Kirkland, Wash.

Melinda Gates walks into the Pacific Northwest-themed conference room at Pivotal Ventures, the investment and incubation company she founded to jump-start progress for U.S. women in technology.

Having just finished a recording session, she moves seamlessly through the day at the companys headquarters on the shores of Lake Washington. As she slips onto a stool at the head of a sleek conference table and starts answering questions, its instantly apparent that Ms. Gates professionalism and poise are matched by her easygoing warmth.

Right now, shes talking energetically about one of her top U.S. policy recommendations: paid family medical leave for both fathers and mothers when a child is born. If the father takes time off, we know that over time he builds a deeper relationship with his child, Ms. Gates says. Her broader agenda? Incentivizing men to do more household work a burden now primarily borne by women. It would kick a door open that has been shut in this country, she says.

Author of a new bestseller on womens empowerment, Moment of Lift, her first book, Ms. Gates would later give a talk in London that was sold out within 48 hours. After that, she would jet to Paris to speak with finance ministers of leading industrial nations about digital financial inclusion for women: a plan to link mobile phones to digital bank accounts that she says will add $3.7 trillion to emerging economies by 2025 and create 95 million jobs, boosting opportunities for women.

Large numbers and superlatives tend to accompany Ms. Gates wherever she goes. She has been at the forefront of some of the most important technological advances of the past half-century, partnering with her husband, Bill, at Microsoft Corp. in the shared belief that writing software for personal computers would give individuals the computing power that institutions had, and democratizing computing would change the world.

With their Microsoft fortune, the couple in 2000 founded what is now the worlds largest philanthropic organization, the Bill and Melinda Gates Foundation. As co-chair of the foundation, which has an endowment of $46 billion, she funds programs that support and drive major government initiatives around the globe.

A self-described perfectionist who wants to have all the answers, shes confident enough to joke about her failures and times she didnt have a clue, such as when a major HIV prevention program in India used foundation funds to build community centers for sex workers. Bill and I never thought in a million years we would be building community centers or renting tiny little spaces that were refuges for sex workers and their children, she laughs. (Still, it worked, helping to curb the AIDS epidemic in India and save millions of lives.)

Prashant Panjiar/Courtesy of The Bill & Melinda Gates Foundation

Melinda and Bill Gates enjoy a moment with women of the village of Jamsaut in India in 2011.

But it wasnt always this way. For more than 20 years after marrying Americas wealthiest man in 1994, the naturally shy Ms. Gates shunned the spotlight and fiercely guarded her privacy. A 1995 Seattle Times article about her, headlined A Microsoft Mystery, raised the question: Equipped with youth, brains and wealth, her power to do good seems vast, but she has yet to make a significant move. What will she do with the tools in her hands?

Little did anyone know that behind the wall of privacy Ms. Gates was struggling uncertain not only of her voice but of who she was.

It was Feb. 28, 2001, and Ms. Gates and a few female confidants had gathered at friend Emmy Neilsons home in Seattles lakefront Laurelhurst neighborhood for the first official meeting of their spiritual group.

Suddenly, as if an omen, a large earthquake rocked the area a 6.8 magnitude temblor, felt as far away as Idaho, that would be named after the nearby Nisqually River delta. I thought that was a very good sign, says K. Killian Noe, a Yale Divinity School graduate and close friend of Ms. Gates who organized the group. Because the spiritual journey should involve inner earthquakes and inner landslides.

At the time, Ms. Gates, a Roman Catholic and mother of two young children, was wrestling not only with spiritual questions, but also with what to do with her life, and even more fundamentally, with her identity.

Her early trajectory had earned her accolades as a quick learner with a knack for science and math. Growing up in Dallas the daughter of an aerospace engineer and a stay-at-home mom, she thrived under the mentorship of liberal nuns at an all-girls Catholic high school, where she first learned computing and was valedictorian of her class. In five years, she earned a degree in computer science and an MBA at Duke University in Durham, North Carolina. College for me was coding with the guys, she writes in Moment of Lift. After summer stints with IBM, she got a job offer in 1987 from the much newer and smaller firm Microsoft, where she was the only woman among the first class of MBAs hired.

She rose swiftly, and by 1996 was general manager of information products at the firm. Glass ceilings seemed a thing of the past. I had thought mistakenly as a young woman that we had broken through [gender barriers], she says. I was in computer science. I had a great career at Microsoft. Yes, I faced issues at Microsoft and slights here and there, but I didnt see the hidden biases, she says.

But her promising tech career came to an abrupt halt when she decided in 1996 to leave her job managing 1,700 employees at Microsoft. Instead, she stayed home to care for her first child, daughter Jenn, because, she thought, thats what women do. Overnight, Ms. Gates found herself isolated in the 66,000-square-foot mansion that her husband had started building before their marriage. Everything came crashing down.

A lot of things cascaded together that caused that crisis of self, Ms. Gates recalls. The shift from having been a working career woman, to all of a sudden I am living behind a gate, with people who have a certain image of my husband, and I am living in a big house ... when I grew up in a tiny little home. And then I am a young new mom, she says, her voice trailing off.

