There’s a new backlash against billionaire philanthropy. Some of its leading voices have argued that “every billionaire is a policy failure” and that it’d be better if billionaires didn’t exist at all — even if that meant the disappearance of philanthropy by billionaires.

The conversation has done a lot of valuable work, encouraging more scrutiny of charitable activity, pointing out where philanthropy is a fig leaf for misconduct, and forcing institutions to grapple with when it’s wrong to accept money that was unethically acquired.

But while I agree with much of this critique, it does have its blind spots. The overall vision laid out by opponents of billionaire philanthropy sees taxation and government policy as the prime levers to effect positive change in the world. That may be true in many cases, but it’s not true in all of them. And one issue in particular would suffer greatly if billionaire philanthropy was reduced in scale or ceased to exist tomorrow: reproductive health care.

Reproductive health care, more than most issues, has been enormously shaped by individual billionaire philanthropists. Many of the critical breakthroughs in the field were philanthropy-funded, as are many basic services today.

The reason for philanthropy’s big role in this issue area? It’s a matter of both logistics and politics. US foreign aid to support reproductive health worldwide is too vulnerable to the whims of the American electorate. Under Republican administrations, funding for access to contraception in both the US and abroad is typically slashed. Meanwhile, abortion is never funded by federal spending under Republicans or Democrats. Other countries provide international aid programs, but the impact of small changes in US policy is still substantial.

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