Interview with Melinda Gates

How Revolutionizing Our Caregiving System Is ‘the Key to Reopening the Economy’

By Marianne Schnall


The Bill & Melinda Gates Foundation has always risen up to confront some of our world’s most complex and serious problems, so it comes as no surprise that they are at the forefront of addressing the global pandemic, having committed more than $300 million to the COVID-19 response since January 2020. They are currently working with partners to accelerate global action against COVID-19, strengthen low- and middle-income countries’ social safety nets and their capacity to respond to the virus, and help ensure the rapid development and widespread availability of essential commodities, including Personal Protective Equipment, diagnostics, therapeutics, and vaccines.

In addition to all of these vital efforts, Melinda Gates—who is the co-chair of the Bill & Melinda Gates Foundation and founder of Pivotal Ventures, and who had been already doing far-reaching and groundbreaking work at the foundation in supporting gender equity and women worldwide—began thinking about the specific impacts the pandemic was having on women, particularly on the domestic caregiving front. Like the many other cracks in our systems the pandemic has exposed and exacerbated, it has become starkly clear that the caregiving system is broken and disproportionately burdening women, given the fact that women are the country’s primary care and service providers, and because they make up a majority share of workers in hard-hit job sectors: 86% of all nurses, 75% of primary caregivers, and 62% of minimum and low-wage workers are women.

And even though most women now work full time outside the home, they still spend two times more hours on caregiving, are ten times more likely to stay home with sick children, and are three times more likely than men to quit their jobs to take care of a family member. Since the pandemic began and schools closed, 43% of employed mothers have said they are primarily responsible for providing childcare, while only 7% of employed fathers say the same.

In a recent op-ed for the Washington Post, Melinda argues that in order to reopen the country and rebuild the economy, we will need much more than testing and contact tracing. To keep sick Americans home and get healthy Americans back to work, we will need a radical new approach to caregiving. In her op-ed, Melinda lays out solutions that policymakers, business leaders, and investors can act on so America’s broken caregiving system doesn’t hinder our recovery and leave vulnerable communities behind.

I had the opportunity to speak to Melinda about the critical issues she raised in her op-ed, including why the impact on women and the aspect of caregiving became an area of focus and concern for her, why she thinks fixing our broken caregiving system is vital to our reopening and recovery, what she sees as the policies, innovations and solutions we can implement to create a more functional and equitable system, and how addressing this issue of caregiving is connected to her overarching goal of achieving gender equality in the U.S. and around the world, a cause which benefits us all.

Her heartfelt passion to these issues was evident, as well as her conviction that this pandemic was making many unseen and unaddressed societal problems “visible,” affording us a unique opportunity to address those issues and “build the world we want.”

Read the interview below or listen to the podcast.


Marianne Schnall: First of all, thank you for all of the critical work that you and Bill and the foundation are doing to address so many vital aspects of this pandemic. And a special thanks for taking on this angle of the disproportionate impact on women, as well as addressing this caregiving angle, which is so important and yet also so overlooked. So just to start there: the pandemic is, of course, looked at mainly as a health issue, and clearly vaccines and treatment development for COVID-19 have received a lot of attention from government, business and philanthropy. But can you share how you think social issues like caregiving have received short shrift? And why is it important we start thinking about this?

Melinda Gates: I think whenever you’re in a crisis like this—and it is a health crisis to begin—you immediately have to go to, okay, let’s address health. I mean, health is the basic thing people need, right? So I think it was right for the country’s response to initially go toward health, and I think much more is still needed to get out of this pandemic. However, we also have to look at the impacts because, as we know, the very few tools we have are social distancing and hand washing and wearing masks and that just even the social distancing—of saying all of a sudden, okay, stay home—that has profound effects on what’s going on now in our homes.

So parents taking care of young kids, parents bringing their elderly parents to their home or trying to take care of them from afar, domestic violence on the rise in the home. And at the same time, people are trying to work. We’re trying to keep this economy going, so we have to look at these societal effects and impacts because they’re real and they’re there. And for one of the first times, some of them are actually visible to us. Where we’ve kind of wanted to shy away and think of them as invisible before, they’re actually quite visible, which means now is our time to use this moment to seize it and to address those issues.

Schnall: I agree with you—this is exposing the many overlooked cracks in our society and systems. Why was the aspect of our broken caregiving system one that you felt the inspiration to focus on?

Gates: Well, one thing I did this past fall was I wrote a piece, and then put a billion dollars down behind it, on what would it take to really move women forward in our country. Because I believe that if you want to have the right society, if you want to take care of everybody, you have to have women and men equal. And we’re just not there yet in the United States.

So I talked in that piece about the two barriers holding women back and the investments needed to move women forward. The two barriers holding women back in this country are sexual harassment and discrimination, followed by caregiving. Our economy is built on the back of women’s caregiving, and we never address that as a nation. We don’t put the right policies in place such as paid family medical leave—we’re the only industrialized nation that doesn’t have that policy—and that is holding women back. So I’m basically taking one of those two barriers that I wrote about, and I’m highlighting it and trying to show what’s needed from a policy and a business perspective to move us forward as a nation.

