This week the Bill and Melinda Gates Foundation published a Valentine to their incredibly generous partner in philanthropy, Warren Buffett. Their letter responds to one from Buffett inviting the Microsoft founder and his wife to tell him how their charitable outreach has been going since he gifted them shares worth $31bn in 2006, and what they hope to do in the future. A lot of people will be interested, he said.
And it is interesting. Even impressive. The combined Gates and Buffett billions (the latter in yearly instalments) have helped speed up a reduction in childhood deaths in poorer countries that amounts to 122 million lives saved since 1990, the year the Gates first got involved in global health.
"Saving children's lives was the goal that launched our global work," says Bill Gates.
However, preventing more births seems to be the obsession that is carrying the work forward.
Contraception emerges from the letter (and other statements the couple have made this week) as the precondition of all real progress in the developing world: child survival, education, social and economic liberation of women and the end of poverty, the extreme of which has already been halved in the last 25 years, though not necessarily by birth control.
This is nothing new for the Gates. Back in 2012 they co-sponsored with the UK government an international get-together of birth control interests to launch a campaign to "deliver modern family planning tools to more women in the poorest countries." The project is known as Family Planning 2020.
Nor is it new territory for Warren Buffett, who, after decades supporting the abortion movement, has more recently poured money into relaunching the IUD in the US as a highly efficient, and supposedly safer (than its forerunner) contraceptive. Buffett thinks women should spend as little time as possible on reproduction and make themselves available for a really productive role in the workforce.
With their combined resources and influence, the Gates and Buffett have given a considerable boost to the number of women in the poorer countries using modern contraceptives. According to the "Dear Warren" letter, there are now 300 million women in the developing world who are using modern contraception. One third of them have been added only in the last 13 years, and the biggest increase has been in the last four years. They want to notch up 120 million more by 2020.
No doubt the couple's intentions are good, and they are great philanthropists. With the huge infusion of funds from Buffett, their foundation has played an important role in keep issues like infant mortality, malnutrition and disease - particularly in Africa and South Asia -- in front of the public and on government agendas over the last 10 years or so.
They can take a good bit of credit for vaccination programmes that now immunise 86 percent of children worldwide against diphtheria, tetanus, whooping cough and other common but often fatal infections. They are rightly proud of their contribution to a 30-year campaign bringing polio down from 350,000 new cases a year to just 37 in 2016.
And they continue to fund research and programmes tackling the stubborn problems of newborn mortality (45 percent of all childhood deaths) and malnutrition, a major contributor to child deaths. Nutrition, says Bill, "the biggest missed opportunity in global health".
Contraception, however, appears to be the biggest opportunity that has been seized in recent years, not least by Mr and Mrs Gates. It's about "empowering women."
Contraception, they argue, enables women to space their children, ensure their survival, feed and care for them better, decide on the number they will have, move into paid work - often by creating their own - educate their children and help lead their communities and countries out of poverty. That may be true, although the West solved poverty and maternal and infant mortality without it.
What they choose to ignore in their glowing account are the physical risks and cultural destruction that go with this impatient technological approach to the human problems of developing nations.
HIV risk. There is strong evidence , for example, that injectable hormonal contraceptives such as Depo Provera - the preferred method of family planning organisations working in Africa - facilitates the transmission of HIV, especially in young women. This has been known for several years, and yet Melinda Gates still promotes injectables, praising one variety in the letter to Buffett because it is so small and convenient and obtainable from an itinerant healthcare worker.
Sexually transmitted diseases are not confined to Africa, of course. One only has to remember the epidemic in the West and the accompanying risk of cervical cancer that has made vaccination of 12-year-olds against the HPV virus necessary to understand that, where contraception is the rule, sexual promiscuity flourishes and brings its own, sometimes fatal consequences. And this is what we want for Africa and India?
Abortion. Nor is disease the worst complication of a contraceptive culture. The legalisation of abortion quickly followed the contraceptive pill throughout the West as a back-up - or replacement - method of birth control, and abortion rights are central to the programme of every mainstream family planning organisation working in developing countries.
Unlike the British government and a few others, the United States has, under Republican presidents since Ronald Reagan, made US aid money to such organisations contingent on a pledge "not to perform or actively promote abortion as a method of family planning," even when those activities are funded by other countries or private foundations. Donald Trump's extension of this Mexico City Policy to all global health organisations that receive US government funding has the entire global "health" industry in an uproar, since they stand to lose a major part - if not the major part - of their funding.
The Gates themselves this week talked to The Guardian about it, Melinda expressing concern "that this shift could impact millions of women and girls around the world." This because, apparently, abortion taints "a broad range of health programs that provide lifesaving treatment and prevention options to those most in need." She mentioned HIV, TB and malaria. Others mention Zika and maternal health.
If nothing else, this confirms how integral abortion is to the aims of those peddling contraception, contrary to the values, usually, of the cultures they are working in.
Undermining the family. Contraception is culturally corrosive in another important way as well. With one exception, throughout the Gates' letter to Buffett the word "family" only appears as part of the phrase "family planning". Most of the time they talk about "women" or "children", or women and their children, but fathers barely get a look-in. And when "men" appear, in the section "Poverty is Sexist", it's to draw attention to their crippling dominance over women.
Empowering women is fine, but in their impatience to limit births the global busybodies want to get women acting independently of their husbands, especially when it comes to using contraception (the more discreet the better), in this way driving a wedge between husband and wife and putting the children at risk of family breakdown. Natural family planning has been used successfully in developing countries and helps build the marital relationship. A slice of the fortunes being thrown at contraceptive technology would empower both women and men to have the families they want.
If the Gates Foundation and partners are not equipped for that, there is plenty else they can do without pushing unnecessary drugs and devices. They could get more action on some of the things that they are already involved in but which, according to their own report, are neglected:
Nutrition, "the biggest missed opportunity in global health," malnutrition contributing to 45 percent of childhood deaths.
Training birth attendants who can ensure that all women have skilled help at the time of birth. With such help, Rwanda reduced newborn deaths by 30 percent just by promoting three simple practices: breastfeeding in the first hour and exclusively for the first six months. Cutting the umbilical cord in a hygienic way. And kangaroo care: skin-to-skin contact between mother and baby to raise the baby's body temperature.
Reducing newborn mortality. The number of babies dying at birth (1 million last year) or within the first month of life (2.5m) has actually increased and they represent 45 percent of all childhood deaths. Well over half these are due to sepsis and other infections; asphyxia/trauma (27 percent), and prematurity (29 percent). Research into the causes is under way, but clearly more action is urgent.
There are dozens more things Bill and Melinda Gates could do and have the power to do that would really improve the health and prospects of the world's poor. Right now they are squandering a lot of that capacity on something that is more likely to do them harm.