know why the world has not thought of nutrition through a gender lens — and what are the needs of girls and women, and how do we get more iron in their diet?

Another example is financial services for the poor. We think about financial inclusion, but we don’t understand: What are the barriers that women face in access to financial services? We’re saying digital finance is a big way for financial inclusion for women. But if they don’t have access to cell phones or the internet, how do you bridge that divide?

Another one is immunization services. Global health is not organized to serve the main people that seek global health, which is women. So for example, we divide up and fragment all of the services. Women have to go somewhere else for family planning, somewhere else to get their children immunized, somewhere else to get themselves immunized, somewhere else to deliver. Why can we not think of women at the center of global health and design services that serve women’s needs? 

The Gates Foundation is supporting a range of efforts to improve the collection and use of data on gender issues. Why is data so central to your gender equality strategy?

Data is a very core part, a cross cutting part, of everything that we will do. If I look at how we made all the progress that we made in the MDG [Millennium Development Goals] era for child mortality — showing progress or lack of progress were very big advocacy tools.

And advocacy of course will be a very big part of our strategy for women. If we’re not measuring progress, it’s very hard to call attention to the problem. If I look at the SDG 5 in the Sustainable Development Goals — achieve gender equality, empower all women and girls — that’s a really great goal, it’s our north star, but how do we know that we’re actually doing that?

When we start looking at the indicators under that goal, the paucity of data is just incredible.

And so all of that is going to be key. We have the Generation Equality Forum coming up in June 2021, which will be a key moment. We hope it will be a galvanizing moment for the world to come together around SDG 5. And to figure out what it is we want to do together as a community of people who really care about this issue, and lay out a framework for what the next 10 years looks like to get to 2030.

The Gates Foundation has made a pivot to address the gendered impacts of the COVID-19 pandemic. Can you expand on that?

There are many ways in which COVID is impacting women, but two that I’ll call out. The first is the obvious one. We knew poverty is sexist, and COVID has really exposed that. COVID shows how our current world is basically built on the backs of women and women's unpaid labor. I think in the recovery phase we cannot forget that, and we really need to mitigate all of these impacts.

There’s also another area that needs attention, which is pregnancy and risks to women during pregnancy from COVID, where we know the risk of mortality is much higher compared to non-pregnant women. Two hundred million women around the world get pregnant every year. And women are predominantly the front-line health workforce. So we have vaccines coming out. Those vaccines have not been tested yet in pregnant women. But we have no reason to believe these vaccines cannot be used.

A good thing has happened for the first time after a lot of women have raised this as an advocacy issue. The emergency use guidance from the U.S. Food and Drug Administration is permissive, where now women can decide if they want the vaccine or not instead of saying that pregnant women cannot get the vaccine.

We will get a lot of the data as women choose to get the vaccine after they've evaluated their risk and what their job is. So it’s not uniform. Not all pregnant women may have equal exposure.

While I know you said you’re in listening and learning mode, looking ahead, what are some other issues that may emerge as priorities?

COVID could end up reversing a lot of progress for women, and so the economic empowerment agenda is really important. I do not want to lose focus on that. That will remain a big priority for us for next year.

I also want to look at new opportunities for our work. Some in health — for example we talked about nutrition and anemia. We will do a whole formal strategy process where we figure out what the opportunities are, what’s the role of philanthropy, are there catalytic opportunities here?

The HPV vaccine is something I care about very much, and we don’t have vaccines rolled out in Africa, so that’s an important advocacy priority. And another thing that’s very personal to me is advancing women in leadership.

What big challenges do you anticipate you and your colleagues will face as you pursue this Gender Equality strategy?

Everyone around the world will agree that poverty is bad and that we should eradicate poverty. You don’t get that same response on gender equality. Not everybody is convinced that gender equality is a worthy goal.

So just the norms and cultural barriers that women and girls face around the world to me is the hardest challenge in this role, and in the work that we will do. How do we change people’s minds? How do we change women's own minds, about themselves and what their potential is? And how do we change the societal roles for women?

One thing I deeply believe is progress for women means progress for everyone. There is a very simple phrase that we’ve been using internally, which I love, so I’ll use that. “Equal is greater.”