Schnall: In talking about caregiving, it’s important to recognize the fact that women are the ones who do the majority of it and that it’s often unpaid work that isn’t given any economic value. How do you think we can begin to shift that?

Gates: I think we can begin by recognizing the fact that our caregiving system has been broken, and if we are going to reopen this economy—which we have to do very slowly and very carefully—this is one of the keys to reopening the economy, to unlocking it again. So we have to recognize the fact that of our nurses who are out on the front lines taking care of us, 86% of them are women. Of the primary caregivers in this country, 75% are women. Low-wage workers who we’re calling essential, we know their jobs are essential—keeping our grocery stores open, making sure our prescriptions are filled—62% of them are women. So if you want to reopen this economy, you better make sure you’re going to protect and keep those women safe because they’re the ones who are caring for everybody else. They’re the ones who are the primary caregiver at home for the young children or the elderly parents. And we know this from good data. So you’re not going to be able to reopen the economy unless you’re really addressing these issues.

Schnall: In terms of addressing the issues, what do you see as some immediate caregiving solutions—either government policies or business decisions—that you think could be put in place to alleviate some of the burden on Americans, especially women right now, as we prepare to reopen?

Gates: Well, from a policymaker perspective, we saw one step—and I consider it a step, a down payment—which is in one of the stimulus packages. They did provide for ten sick days for people when it’s needed during this time. But if you just look at those ten sick days, if somebody goes out into work and is exposed to COVID-19, they are supposed to quarantine themselves for 14 days to keep themselves and their family safe. So ten days? What are you going to do on the other four days? Well, we know a huge portion of our economy of our workers don’t even have access to one sick day. So Congress needs to step up in the next stimulus package and offer far more sick days and paid leave that cover not just this acute time right now but cover the entire time we’re in the pandemic because we’re going to have to reopen very slowly. And it means we’ve got to be a bit more flexible. So what can businesses do? They can be more flexible in their work hours where they can. They can change over some of the shifts in the way they do that for their assembly line workers or their warehouse workers. They can give credits for childcare options. And long term, even think about even childcare solutions that maybe are on site. We’ve got to be creative during this time.

Schnall: What happens if we don’t? What are the actual functional consequences of leaving caregiving issues unaddressed coming out of this pandemic?

Gates: Well, what you’re going to see is far more women dropping out of the workforce. We know women are ten times as likely to stay home when there’s a sick family member versus their husband. We know they’re three times as likely to leave their job if there’s somebody really sick. So you’re going to have women dropping out of the economy at a time when what’s been propelling our economy forward is to have great female workers. So when you think that and you think about, okay, where do we want to be going as a nation when we know it’s often women who see the full picture of family and work life? Wow, that would be an enormous step backward. I talk about in my op-ed how it’s going to be like after World War II—we are going to be rebuilding our economy and we get chances to rebuild.

After World War II amazing institutions were built. NATO was built, the World Health Organization, the United Nations. We had nurseries for women’s children during World War II because women were working in droves; men were off at war. But we didn’t keep those nurseries up, and so women went back home. Whereas if you look at the Nordic countries, they actually not only kept that childcare in place, they expanded it. So it meant women could work and could have really great childcare options. It meant you have more female leaders, more women working in those Nordic countries and more equality, which is just good for a society.

Schnall: Absolutely. And I think there is the concern that if we were already making some progress, albeit slow progress, in these areas, there’s a danger that we could actually regress if we don’t take proactive steps.

Gates: Yes, and the other thing is we can invest in businesses. Look, we’re bringing marketplaces together on the internet, right? We’ve been doing it—you see it with driving services that you see with grocery services. There are great ideas out there that just aren’t being invested in. Like one of them I talk about in my op-ed, a platform called Winnie: literally parents can go online and find out, not only before COVID but during this COVID crisis, which childcare centers are still open, which ones are doing safe practices and which ones are high quality. So that if I need to go and work on the front lines in my grocery store, I actually have a childcare option. I mean that’s just matching marketplace. We haven’t done that in the past. We need to invest in those kinds of businesses. The opportunities are there, but as investors, we kind of pattern match; investors go after what they know. No. Let’s go after some of these $4 trillion opportunities—that’s what the size of the caregiving economy is—and let’s build what we need for families.

Schnall: And obviously employers have a role to play in creating better working situations in the wake of this pandemic. How would you advocate that in terms of employers creating more flexible working arrangements to help alleviate some of the caregiving burden for both men and women? How should employers plan for these options when we do return to work?

Gates: I think employers are going to have to be incredibly flexible with their workforce because you’ll have some workers who can come back right away, some who will come back but then need to go out because they have a sick family member or they get sick, or you’ll have some workers who can’t come in right away because they don’t have childcare. And school is closed in 47 states; we don’t know yet if it’s going to reopen in the fall. So employers are going to have to be incredibly flexible with what do meetings even look like in the future? How many of them are online or are they mixed, where a few people are in the office and a few people are online? How are they flexible about the timing of those meetings because, guess what?, kids need to have breakfast, lunch and dinner, right? So there’s going to have to be flexibility in the system, and there’s going to have to be more give on sick days for people or medical leave days.

