Lets put birth control back on the agenda Melinda Gates

today I’d like to talk with you about

something that should be a totally

uncontroversial topic but unfortunately

it’s become incredibly controversial

this year if you think about it over a

billion couples will have sex with one

another couples like this one and this

one and this one and yes even this one

and my idea is this all these men and

women should be free to decide whether

they do or do not want to conceive a

child and they should be able to use one

of these birth control methods to bake

act on their decision now I think you’d

have a hard time finding many people who

disagree with this idea over 1 billion

people use birth control without any

hesitation at all they want the power to

plan their own lives and to raise

healthier better educated and more

prosperous families but for an idea that

is so broadly accepted in private birth

control certainly generates a lot of

opposition in public now some people

think when we talk about contraception

that it’s code for abortion which it’s

not some people let’s be honest they’re

uncomfortable with the topic because

it’s about sex some people worry that

the real goal of family planning is to

control populations but these are all

side issues they’ve attached themselves

to this core idea that men and women

should be able to decide when they want

to have a child and as a result birth

control has almost completely and

totally disappeared from the global

health agenda

and the victims of this paralysis are

the people of sub-saharan Africa and

South Asia here in Germany the

proportion of people that use

contraception is about sixty six percent

but that’s about what you’d expect in El

Salvador very similar sixty-six percent

Thailand sixty-four percent but let’s

compare that to other places like Uttar

Pradesh one of the largest states in

India in fact if mutare Pradesh was its

own country it would be the fifth

largest country in the world they’re

contraception rate twenty-nine percent

Nigeria the most populous country in

Africa ten percent Chad two percent so

let’s just take one country in africa

senegal their rate is about 12% but why

is it so low well one reason is that the

most popular contraceptives are rarely

available women in Africa will tell you

over and over again that what they

prefer today is an injectable they get

it in their arm and they go about four

times a year they have to get it every

three months to get their injection the

reason women like it so much in Africa

is they can hide it from their husbands

who sometimes want a lot of children the

problem is every other time a woman goes

into a clinic in Senegal that injection

is stalked out it stalked out a hundred

and fifty days out of the year so can

you imagine the situation she walks all

this way to go get her injection she

leaves her field sometimes leaves her

children and it’s not there and she

doesn’t know when it’s going to be

available again this is the same story

across the continent of Africa today and

so what we’ve created as a world has

become a life-and-death crisis there 100

thousand women who say they don’t want

to be pregnant and they died in

childbirth a hundred thousand women a

year there’s another 600,000 women who

say they didn’t want to be pregnant in

the first place and they give birth to a

baby and her baby dies in that first

month of life now I know everyone wants

to save these mothers and these children

but somewhere along the way we got

confused by our own conversation and we

stopped trying to save these lives so if

we’re going to make progress on this

issue we have to be really clear about

what our agenda is we’re not talking

about abortion we’re not talking about

population control well I’m talking

about is giving women the power to save

their lives to save their children’s

lives and to give their families the

best possible future now as a world

there are lots of things we have to do

in the global health community if we

want to make the world better in the

future things like fight diseases so

many children today die of diarrhea as

you heard earlier and pneumonia they

kill literally millions of children a

year we also need to help small farmers

farmers who plows small plots of land in

Africa so that they can grow enough food

to feed their children and we have to

make sure that children are educated

around the world but one of the simplest

and most transformative things we can do

is to give everybody access to birth

control methods that almost all Germans

have access to and all Americans at some

point they use these tools during their

life and I think as long as we’re really

clear about what our agenda is there’s a

global movement waiting to happen and

ready to get behind this totally

uncontroversial idea when I grew up I

grew up in a Catholic home

I still consider myself a practicing

Catholic my mom’s great uncle was a

Jesuit priest my great aunt was a

Dominican none she was a schoolteacher

and a principal her entire life in fact

she’s the one that taught me is a young

girl how to read I was very close to her

and I went to Catholic schools for my

entire childhood until I left home to go

to university and in my high school

ursuline academy the nuns maid service

and social justice a high priority in

the school and today in the Foundation’s

work I believe I’m applying the lessons

that I learned in high school so in the

tradition of Catholic scholars the nuns

also taught us to question receive

teachings and one of the teachings that

we girls and my peers questioned was is

birth control really a sin because I

think one of the reasons we have this

huge discomfort talking about

contraception is this lingering concern

that if we separate sex from

reproduction we’re going to promote

promiscuity and I think it’s a

reasonable question to be asked about

contraception what is its impact on

sexual morality but like most women my

decision about birth control had nothing

to do with promiscuity I had a plan for

my future I wanted to go to college I

studied really hard in college and I was

proud to be one of the very few female

computer science graduates at my

university I wanted to have a career so

I went on to business school and I

became one of the youngest female

executives at Microsoft I still remember

though when i left my parents home to

move across the country to start this

new job at microsoft they had sacrificed

a lot to give me five years of higher

education but they said as i left home

and I

Shirley went down the front steps down

the porch at home and they said even

though you’ve had this great education

if you decide to get married and have

kids right away that’s okay by us too

they wanted me to do the thing that

would make me the very happiest and I

