Melinda French Gates announces $215 million for women’s health and urges philanthropists to act without fear

“It’s very freeing,” she says. 

So what is she doing with that freedom? She’s showing other billionaires how to spend their money—starting with addressing a lack of funding for women’s health in the U.S. and around the globe. 

In mid-May, that meant sitting on a couch at a former abortion clinic in Tuscaloosa, Alabama, with an 8-month-old baby on her lap. She was listening to the story of Asia Brooks, who had a difficult first birth and suffered postpartum depression. Brooks came to this clinic, WAWC, and had a completely different—and much more positive—experience for the birth of her second child last year. 

The clinic had closed after the overturn of Roe v. Wade, and then pivoted to provide other health services to women—reopening in a stately brick building that used to house a software company, funded by French Gates’ $5 million grant. French Gates was there to see how the clinic is incorporating mental health services to help people like Brooks, whose baby was busy playing with the multibillionaire’s notebook. 

Stories like Brooks’ influenced French Gates’ decision, announced today: She will put a fresh $215 million into women’s health, both in the U.S. and around the world, for a total of $600 million committed so far. Those numbers are just the start; the commitments are in a two-to-three-year “testing phase” that will focus on access to care during reproductive years, health during midlife and menopause, and mental health. With partners like the research-focused Wellcome Leap and the Menopause Society, which trains health care providers, those priorities will be applied across her firm Pivotal’s three signature levers: philanthropy, investing, and policy advocacy. 

The point is to dramatically grow support—not only from French Gates, but also from others among the ultra-wealthy. “I’m trying to send a signal,” she explains—that women’s health, always underfunded and now politicized as donors fear angering the Trump administration, is a viable category to back. 

Across two hourlong interviews, one in Tuscaloosa and one over Zoom, French Gates talked to Fortune about why this work matters to her and to the world—and how she hopes it might influence others with power. 

The following has been condensed and edited for clarity.

Why was now the right moment to add women’s health to your portfolio of work? 

Luckily, we’re living longer. I want to make sure women can reach their full potential, because when they do, society changes. Family, their community, countries change. But you can’t step into your full potential or your full power or influence if you’re not healthy. I’m also trying to send a signal that this is a space that really has not been focused on very much. 

How did your own experience in midlife influence your desire to do more work in this space? 

I had a pretty good experience, luckily, going into midlife. I was lucky enough to have a doctor who gave me options, but he did not tell me certain things about estrogen. But thank God I have older friends, and my older friends who had gone through these problems literally said, get on this now. Don’t wait until your doctor asks.  

When did it click for you that women’s health was the most important underlying factor for women to access power? 

Maybe 10 years ago. I was traveling so much, to so many countries in Africa. You’d be out in these communities and you would just see it—that if a woman had a sick child herself or she was dealing with her own illness, she just couldn’t work, she couldn’t provide. I would realize, we’re trying to help women step into their full power, have more control of the resources, more control of their decision-making. But if they are in poor health, there’s just no way. Then you carry it back to the U.S., and of course, it’s true here too. 

Are there any specific changes, pivots, strategy shifts that you’ve made over the past year as funding sources elsewhere for women’s issues have stalled? 

I put more money into the National Women’s Law Center. I put more money than I would have into the Center for Reproductive Rights. It’s gotten harder for them to do their work, because other philanthropists have also gotten afraid of doing that work. I’ve got to keep being bold and keep showing that, no, we can move forward and we should move forward.

What is the source of that fear? Why do you think other philanthropists are scared to put money into these causes? 

Because of the administration. They’re causing chaos and fear. Some of the spirit at the top is purposeful to push women back in society. I’m trying to demonstrate to philanthropists: These are spaces we should be moving forward in. Hopefully others will follow. 

Whether or not a philanthropist is having these concerns or fears—does it depend on whether they’re still active in their business and concerned about retaliation? 