Jonas Bendiksen/Rockefeller Foundation/AP/File

Farmers gather in Malawi under a program funded by the Gates and Rockefeller foundations to help small farms across Africa.

On a scale of difficulty, the crisis of self felt like a 10, the numerically minded Ms. Gates says. It feels like [the] bottom is falling out of your life, like who am I?

Slowly, she began making friends outside work, and in 1999 started jogging with three other women on Monday mornings after they got their children to school. One of them was Ms. Noe. Right off the bat ... we went deep really quickly, Ms. Noe recalls of Ms. Gates. Ms. Noe realized the women all well-off materially could come together powerfully in a journey of faith and purpose.

In all, nine women joined the spiritual group that first met on the day of the 2001 earthquake. They encouraged one another to be vulnerable, to tap into their inner wisdom and pain. In that way, Ms. Noe says, they could discover how to best be an instrument of love in the world.

We worked a lot on that in this spiritual group that Melinda was part of and still is a part of, Ms. Noe says. What does it mean to go inward to the places of your own pain and brokenness and woundedness, and from there, go outward into the world?

Buoyed by her intimate friends and spiritual discovery, Ms. Gates would carry the question with her that year as she made her first trip to Asia for the Gates Foundation.

From dirt-floored huts in India to windswept fields in Africa, Ms. Gates launched into a series of trips over the next decade that would fundamentally shape her priorities for the foundation, her views on feminism, and her own voice. The goal of saving childrens lives in developing countries drove the early work of the foundation. But Ms. Gates quickly learned family planning was also an urgent priority, by listening directly to impoverished women.

None spoke more powerfully than Meena, a young woman Ms. Gates met in 2010 in Indias northern state of Uttar Pradesh, where infant mortality is high. Meena stood in the doorway of her mud hut, cradling her infant. The baby was born at a health center and was breastfeeding both goals of a foundation-sponsored health program. But when Ms. Gates asked if she wanted more children, Meena, despondent, said no. Hopeless about educating or even feeding her infant and her other son, Meena pleaded with Ms. Gates to take them both.

Courtesy of Gates Archive

Meena, a young mother from India who Melinda Gates met in 2010, influenced the philanthropists views on family planning.

It was a heart-wrenching encounter for the foundation executive who realized that, despite the programs successes, it had tragically failed to meet Meenas need for family planning. It was really a catalyst on her own journey, recalls Gary Darmstadt, former director of family health at the Gates Foundation, who was with Ms. Gates when she spoke with Meena. Here is a stunning example of how we kind of missed it.

Family planning using birth control to prevent or space out births is what women were asking her for, and in many cases, they literally were dying as a result of not having the access, says Dr. Darmstadt, associate dean for maternal and child health at the Stanford University School of Medicine.

Convinced family planning was vital for the overarching goals of health and poverty alleviation, Ms. Gates decided to take a major public stance. She announced at a 2012 London conference that the foundation would double its investment in family planning to $1 billion by 2020, leading a huge reinvestment by governments.

The truth spoken by ordinary women that Ms. Gates delivered to high-level government officials and international conferences was unusual. She would be sitting in a circle on a dirt floor in a hut one morning, and then in the afternoon would be talking to the president of the country, says Dr. Darmstadt. Being able to bring that voice from women from the field into the room at that level, that was definitely new.

For Ms. Gates personally, it was a turning point, as well. She overcame her shyness to take a bold public stance, braving criticism even from the Catholic Church. Having witnessed the frailty of newborns, she disagreed with the Vaticans opposition to contraceptives. My conscience at the end of the day says, I dont want babies and moms to die, she says.

The more she learned about the struggles of poor women in Africa and Asia including the discrimination and abuse they faced from husbands who, for example, beat their wives for using birth control the stronger her voice became.

It wasnt until I saw these other women and what they were up against that I could turn the question back on myself and say Wow, we have a long way to go in the United States and all over the world, she says.

After years of doubt, Ms. Gates emerged as an ardent feminist. I realized that many of the things that had been said earlier in the feminist movement were true that all these barriers existed.

Connecting with women overseas also helped Ms. Gates look deep inside and confront an earlier abusive, controlling relationship before she met Bill that she felt silenced her for many years. I really explored that with the help of a therapist ... who could support me to even go back through what had happened to me, she says haltingly.

Courtesy of Frederic Courbet/Bill & Melinda Gates Foundation

Melinda Gates visits a baby at a health care center in Dakar, Senegal.

Ultimately, that allowed her to speak up more forcefully within her marriage to Mr. Gates, whom, she notes, was pretty used to running things at Microsoft. It wasnt until I could face that [earlier] abuse that I could understand why in certain places in my marriage I hadnt used my voice as strongly as I would have liked.

In a dark room in a village southwest of Dakar, Senegal, Ms. Gates was listening to a woman sob. She was expressing regret over her past role restraining girls undergoing traditional genital cutting. Back in her hotel room later that night, Ms. Gates, too, couldnt stop crying.