was free to decide what that would be it

was an amazing feeling but in fact I did

want to have kids but I wanted to have

them when I was ready and so now bill

and I have three and when our eldest

daughter was born we weren’t I would say

exactly sure how to be great parents

maybe some of you know that feeling and

so we waited a little while before we

had our second child and you know it’s

no accident that we have three children

that are spaced three years apart and

now as a mother what do I want the very

most for my children I want them to feel

the way I did like they can do anything

they want to do in life and so what has

struck me as I’ve traveled the last

decade for the foundation around the

world is that all women want that same

thing last year I was in nairobi in the

slums and one called Cora Gocha which

literally means it when translated

standing shoulder to shoulder and I

spoke with this women’s group that’s

pictured here and the women talked out

very openly about their family life in

the slums what it was like and they

talked quite intimately about what they

did for birth control and Marianne who’s

in the center of this screen in the red

sweater she summed up that entire

two-hour conversation in a phrase that I

will never forget she said I want to

bring every good thing to this child

before I have another and I thought

that’s it that’s universal

we all want to bring every good thing to

our children but what’s not a universal

is our ability to provide every good

thing so many women suffer from domestic

violence and they can’t even broach the

subject of contraception even inside

their own marriage there are many women

who lack the basic education but even

many of the women who do have knowledge

and they do have power don’t have access

to contraceptives you know for 250 years

parents around the world have been

deciding to have smaller families this

trend has been steady for a quarter of a

millennium across cultures and across

geographies with the glaring exception

of sub-saharan Africa and South Asia you

know the French started bringing down

their family size in the mid 1700s and

over the next hundred and fifty years

this trend spread all across Europe and

the surprising thing to me as I learned

this history was that it spread not

along socio-economic lines but around

cultural lines people who spoke the same

language made that change as a group

they made the same choice for their

family whether they were rich or whether

they were poor and the reason that trend

towards smaller families spread was that

this whole way was driven by an idea the

idea that couples can exercise conscious

control over how many children they have

this is a very powerful idea it means

that parents have the ability to affect

the future not just accept it as it is

in France the average family size went

down every decade 450 years in a row

until it’s stabilized it suck so long

back then because the contraceptives

frankly weren’t that good in Germany

transition started in the 1880s and it

took just 50 years for family size to

stabilize in this country and in Asia

and Latin America the transition started

in 1960s and it happened much faster

because of modern contraception but I

think as we go through this history it’s

important to pause fern for a moment and

to remember why this has become such a

contentious issue it’s because some

family planning programs resorted to

unfortunate incentives and coercive

policies for instance in the 1960s India

adopted very specific numeric targets

about and they paid women to accept

having an IUD placed in their bodies now

Indian women were really smart in the

situation when they went to get an iud

inserted they got paid six rupees and so

what did they do they waited a few hours

or a few days and they went to another

service provider and they had the iud

removed for one rupee for decades in the

United States African American women

were sterilized without their consent

the procedure was so common it became

known as the Mississippi appendectomy a

tragic chapter in my country’s history

and as recently as the 1990s in Peru

women from the Andes region were given

anaesthesia and they were sterilized

without their knowledge the most

startling thing about this is that these

course of policies weren’t even needed

they were carried out in places where

parents already wanted to lower their

family size because in region after

region again and again parents have

wanted to have smaller families so

there’s no reason to believe that

African women have innately different

desires given the option they will have

fewer children the question is will we

invest

in helping all women get what they want

now or are we going to condemn them to

some century long struggle as if this

was still revolutionary France and the

best method was coitus interruptus

empowering parents it doesn’t need

justification but here’s the thing our

desire to bring every good thing to our

children is a force for good throughout

the world it’s what propels society’s

forward in that same slum in Nairobi I

met a young businesswoman and she was

making backpacks out of her home she and

her young kids would go to the local

jeans factory and collect scraps of

denim she create these backpacks and

resell them and when I talked with her

she had three children and I asked her

about her family and she said she and

her husband decided that they wanted to

stop having children after their third

one and so when I asked her why she

simply said well because I couldn’t run

my business if I had another child and

she explained the income that she was

getting out of her business afforded her

to be able to give an education to all

three of her children she was incredibly

optimistic about her family’s future

this is the same mental calculus that

hundreds of millions of men and women

have gone through and evidence proves

that they have it exactly right they are

able to give their children more

opportunities by exercising control over

when they have them in Bangladesh

there’s a district called matlab it’s

where researchers have collected data on

over a hundred and eighty thousand

inhabitants since 1963 in the global

health community we like to say it’s one

of the longest pieces of research that’s

been running we have so many great

health statistics so in one of the

studies what did they do they gave half

the villagers were chosen to get

contraceptives they got education access

to contraception in 20 years later in

following those villages what we learned

is that they

had a better quality of life than their

neighbors the families were healthier

the women were less likely to die in

childbirth their children were less

likely to die in the first 30 days of

life they were better nourished the

children the families were also

