Let's put birth control back on the agenda | Melinda Gates

248,991 views ・ 2012-04-11

TED


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00:04
Today, I'd like to talk with you
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Heute möchte ich mit Ihnen
00:06
about something that should be a totally uncontroversial topic.
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über ein Thema sprechen, das eigentlich ganz und gar nicht strittig sein sollte
00:11
But, unfortunately, it's become incredibly controversial.
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Aber unglücklicherweise, ist es sehr umstritten geworden
00:17
This year, if you think about it,
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Denken Sie einmal daran: Dieses Jahre werden
00:19
over a billion couples will have sex with one another.
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über eine Milliarde Paare Sex miteinander haben
00:24
Couples like this one,
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Paare wie dieses,
00:26
and this one,
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oder dieses
00:28
and this one,
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und dieses
00:29
and, yes,
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und, ja,
00:31
even this one.
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sogar dieses.
00:32
(Laughter)
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(Lachen)
00:34
And my idea is this --
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Und meine Idee ist die folgende:
00:37
all these men and women should be free to decide
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Alle diese Männer und Frauen sollten frei sein, zu entscheiden
00:41
whether they do or do not want to conceive a child.
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ob sie ein Kind empfangen möchten oder nicht
00:46
And they should be able to use one of these birth control methods
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Und sie sollten eine dieser Verhütungsmethoden anwenden dürfen
00:49
to act on their decision.
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und ihre Entscheidung in die Tat umsetzen.
00:53
Now, I think you'd have a hard time
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Nun, ich denke Sie werden kaum jemanden finden,
00:56
finding many people who disagree with this idea.
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der mir hier nicht zustimmen würde
01:00
Over one billion people use birth control without any hesitation at all.
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01:07
They want the power to plan their own lives
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01:12
and to raise healthier, better educated and more prosperous families.
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01:18
But, for an idea that is so broadly accepted in private,
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01:24
birth control certainly generates a lot of opposition in public.
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01:30
Some people think when we talk about contraception
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01:33
that it's code for abortion,
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01:35
which it's not.
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01:37
Some people -- let's be honest --
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01:39
they're uncomfortable with the topic because it's about sex.
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01:43
Some people worry
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that the real goal of family planning is to control populations.
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01:51
These are all side issues
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01:55
that have attached themselves to this core idea that men and women
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02:00
should be able to decide when they want to have a child.
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02:05
And as a result, birth control has almost completely and totally disappeared
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02:12
from the global health agenda.
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02:14
The victims of this paralysis are the people of sub-Saharan Africa
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02:21
and South Asia.
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02:23
Here in Germany, the proportion of people that use contraception
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02:27
is about 66 percent.
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02:29
That's about what you'd expect.
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02:32
In El Salvador, very similar, 66 percent.
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Thailand, 64 percent.
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02:39
But let's compare that to other places,
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02:42
like Uttar Pradesh, one of the largest states in India.
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02:46
In fact, if Uttar Pradesh was its own country,
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it would be the fifth largest country in the world.
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Their contraception rate -- 29 percent.
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Nigeria, the most populous country in Africa, 10 percent.
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03:05
Chad, 2 percent.
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Let's just take one country in Africa, Senegal.
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03:13
Their rate is about 12 percent.
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03:15
But why is it so low?
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One reason is that the most popular contraceptives are rarely available.
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03:24
Women in Africa will tell you over and over again
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that what they prefer today is an injectable.
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03:30
They get it in their arm -- and they go about four times a year,
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they have to get it every three months -- to get their injection.
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03:37
The reason women like it so much in Africa is they can hide it from their husbands,
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who sometimes want a lot of children.
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The problem is every other time a woman goes into a clinic in Senegal,
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that injection is stocked out.
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It's stocked out 150 days out of the year.
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03:58
So can you imagine the situation --
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04:00
she walks all this way to go get her injection.
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04:03
She leaves her field, sometimes leaves her children,
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and it's not there.
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And she doesn't know when it's going to be available again.
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04:11
This is the same story across the continent of Africa today.
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04:17
And so what we've created as a world has become a life-and-death crisis.
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There are 100,000 women [per year] who say they don't want to be pregnant
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and they die in childbirth -- 100,000 women a year.
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04:32
There are another 600,000 women [per year]
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who say they didn't want to be pregnant in the first place,
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04:37
and they give birth to a baby
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and her baby dies in that first month of life.
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04:44
I know everyone wants to save these mothers and these children.
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04:51
But somewhere along the way, we got confused by our own conversation.
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04:57
And we stopped trying to save these lives.
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05:01
So if we're going to make progress on this issue,
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we have to be really clear about what our agenda is.
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05:09
We're not talking about abortion.
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05:11
We're not talking about population control.
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What I'm talking about is giving women the power to save their lives,
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05:21
to save their children's lives
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and to give their families the best possible future.
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05:28
Now, as a world,
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there are lots of things we have to do in the global health community
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if we want to make the world better in the future --
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things like fight diseases.
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So many children today die of diarrhea, as you heard earlier, and pneumonia.
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They kill literally millions of children a year.
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We also need to help small farmers --
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farmers who plow small plots of land in Africa --
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so that they can grow enough food to feed their children.
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05:55
And we have to make sure that children are educated around the world.
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05:59
But one of the simplest and most transformative things we can do
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06:04
is to give everybody access to birth control methods
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that almost all Germans have access to and all Americans, at some point,
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they use these tools during their life.
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06:17
And I think as long as we're really clear about what our agenda is,
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there's a global movement waiting to happen
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and ready to get behind this totally uncontroversial idea.