There’s a calculus. If somebody’s still running their business, or their spouse is still running their business, their spouse will say, “Can we just slow down on some of that kind of work for a while?” It’s then up to the other spouse to say, “No, I want to keep going.” I think it’s situational where they live—who’s the governor in their state, who’s the state legislature. I also think sometimes when they see other philanthropists stepping out and being bold and doing the thing they want to do, then, look, OK, I can fund that too. 

Someone who’s in this circumstance you described, let’s say their spouse is still very active in their business and is asking them to slow down. What would you advise that person?

I say to them: What do you want to do? And is there a way that you can do this where you’re furthering what you care about in society, as well as supporting your spouse in their business? But I really often go back to, what is it you want? What do you stand for? 

You want to send a message to other philanthropists. Do you see any signs that that message is working? Is it being received?

Yes, by some. Absolutely, because I am talking with others and they’re saying, oh, I want to put some bets down in there. I am talking to more and more women, and it’s encouraging. 

What can you tell the general public who are not privy to those private conversations and are struggling to see signs that the ultra-wealthy have the world’s best interests in mind right now?

I would say to them that look, it’s challenging to speak out right now. There are many people doing work behind the scenes, but I think you can look at what people do, their actions. We have the old adage, actions speak louder than words. I look back at the giving MacKenzie [Scott] has done in the last year. Look at what she has said about historically Black colleges in the United States and the importance of them. People are maybe not always speaking about their grant-making, but boy, they are doing it behind the scenes.

Are you disappointed in your fellow billionaires? 

Depends on which one you ask me about. Anybody who is a billionaire in the United States right now benefited from growing up in the United States or coming to the United States. We have, by and large, good roads. By and large, you can get some quality of an education. By and large, you can get some quality of health care. We benefit from this country. My belief is, to whom much is given, much is expected. We should be giving back to society. Some of these businesses that have turned into gigantic businesses, you couldn’t start those businesses in Sudan, for all the reasons you and I can name. 

So for those who are not necessarily living up to those standards, what specific billionaire behaviors are disappointing to you?

I’ve never thought it’s good for billionaires to be flashy about their wealth, like we’ve seen that over time at all levels of wealth. You see it with people who have a million dollars, you see it with people who have $100,000. Flashing that around, that doesn’t do anybody any good. Fine, buy some nice things for yourself, but you don’t have to be flashy about it. 

I know we have an effect on other people. We know network effects, right? If there are five of us in a book club, and one of us starts smoking—or we’re in a group that decides we’re going to start exercising, we’re all likely to exercise. We have effects on one another. 

We’re at this pivot point right now, in the sense that a lot of new wealth is about to be minted in these mega-IPOs this year and in AI. What would you say to this new generation of people who are coming into this level of wealth?

I would say commit now to giving at least half of it away, no matter what it turns out to be, no matter how large, how small it turns out to be. Commit to giving half of it away, if you can. If you even have the ability to invest in those IPOs, believe me, you have the ability to give half away,

These conversations you’re having with women philanthropists about doing things differently, what does that mean? What does it look like to do things differently?

They’re thinking early and often at the very beginning about a partnership model. Who are the partners I need to pull in? Who knows something about this space? How do I learn? Is there anybody I could co-invest with? What I’m seeing is that women, as they’re getting started with their giving, often feel better when they’re co-investing with others, because it gives them confidence. 

Courtesy Pivotal Ventures

What makes you unafraid and bold to continue doing this work? 

I’m 60 now—I don’t know how much longer I have left. I hope I have a long time, but if not now, when? I grew up in a house where my mom said, Set your own agenda, or someone else will. Well, I’m setting an agenda, and it just feels right.

You’ve spoken about, in this chapter, having full control over how your philanthropic resources are used for the first time in your career. What has felt different about that to you?

It’s just different. If you’re in a role where you’re sitting next to somebody else and you’re trying to make a decision together, both people have to agree. We all have different points of view, we come from different places in life and different lenses, so to be free to make those decisions by myself and say no, I have enough knowledge here, I know enough, I’ve learned enough, I’m surrounded by the right people, we have the right research, I know enough to be able to make that investment decision, that philanthropic decision—I may not always get it right, but that’s OK. It’s very freeing. That is why you hear me often talk about how women’s power means they can use their full voice, they have full control over their decision-making, 

What are your values?

