Ouagadougou - While widespread malnutrition remains the biggest child killer in Burkina Faso, mothers' tasks are made all the more arduous by a chronic lack of access to contraception, Melinda Gates, wife of billionaire philanthropist Bill, told AFP in Ouagadougou this week.
Like other west African nations, the landlocked country has a rapidly growing population that is struggling to feed itself, and nearly 40% of all deaths under five are down to malnutrition.
Gates announced a $34m investment in nutritional programmes, to teach young mothers to breastfeed their children until the age of six months, and healthier eating in general.
"If you care about the children in your country and you want them to reach their full potential, they need to be fed properly," she said.
The Bill and Melinda Gates Foundation, a multi-billion dollar charity and one of the most powerful in the world, has also earmarked $10m for contraceptive programmes in Burkina Faso to help women plan and space their pregnancies.
"If you don't give women access to contraceptives you are locking them into a cycle of poverty," Gates told AFP.
"When women have one child after another then they can't feed the kids properly so they don't grow properly and then the family don't have the resources... to then educate their kids."
In a country like Burkina Faso, with a population of nearly 20 million growing 3% a year, contraception can be a tool to not only cut birth rates, but also improve health, education and business opportunities for all.
But it can be hard to access in a society where condoms, the pill and other methods, are often unavailable or frowned upon.
"You have to go to religious leaders, traditional leaders, they need to hear it from a trusted community health worker," Gates implored.
"To be honest we also have to educate their husbands, sometimes even the husbands first and the mother-in-law," she said.
Knowledge about what contraceptive methods are available and how to use them is relatively low in Burkina Faso. And many community leaders are ambivalent or opposed to the benefits of birth control.
The fertility rate in Burkina Faso was 5.71 children per woman in 2017, according to the CIA World Factbook.
Melinda Gates' trip to the country is, in part, to promote the initiative and to learn about the problems the programme is up against.
"The Gates Foundation invests in access to contraception because we know the beneficial impact of birth spacing on the health of women, and children under five, as well as empowering women to choose if and when they wish to have a child," a spokesperson from the charity told AFP.
The $10m donation will boost efforts already promoted by the Ouagadougou Partnership, an alliance of nine Francophone West African countries and several international groups set up in 2011 to expand access to family planning in the region.
Gates lauds the success of the partnership, saying initial targets have already been met and that the nine governments are "learning from each other".
"You have nine governments in west Africa saying we want to do this and we want to do it well," she said.
"They see the difference it will make for their country, for women and families in their country, they see the difference it will make for children and they see the difference it will make in their economy."
The Ouagadougou Partnership now aims to bring family planning to 2.2 million more people across the region by 2020.
For Gates, a former Microsoft employee who ended up marrying her boss in 1994, it has been a long journey from Texan business executive to international philanthropist highflyer.
Now used to bending the ear of presidents and billionaire friends to support anti-poverty initiatives or to combat diseases such as HIV and cholera, the Gates foundation has pledged hundreds of millions to changing the lives of some of the poorest people in the world.
