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Eight days before the Supreme Court struck down Roe v. Wade, I found myself in Rwanda, in a crowded room with a group of 52 teen moms. One 14-year-old girl, already a mother of twins, talked to me while trying to wrangle her two boys. There was a hopelessness in her voice. “This is our only community,” she said.
Their weekly Thursday meeting was a joint project of the Rwandan government and Partners in Health (PIH), an international nonprofit that tries to bring modern medicine to the world’s most vulnerable. They’ve made huge inroads, but the work that looms before them with these women is practically insurmountable. Many had been abandoned by their families. Some were victims of rape or incest. And everybody knew a story about a girl who might have been at the meeting but wasn’t—because she didn’t survive the complications of an unsupervised illegal abortion.
My mom, Melinda French Gates, has told me time and again about Rwanda as a story of hope, and of what a community coming together can look like, given how the country rebuilt itself after one of the 20th century’s most horrific genocides. Yet bodily autonomy remains a critical issue.
During the meeting, I had a brilliant insight. At least, I thought it was brilliant. When the Roe opinion leaked in May, everybody said it would take us back 50 years. But you didn’t need to read history books to see what pre-Roe America looked like. That room in Rwanda was what pre-Roe America was like. And if more Americans could just see it, I thought, we’d never go back.
But then last Friday happened—and I realized that I was wrong. Completely wrong.
When you’re Melinda’s daughter, it’s easy to be passionate about reproductive health. My mom is my hero. She’s a brilliant reformer who travels around the world advocating for gender equality.
I was with her on Friday when the Supreme Court’s decision came down, and I told her about my revelation with the Rwandan teen moms. But she didn’t find it quite as insightful as I did. “I don’t think this is a communication or compassion problem,” she said. “More people agree with Roe than they did 50 years ago. Women won the argument, but we still lost the policy battle.”
She was right—as moms are, annoyingly, most of the time. Did I really believe that putting Clarence Thomas in a room with 52 Rwandan teen moms would suddenly make him vote like Elena Kagan?
The problem was never that we didn’t share enough compelling stories or appalling statistics. One more viral Gloria Steinem or RBG quote wouldn’t have saved Roe. This wasn’t about persuasion at all. It was about power. The wrong six people were in positions of authority. And they are why women lost the right to choose.
When I started college last year, I wanted to become an advocate, like my mom. So I tried to learn as much as I could about making policy, finding the best data, gathering the best ideas, and educating the right people. But now I realize I was blind.
There was a fundamental flaw in my thinking. Public health—especially women’s health—requires learning about power, and how to wield it. It’s not just about what to do, but also about how to get it done.
They understand this intuitively in places where women’s health is not guaranteed by the law. In Rwanda, my heroes are people like Dr. Florence Akiiki Bitalabeho, head of the community health department for the University of Global Health Equity; Raissa Umutesi, an oncology nurse; and Mariella Munyuzangabo, the associate director of maternal health for PIH Rwanda, where I’m interning this month.
Dr. Bitalabeho, who is also a professor, uses community engagement to make sure that PIH programs are both sustainable and driven by what the community asks for. Umutesi is not just a nurse; she also runs an entire support program for girls like the teen moms I met. Munyuzangabo helps maintain PIH’s vast maternal health program by constantly surveying female patients and training doctors around the clock. They’re almost more like revolutionaries than medical professionals. Yes, they treat patients. But they are activists too.
When Roe was overturned, these incredible workers and their colleagues told me they were concerned—not just for women in the United States but also for women in Africa. The United States sets the global agenda for women’s health. In developing countries, the United States funds more birth control pills, more condoms, and more maternal care than any other donor nation. Now that America has so drastically diminished women’s reproductive rights, doctors around the world are worried that their governments might say: “So will we.”
But this is the most important thing to know about people like Dr. Bitalabeho and Munyuzangabo: Nothing about their work is short-term. Women’s health, for them, has been a decades-long struggle for power and dignity. They are icons of a countrywide trend toward dedication and community uplift.
Rwanda has a remarkable corps of 58,000 community health workers who handle 80% of the country’s disease burden—and are not paid a dime as an official salary. For them, health care in general, and women’s health in particular, is not just a job—it’s a movement.
They form local support groups, and find strength in each other to keep going. Nurses serving severely understaffed communities figure out how to split their workload. And they often live in houses right next to their hospitals so they can, collectively, be on call 24/7. People like them are why, in Rwanda today, the big picture on the ground remains a hopeful one.
Today, the big question I have is: How many people are going to act like Dr. Bitalabeho and Munyuzangabo in the United States? Will my generation show that same commitment? Will we come together in large enough numbers to start a movement?
It’s been a terrible week for American women, and I know that just about everybody needs an emotional outlet right now—to fire off an angry tweet or post an abortion fund donation link. But the real test is whether we stay angry. Will we still be enraged next week? Next year? Over the next decade? Because that’s how long the power struggle for abortion rights may take. It took decades to gain the right to choose and 50 years to lose it. It may well take 50 more years to regain it again.
I’m only 19 years old, and I don’t know where life will take me, especially not decades from now. But I am sure of this: Wherever I end up, I’ll still be working to ensure that no woman–in America, or in any country–ends up in a room like the one where I met those 52 teen girls in Rwanda.
That, I hope, is the final legacy of Friday’s decision: that it created a whole generation of pissed-off young people who will devote our lives to winning back a woman’s right to choose. This time, for good.