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TED: Ideas worth spreading, Melinda Gates: Let's put birth control back on the agenda (2)

Melinda Gates: Let's put birth control back on the agenda (2)

In France, the average family size went down every decade for 150 years in a row until it stabilized.

It took so long back then because the contraceptives weren't that good. In Germany, this 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 the 1960s, and it happened much faster because of modern contraception. I think, as we go through this history, it's important to pause 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 and they paid women to accept having an IUD placed in their bodies. Now, Indian women were really smart in this 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 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 anesthesia and they were sterilized without their knowledge. The most startling thing about this is that these coercive 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. 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 societies 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'd 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 180,000 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. In one of the studies, what did they do? Half the villagers were chosen to get contraceptives. They got education and access to contraception. Twenty years later, 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 thirty days of life. The children were better nourished. The families were also wealthier. The adult women's wages were higher. Households had more assets -- things like livestock or land or savings. 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. 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 and that decision, those become sweeping regional and national trends. 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 governments 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 that don't have access to contraception today and what it would do to change their lives if they did have access. 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.

(Applause)

Chris Anderson: Thank you.

I have some questions for Melinda. (Applause ends)

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.

Family sizes are coming down naturally all over the world. We're going to peak at nine or 10 billion. And that's it." Are they wrong? Melinda Gates: If you look at the statistics across Africa, they are wrong.

And I think we need to look at it, though, from a different lens. We need to look at it from the ground upwards. I think that's one of the reasons we got ourselves in so much trouble on this issue of contraception. 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 Africa and those places in South Asia and Afghanistan. CA: Some people on the right in America and in many conservative cultures around the world might say something like this: "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 that lots of sex happens outside marriage. And that is wrong." What would you say to them? MG: I would say that sex is absolutely sacred.

And it's sacred in Germany, and it's sacred in the United States, and it's sacred in France and so many places around the world. And the fact that 98 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 childrens' lives by saving their lives. To me, that's incredibly sacred, too. CA: 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? MG: I would say this -- join the conversation.

We've listed the website up here. Join the conversation. Tell your story about how contraception has either changed your life or somebody's life that you know. And say that you're for this. We need a groundswell 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 July 11 in London, with a whole host of countries, a 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 bottom up with governments to make sure that women are educated -- so that if they want the tool, they have it, and that they have lots of options available either through their local healthcare worker or their local community rural clinic. CA: Melinda, I'm guessing that some of those nuns who taught you at school are going to see this TED Talk at some point.

Are they going to be horrified, or are they cheering you on? MG: I know they're going to 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 were incredibly progressive. I hope that they'll be very proud of me for living out what they taught us about social justice and service. 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 a 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 foundation. CA: So, you and your team brought together today an amazing group of speakers to whom we're all grateful.

Did you learn anything? (Laughter)

MG: Oh my gosh, I learned so many things.

I have so many follow-up questions. And I think a lot of this work is a journey. You heard the discussion about the journey through energy, or the journey through social design, or the journey in the coming 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 questions you ask 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. CA: Melinda, thank you for inviting all of us on this journey with you.

Thank you so much.

MG: Great. Thanks, Chris.


Melinda Gates: Let's put birth control back on the agenda (2)

In France, the average family size went down every decade for 150 years in a row until it stabilized.

It took so long back then because the contraceptives weren’t that good. In Germany, this 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 the 1960s, and it happened much faster because of modern contraception. I think, as we go through this history, it’s important to pause 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 and they paid women to accept having an IUD placed in their bodies. Now, Indian women were really smart in this 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 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 anesthesia and they were sterilized without their knowledge. The most startling thing about this is that these coercive 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. 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 societies 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’d 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 180,000 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. In one of the studies, what did they do? Half the villagers were chosen to get contraceptives. They got education and access to contraception. Twenty years later, 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 thirty days of life. The children were better nourished. The families were also wealthier. The adult women’s wages were higher. Households had more assets -- things like livestock or land or savings. 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. 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 and that decision, those become sweeping regional and national trends. 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 governments 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 that don’t have access to contraception today and what it would do to change their lives if they did have access. 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.

(Applause)

Chris Anderson: Thank you.

I have some questions for Melinda. (Applause ends)

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.

Family sizes are coming down naturally all over the world. We’re going to peak at nine or 10 billion. And that’s it." Are they wrong? Melinda Gates: If you look at the statistics across Africa, they are wrong.

And I think we need to look at it, though, from a different lens. We need to look at it from the ground upwards. I think that’s one of the reasons we got ourselves in so much trouble on this issue of contraception. 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 Africa and those places in South Asia and Afghanistan. CA: Some people on the right in America and in many conservative cultures around the world might say something like this: "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 that lots of sex happens outside marriage. And that is wrong." What would you say to them? MG: I would say that sex is absolutely sacred.

And it’s sacred in Germany, and it’s sacred in the United States, and it’s sacred in France and so many places around the world. And the fact that 98 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 childrens' lives by saving their lives. To me, that’s incredibly sacred, too. CA: 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? MG: I would say this -- join the conversation.

We’ve listed the website up here. Join the conversation. Tell your story about how contraception has either changed your life or somebody’s life that you know. And say that you’re for this. We need a groundswell 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 July 11 in London, with a whole host of countries, a 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 bottom up with governments to make sure that women are educated -- so that if they want the tool, they have it, and that they have lots of options available either through their local healthcare worker or their local community rural clinic. CA: Melinda, I’m guessing that some of those nuns who taught you at school are going to see this TED Talk at some point.

Are they going to be horrified, or are they cheering you on? MG: I know they’re going to 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 were incredibly progressive. I hope that they’ll be very proud of me for living out what they taught us about social justice and service. 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 a 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 foundation. CA: So, you and your team brought together today an amazing group of speakers to whom we’re all grateful.

Did you learn anything? (Laughter)

MG: Oh my gosh, I learned so many things.

I have so many follow-up questions. And I think a lot of this work is a journey. You heard the discussion about the journey through energy, or the journey through social design, or the journey in the coming 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 questions you ask 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. CA: Melinda, thank you for inviting all of us on this journey with you.

Thank you so much.

MG: Great. Thanks, Chris.