It was 2012, and the further Ms. Gates delved into the struggles girls and women faced in the developing world from child marriage to forced prostitution the stronger her convictions grew about the overarching importance of womens equality.

If you want to lift up humanity, empower women, she writes in Moment of Lift. Year by year ... I see more clearly that the primary causes of poverty and illness are the cultural, financial, and legal restrictions that block what women can do and think they can do for themselves and their children. When women have power and use it, societies prosper. No other single change can do more to improve the state of the world than elevating women to equality with men, she writes.

Ms. Gates views male-dominated culture, religion, and law as the roots of much oppression of women. But instead of seeing such forces as immutable, she has sought out and promoted grassroots programs that have carefully ended practices that harm women and girls.

One such program is Tostan, which in the Wolof language in Senegal means breakthrough or, literally, when a chick cracks open its eggshell. Launched in Senegal in 1991, Tostan is a community-led empowerment project based on empathy and understanding between those providing aid and the people they serve. In the Tostan model, a small team of facilitators fluent in the local language moves into a village for three to five years. The team invites the villagers to discuss their ideals, while teaching them about health, reading, math, and human rights. The conversation often sheds light on the gap between villagers own ideals and practices that hurt women and girls.

Our whole approach is reinforcing the positive values of the community, says Tostan founder Molly Melching, who arrived in Senegal as an exchange student in 1974 and has devoted her life to humanitarian projects in Africa. Tostan, now active in eight African countries, has achieved striking results: More than 8,000 communities where the program is operating have decided to abandon child marriage and female genital cutting.

Ms. Gates credits Tostan with changing how she thinks about development work, showing the best answers to problems are already present in the locals drive for a better future. You have to go in and really listen, then design solutions with the local community, she says. You do not get cultural change unless there is openness and ... discussion.

Even religious practices can be changed from the inside, Ms. Gates says. Senior imams in Senegal told her there is this mistaken understanding that the Koran doesnt allow for family planning, but it does, she says. They said ... we can use our network so the imam all the way down at the local village level in Senegal is giving the right messages to women, she says. Thats a great change from within.

Ms. Melching and other development experts say theyre impressed by Ms. Gates thoughtful questions and ability to listen, as well as by her willingness to make anonymous, extended stays in the field that are rare for a wealthy philanthropist.

Its the head and the heart that come together in a very powerful and unique way, Dr. Darmstadt says of Ms. Gates. On one hand, Melinda is very data driven and evidence driven, but on the other hand she is very relational. ... She wants to sit down and hear these womens stories. She wants to really understand what life is like for them.

In 2014, Ms. Gates and her daughter Jenn spent three days living with a family in a village in Tanzania. It was the first time Ms. Gates stayed overnight with a family in the field. They slept in a former goat hut. Ms. Gates helped chop firewood and cooked over a fire. She walked half an hour to fetch water, carrying it in a bucket on her head. I learned more on that homestay than ... on any previous foundation trip, she writes. Seeing the mother, Anna, labor 17 hours a day, Ms. Gates says she gained a visceral appreciation for the massive burden of unpaid labor that weighs on womens futures.

Increasingly, such insights from abroad galvanized Ms. Gates to act on problems in the U.S. and even closer to home. At the foundation, she has moved to ensure women and girls are at the forefront of global development initiatives, a decision announced in Science magazine in 2014. It was, she writes, the strongest lever I ever pulled to direct the focus and emphasis of our foundation. For American women of her daughters generation, she sees hidden biases as a big challenge, particularly in the workplace. Through Pivotal Ventures, which she started in 2015, Ms. Gates is working to boost opportunities for women where they are badly lagging in technology and venture capital. If women are not in tech, women will not have power, Ms. Gates writes.

All such efforts are amplified by Ms. Gates heavyweight role in directing the worlds largest foundation. They use their size as leverage, says Brad Smith, president of Candid, a nonprofit that researches foundations work. Mr. Smith lauds the Gates Foundation for leading by example and collaborating with other foundations around the world. They have been refreshingly good about sharing what they have learned about the work, including failure ... saying what they have done wrong, and what they could do better.

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The Gates Foundation, which has given away $50 billion since its inception, has contributed to a significant decline in child deaths and poverty worldwide. Still, important targets remain. When asked what keeps her up at night, Ms. Gates doesnt hesitate: contraceptives. In 2012, the foundation spearheaded a global partnership that set the goal of giving 120 million more women and girls in the worlds poorest countries access to modern contraceptives by 2020. So far, the initiative has reached about 50 million women and girls. When you move forward for women and you start to provide contraceptives, there are things that chip away at that progress all the time, she says.

As with the foundations trials and errors, Ms. Gates is more forgiving of her own imperfections and willing to speak out a sign her activism on the world stage has just begun. Maybe my best self is when Im open enough to say more about my doubts or anxieties, admit my mistakes, confess when Im feeling down, she writes. Maybe my best self is not my polished self.

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Melinda Gates: What shes learned - The Christian Science Monitor