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