Schnall: I know we talk about the impact on women generally, but this of course has even more serious implications for women of color who face additional obstacles. How do you think we can make sure we incorporate an intersectional approach in how we think about these issues and how we offer help and support?

Gates: I think you need to have those women of color voices at the table to say what are the stresses that they are uniquely under. I mean, women of color represent more than half of our direct care workforce—more than half. So they have to be there in terms of helping design the solutions that could possibly work and explain what are the unique stresses in their environment.

What are we doing for the single mother that typically relies on grandparents for care so that they can go to work? Or the woman that has to ride two buses each day to her essential job and find care for her two children when they’re supposed to be physically distancing? I think about them. Those are the women who are being the most exposed. So what do we do to help design into jobs and policies, things that allow them to still have an income and put food on the table for their kids and not have to be the ones that get up on public transport? Or maybe they can have more flexible work hours at a time when a neighbor can help them with their kids. But those are the women we need to be thinking about. They’re the most vulnerable who are helping us hold up our society.

Schnall: The other topic that seems to be in the zeitgeist right now is, there’s all this talk about how female leaders around the world are fairing so much better during the pandemic and being such effective leaders. Why do you think that is, and what do women ultimately bring to leadership? How can we better support women’s leadership across sectors here in the U.S.?

Gates: I think that we need to hold up those female leaders and make sure everybody sees them—young girls see them, girls in college see them, young women entering the workforce see them—and see that a woman can be a leader, an effective leader. You asked me why I think those women are being particularly effective right now? Because I think those women bring a whole life perspective to their job. They don’t come just as, “Ah, we have to do the right thing for the economy or the right thing for our capitalist structure.” They come with a full perspective of, “Wow, maybe I’ve lived through the sandwich generation of having older parents and young kids in the house and I’m a working mom.” That is hard, right?

And so you see Jacinda Ardern in New Zealand—she’s a young mother, with a young child. So she knows how hard it is to be a prime minister and be a working mom and have a child. You see Chancellor Merkel—you know, I’ve talked to both of these women numerous times. Chancellor Merkel was underestimated at her job from the very get-go. She’s a physicist. Look who is leading that country. And it is taking a full perspective of taking the science, do the testing, do the tracing, think about the vulnerable, open up slowly. That’s full female leadership at its core. And the male leaders who are doing well in this crisis are the ones who also, quite frankly, have that full perspective of how do we care for everybody? They let some of their feminine side come through. So I think for too long we’ve looked at leadership as being this male style and we instead need to say, “No, no, no, no. We need leaders who get to be whole life perspective leaders in their roles.”

Schnall: I one-hundred percent agree with you. This moment is a time for reflection and hopefully recreating new paradigms as the old world as we know it falls away and we have the opportunity to reimagine and rebuild. What is your highest, most aspirational vision of a new improved world that is possible?

Gates: A new improved world to me looks like one where we have true equality for everybody in society. Real equality. That we stop having these side conversations about women’s issues or saying they’re soft issues. We just say no: women deserve their seat at the table alongside men. They have the same skills, they can be trained up, they can do the right things. And not just white women—all women, women of color. Gosh, I have some incredible friends, women of color, whose ideas are just as amazing as those of white males I know. They just have a harder time getting their ideas funded. So let’s open up these diverse perspectives and build the world that we want, that takes care of everybody in our human family and, quite frankly, takes care of the earth as well. I mean, it’s pretty nice to see a clear sky in Seattle. You know, I didn’t grow up here and I keep saying to some of my friends, “My gosh, I can see the mountains when I go out for a walk.” And they said, “Yeah, you didn’t grow up here. This is what it was like when we grew up here.” The skies are clear because we have less people driving their cars. And so I think we have a chance to do a rethink on society and what we want both for future generations and for this earth.

Schnall: This is a time of such concern and overwhelm, and it’s easy to feel perhaps a little bit despondent. What keeps you hopeful and energized in doing this work?

Gates: You know, I see human ingenuity all the time. When I’ve been able to travel, which I can’t right now, to many African countries I love going to, I see the spark of human ingenuity and the lengths people go to to start a business or feed their kids. And right now in the U.S. you’re seeing that human ingenuity, you’re seeing it in our healthcare workers who are showing up under hard circumstances to do their jobs or the employees in this country who are essential, who we don’t normally say to them, “You’re essential,” but they’re the ones that are keeping our grocery stores open so we can go buy a loaf of bread. That’s the human spirit and the best of human beings, and that keeps me deeply hopeful.


This interview originally appeared at ForbesWomen


Visit COVID Gendered for more articles, information and resources. 


Marianne Schnall is a widely-published interviewer and journalist and author of What Will It Take to Make a Woman President?Leading the Way, and Dare to Be You. She is also the founder of and What Will It Take Movements.