wealthier the adult women’s wages were

higher households had more assets things

like livestock or land or savings and

finally their sons and daughters had

more schooling so when you multiply

these types of effects over millions of

families the product can be large-scale

economic development people talk about

the Asian economic miracle of the 1980s

but it wasn’t really a miracle one of

the leading causes of economic growth

across that region was this cultural

trend towards smaller families so

sweeping changes start at the individual

family level the family making a

decision about what’s best for their

children when they make that change in

that decision those become sweeping

regional and national trends so when

families in sub-saharan Africa are given

the opportunity to make those decisions

for themselves I think it will help

spark a virtuous cycle of development in

communities across the continent we can

help poor families build a better future

we can insist that all people have the

opportunity to learn about

contraceptives and have access to the

full variety of methods I think the goal

here is really clear universal access to

birth control that women want and for

that to happen it means that both rich

and poor governance alike must make

contraception a total priority we can do

our part in this room and globally by

talking about the hundreds of millions

of families but don’t have access to

contraception today and what it would do

to change their lives if they did have

access

and I think if Marianne and the members

of her women’s group can talk about this

openly and have this discussion out

amongst themselves and in public we can

too and we need to start now because

like Marianne we all want to bring every

good thing to our children and where is

the controversy in that thank you

look

I have some I have some questions versus

normal um thank you for your courage and

everything else so Melinda in the last

few years I’ve heard a lot of smart

people say something to the effect of we

don’t need to worry about the population

issue anymore you know family sizes are

coming down naturally all over the world

we’re going to peak at nine or ten

billion and that’s it are they wrong

well if you look at the statistics a

crawfish Africa they are wrong and and I

think we need to look at it though from

a different lens we need to look at it

from the ground up words I think that’s

one of the reasons we got ourselves in

so much trouble on this issue of

contraception is we looked at it from

top down and said we want to have

different population numbers over time

yes we care about the planet yes we need

to make the right choices but the

choices have to be made at the family

level and it’s only by giving people

access and letting them choose what to

do that you get those sweeping changes

that we have seen globally except for

sub-saharan Africans set for those

places in South Asian and Afghanistan

some people on the right in America and

in many conservative cultures around the

world with might say something like this

they might say it’s all very well to

talk about saving lives and empowering

women and so on but sex is sacred what

you’re proposing is going to increase

the likelihood the lots of sex happens

outside marriage and that is wrong well

what do you say to that i would say that

sex is absolutely sacred and it’s sacred

in germany and it’s sacred in the united

states and its sacred in france and so

many places around the world and the

fact that ninety eight percent of women

in my country who are sexually

experienced say they

use birth control doesn’t make sex any

less sacred it just means that they’re

getting to make choices about their

lives and I think in that choice we’re

also honoring the sacredness of the

family and the sacredness of the

mother’s life and the children’s life by

saving their lives and to me that’s

incredibly sacred do so what is your

foundation doing to promote this issue

and what could people here and people

listening on the web what would you like

them to do well I would say this join

the conversation we’ve lifted the

website up here join the conversation

tell your story about how contraception

is either changed your life or

somebody’s life that you know and say

that you’re for this we need a ground

swell of people saying this makes sense

we’ve got to give all women access no

matter where they live and one of the

things that we’re going to do is do a

large event in july july eleventh in

london with a whole host of countries

whole host of african nations to all say

we’re putting this back on the global

health agenda we’re going to commit

resources to it and we’re going to do

planning from the bottoms up with

governments to make sure that women are

at our educated so that if they want the

tool they have it and then they have

lots of options available either through

their local healthcare worker or in

their local community rural clinic

Melinda I’m guessing that some of those

nuns who who taught us at school are

going to see this TED talk at some point

they going to be horrified are they

cheering you on well I know they’re

gonna see the TED talk because they know

that I’m doing it and I plan to send it

to them and you know the nuns who taught

me we’re incredibly progressive and I

hope that they’ll be very proud of me

for living out what they taught us about

social justice and service and i have

come to feel incredibly passionate about

this issue because of what I’ve seen in

the developing world and for me this

topic has become very close to heart

because you meet these women and they

are so often voiceless and yet they

shouldn’t be they should have voice they

should have access and so I hope they’ll

feel that I’m living out what I’ve

learned from them and from the decades

of work that I’ve already done at the

founding

hmm so you and your team brought

together today an amazing group of

speakers to whom were all grateful did

you do you learn anything from oh my

gosh I learned so many things that have

so many follow-up questions and I think

a lot of this work is a journey you hear

heard the discussion about the journey

through energy or the journey through

social design or the journey in the

coming to and saying why aren’t there

any women on this platform and I think

for all of us who work on these

development issues you learn by talking

to other people you learn by doing you

learn by trying and making mistakes and

it’s the questions you ask sometimes

it’s the question you asked that helps

lead to the answer the next person that

can help you answer it so I have lots of

questions for the panelists from today

and I thought it was just an amazing day

Melinda thank you for inviting all of us

on this journey with you thank you so

much thanks Chris