How billionaire philanthropy provides reproductive health care when politicians won’t

How philanthropists brought us modern contraception — and where we’d be without them.

There’s a new backlash against billionaire philanthropy. Some of its leading voices have argued that “every billionaire is a policy failure” and that it’d be better if billionaires didn’t exist at all — even if that meant the disappearance of philanthropy by billionaires.

The conversation has done a lot of valuable work, encouraging more scrutiny of charitable activity, pointing out where philanthropy is a fig leaf for misconduct, and forcing institutions to grapple with when it’s wrong to accept money that was unethically acquired.

But while I agree with much of this critique, it does have its blind spots. The overall vision laid out by opponents of billionaire philanthropy sees taxation and government policy as the prime levers to effect positive change in the world. That may be true in many cases, but it’s not true in all of them. And one issue in particular would suffer greatly if billionaire philanthropy was reduced in scale or ceased to exist tomorrow: reproductive health care.

Reproductive health care, more than most issues, has been enormously shaped by individual billionaire philanthropists. Many of the critical breakthroughs in the field were philanthropy-funded, as are many basic services today.

The reason for philanthropy’s big role in this issue area? It’s a matter of both logistics and politics. US foreign aid to support reproductive health worldwide is too vulnerable to the whims of the American electorate. Under Republican administrations, funding for access to contraception in both the US and abroad is typically slashed. Meanwhile, abortion is never funded by federal spending under Republicans or Democrats. Other countries provide international aid programs, but the impact of small changes in US policy is still substantial.

This is how we’ve arrived at a point where Bill Gates and Warren Buffett, two of the biggest philanthropists in the world, are the leading providers of access to contraception worldwide, and Buffett is the leading provider of abortion access for poor women in the U.S.

f you could snap your fingers and rid the world of billionaire philanthropists instantly, hundreds of millions of women worldwide would lose access to contraception. And in the US, only the rich would have access to legal abortion.

“The ideal solution is for the federal government to fund accessible high-quality voluntary family planning for anyone who wants it,” Liz Borkowski, a researcher in the Department of Health Policy and Management at George Washington University, told me. “Obviously, this is not what we’re seeing.”

Much opposition to billionaire philanthropy has focused on the injustice of letting the few decide policy for everyone else. And to be sure, “taxes, not billionaires, should fund key services” is a noble idea. But without a plan to dramatically change the funding priorities of the US government, the idea of doing away with billionaire philanthropy can lead to consequences that many of its supporters would probably agree are unjust.

In the realm of reproductive health care, making the idea a reality would mean ripping the rug out from under vulnerable women. The best critiques of billionaire philanthropy are those that are mindful of where it’s doing harm, where it’s doing good — and where it’s doing good that otherwise might not get done at all.