To know that one life has breathed easier because I have lived—that to me is success. Can everybody thrive and live the life that they want? And we can’t today.

Do you feel like you have a strong gut instinct?

Yes. I’ve long had a strong gut instinct, and one of the things I’ve really had to learn to do is to trust it and not push it away at times. It’s been making sure I keep constantly checking my gut to make sure it’s right. I will check in with other people to say, did you hear that in the way I did, or do you understand what that person was saying? I will often ask more questions of the person if I feel like they’re trying to, let’s say, sell me on something. I often have to also check with other people to see if my gut instinct is right, because they may see something that I don’t see. I don’t make decisions in a vacuum. 

Your gut instinct—we can see how it manifests through a few different parts of your life. You’ve written about knowing you needed to leave your marriage, you’ve described your clarity when meeting Jeffrey Epstein, and knowing right away that he was evil, and now in a different way, relying on your gut as you make decisions about where to put your money and how to invest in startups. How do you trust your instinct through all those very different circumstances?

I sit in silence. In silence I will go back and review the day before, what was I feeling in that room? How did that person interact? Because sometimes it’s hard to see in the moment, particularly if you’re in a big group. How did I feel when that person approached me? Well, what did they actually say? What did they mean about that? So it’s often in the quiet time that I’ll be able to go back and reflect. And that’s when I then come back to kind of a set of questions. Let me check on with someone else who was in that meeting, let me check with their perspective, let me call somebody, let me go for a walk with a friend, let me talk about it in therapy, those are all sort of gut checks for me, and once I am sure, then I’m ready to make a decision.

What has surprised you most about yourself, about who you are, without some of these structures around you that you had for so long, like the foundation and your marriage? 

I like spontaneity, and I’ve known that for a long time, but when you’re running a big institution, it needs to have certain processes. You lose some of that spontaneity. It surprised me how much I’m enjoying having a little more spontaneity in life. It just feels really, really good.

What’s something spontaneous you’ve done recently?

I’m kayaking this weekend with a friend. It just feels spontaneous to have some flexibility or flexibility of time. I was in Southern California recently over Memorial Day weekend, and I was like, I just want to go to In-N-Out Burger. It has nothing to do with philanthropy, I just want to go to In-N-Out Burger! I like to be able to just walk to a bookstore. There’s a place I can go to a bookstore that I can walk to, or a deli that I really like that I can walk to. It’s just really nice to just wake up on a morning, go, I want to do that today, right, versus having the day jam-packed from the second you get up to the second you basically are going to sleep. Don’t get me wrong, I still have some of those days, for sure I do, but I just have a little bit more flexibility again because we’re scheduling around one person, not two. 

We’re now only two years away from the next presidential election. How involved do you plan to be, or think you will be, as a political donor? Is that an area that you think is a good use of your resources?

In certain legislative seats, I’m investing in candidates on both sides of the aisle who have the same goals I have. If they’re for paid family medical leave and they’re for families, I’m probably supporting their campaign in some way. When it comes to the presidential election, I don’t know yet. I will wait and see, but I do know it’s important to speak our values, and for me that has always meant a centrist candidate. I feel like our country is governed better when we are closer to the center and we can hear one another. We’ll see where we get in the next election and who the candidates are. And then I’ll make a decision about, am I going to step in with funding or not? It’s about the candidate and what they really stand for.

In your professional life, what’s the hardest decision you’ve had to make?

Leaving the foundation. I love that institution. I love what we started there. I believe in it. I believe in many of the people I nurtured, many of those people’s careers. I started the strand of women’s health work there and other women’s economic empowerment. Luckily, that work goes on, but it was a very, very difficult decision to leave an institution I cared about so much.

The Gates Foundation has announced plans to spend all its resources, and then eventually shut its doors. Is that a model you would consider for Pivotal?

I don’t know yet. We’ve been around since 2015 but in a much smaller way back then. Now we have a lot more resources. Ask me in 10 years. Right now I’m just trying to keep things very nimble and flexible.