Ann Starrs is in the middle of her “quiet week,” a time to step aside from her busy schedule as director of family planning at the Bill and Melinda Gates Foundation and recharge. Yet, here she is on the phone talking enthusiastically about the new family planning strategy being undertaken by the foundation, about the importance of scientific data in policy- and decision-making, and the role of family planning in women’s empowerment.
“I was in an airport the other day and I passed by a shop and saw all these books about self-care, and I thought, ‘Yeah, that’s not my strong suit,’” Starrs says with a laugh after it’s pointed out that she scheduled this work-related interview during her so-called quiet week. “I’m very much about getting the work done.”
Starrs has been getting the work done ever since she graduated from UC Santa Cruz in 1984 with a degree in politics and a minor in economics. The Merrill College grad spent 25 years at Family Care International, a nongovernmental organization dedicated to making pregnancy and childbirth safe for women around the world, the last five years as CEO. Then, for four years, she was president of the Guttmacher Institute, which researches issues around sexual and reproductive rights. In July 2019, she landed the top family planning job at the Gates Foundation.
“I came to reproductive health work from a really strong commitment to feminism, to gender equality and women’s empowerment,” Starrs says. “It’s the belief that every girl and woman should be able to fulfill their potential.” Which means access to education, to economic opportunity, and the ability to prevent unintended or unwanted pregnancies and go through childbirth safely and in good health, she says.
Committing to an activist position
Her path to this belief is rooted not only in her childhood, but also in her time at UC Santa Cruz.
Starrs’s father was a foreign service officer, and she spent most of her childhood living in Spanish-speaking countries like Spain, Mexico, and Guatemala.
“I knew I was an American citizen, but I had much more of a global identity,” she says.
After spending three semesters at Swarthmore College in Pennsylvania, she transferred to UC Santa Cruz when her whole family moved west. She joined City on a Hill Press and found herself shifting from a focus based primarily on academics to one of social justice, feminism, and activism.
“Santa Cruz is what woke me up and engendered in me a commitment to a much more activist position,” she says. “I wanted to do what I could to make the world a better place.”
To help today's students get the same kind of activist education, Starrs has contributed to various programs that reflect her own experiences and values, such as City on a Hill Press and campus writing enrichment programs. She has also directed significant gifts recently to the UCSC Fund, which allows administrators to direct funds where they are needed most and can have an immediate impact.
A game-changing commission
Evidence of her desire to make the world a better place runs throughout her career, including her time at the Guttmacher Institute, where Starrs created a commission on sexual and reproductive health and rights in partnership with The Lancet medical journal. Made up of 16 experts from around the world, the group’s influential report laid out a series of evidence-based, essential, and affordable interventions to give people around the globe the right to make decisions about their bodies without coercion, stigma, or discrimination, according to Jonathan Wittenberg, executive vice president of the Guttmacher Institute in New York. The report still influences policy decisions around the world today.
The work of the game-changing commission, says Wittenberg, “speaks to Ann’s ability to shape, articulate, and execute a vision” while also building consensus.
It’s the same approach she is taking at the Gates Foundation.
Starrs talks excitedly of the organization’s updated family planning program, which has a budget of $280 million and was approved in January of this year.
Focused primarily on India, Nigeria, Ethiopia, and, to a lesser extent, Kenya, Pakistan, and French-speaking West Africa, the strategy will fund programs that give women the opportunity to have more and better choices around pregnancy and family planning. Almost half of the initiative’s budget will go to contraceptive research and development along with market shaping—what the Gates Foundation excels at, says Starrs.
Women’s concerns about the side effects of contraceptive methods, and the inconvenience of obtaining them, are major reasons women don’t use family planning even when they don’t want to have a child, Starrs says. As a result, the foundation’s strategy will fund research into things like a once-a-month oral contraceptive pill, a micro-array patch that delivers contraception through the skin, a self-administered injectable that will protect against pregnancy for three months, and even non-hormonal contraception methods that will make birth control more attractive and easier to obtain.
“By providing better options, we hope women will find a method that works for them,” she says. “It’s all anchored to a commitment to voluntary choice.”
Rodio Diallo, interim deputy director of Optimize FP Interventions at the Gates Foundation, says she was impressed not only by Starrs’s focus on data-driven evidence, but also by her collaborative approach. Speaking by phone from Nigeria, she says: “Ann would go across the foundation to build bridges and make sure we partner and complement each other.”
Policy anchored to data
Ask Starrs what she’s most proud of in her career and she says it’s her focus on making science-based decisions and not relying on simple narratives that can lead to ineffective policy, especially on the sometimes hot-button topic of reproductive rights.
“You want to have the change be what it needs to be. You need to anchor it to data,” she says.
Policy makers must know the scope of the problem, the impact it has, and why it is happening before making decisions because perceptions can often be wrong, she says.
“For me, it always comes back to enabling women and girls to achieve their potential, to manage their lives,” she says, “because having to go through an unintended or unwanted pregnancy can be a huge barrier to that.”
“Ann’s commitment to ensure there are expanded choices for women when it comes to contraception and letting women use their voices to make the decision that is right for them is very strong,” says Diallo.