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When I grew up, I grew up in a Catholic home.
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I still consider myself a practicing Catholic.
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My mom's great-uncle was a Jesuit priest.
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My great-aunt was a Dominican nun.
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She was a schoolteacher and a principal her entire life.
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06:51
In fact, she's the one who taught me as a young girl how to read.
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I was very close to her.
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And I went to Catholic schools for my entire childhood
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until I left home to go to university.
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In my high school, Ursuline Academy,
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the nuns made service and social justice a high priority in the school.
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Today, in the [Gates] Foundation's work,
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I believe I'm applying the lessons that I learned in high school.
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So, in the tradition of Catholic scholars,
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the nuns also taught us to question received teachings.
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07:31
And one of the teachings that we girls and my peers questioned
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was is birth control really a sin?
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07:41
Because I think one of the reasons
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we have this huge discomfort talking about contraception
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is this lingering concern
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that if we separate sex from reproduction, we're going to promote promiscuity.
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And I think that's a reasonable question to be asked about contraception --
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what is its impact on sexual morality?
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But, like most women,
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my decision about birth control had nothing to do with promiscuity.
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I had a plan for my future. I wanted to go to college.
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I studied really hard in college,
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and I was proud to be one of the very few female computer science graduates
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at my university.
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I wanted to have a career, so I went on to business school
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and I became one of the youngest female executives at Microsoft.
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I still remember, though, when I left my parents' home
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to move across the country to start this new job at Microsoft.
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They had sacrificed a lot to give me five years of higher education.
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But they said, as I left home --
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and I literally went down the front steps, down the porch at home --
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and they said,
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"Even though you've had this great education,
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if you decide to get married and have kids right away,
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that's OK by us, too."
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They wanted me to do the thing that would make me the very happiest.
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I was free to decide what that would be.
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It was an amazing feeling.
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In fact, I did want to have kids --
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but I wanted to have them when I was ready.
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And so now, Bill and I have three.
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And when our eldest daughter was born,
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we weren't, I would say, exactly sure how to be great parents.
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Maybe some of you know that feeling.
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And so we waited a little while before we had our second child.
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And it's no accident that we have three children
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that are spaced three years apart.
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Now, as a mother, what do I want the very most for my children?
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I want them to feel the way I did --
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like they can do anything they want to do in life.
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And so, what has struck me
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as I've travelled the last decade for the foundation around the world
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is that all women want that same thing.
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Last year, I was in Nairobi, in the slums, in one called Korogocho --
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which literally means when translated, "standing shoulder to shoulder."
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And I spoke with this women's group that's pictured here.
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And the women talked very openly about their family life in the slums,
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what it was like.
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And they talked quite intimately about what they did for birth control.
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Marianne, in the center of the screen in the red sweater,
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she summed up that entire two-hour conversation
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in a phrase that I will never forget.
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She said, "I want to bring every good thing to this child
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before I have another."
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And I thought -- that's it.
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That's universal.
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We all want to bring every good thing to our children.
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But what's not universal is our ability to provide every good thing.
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So many women suffer from domestic violence.
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And they can't even broach the subject of contraception,
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even inside their own marriage.
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There are many women who lack basic education.
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Even many of the women who do have knowledge and do have power
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don't have access to contraceptives.
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For 250 years, parents around the world
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have been deciding to have smaller families.
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This trend has been steady for a quarter of a millennium,
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across cultures and across geographies,
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with the glaring exception of sub-Saharan Africa and South Asia.
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The French started bringing down their family size in the mid-1700s.
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And over the next 150 years, this trend spread all across Europe.
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The surprising thing to me, as I learned this history,
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was that it spread not along socioeconomic lines but around cultural lines.
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People who spoke the same language made that change as a group.
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They made the same choice for their family,
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whether they were rich or whether they were poor.
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The reason that trend toward smaller families spread
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was that this whole way was driven by an idea --
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the idea that couples can exercise conscious control
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over how many children they have.
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This is a very powerful idea.
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It means that parents have the ability to affect the future,
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not just accept it as it is.
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In France, the average family size went down every decade
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for 150 years in a row until it stabilized.
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It took so long back then because the contraceptives weren't that good.
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In Germany, this transition started in the 1880s, and it took just 50 years
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for family size to stabilize in this country.
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And in Asia and Latin America, the transition started in the 1960s,
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and it happened much faster because of modern contraception.
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I think, as we go through this history, it's important to pause for a moment
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and to remember why this has become such a contentious issue.
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It's because some family planning programs
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resorted to unfortunate incentives and coercive policies.
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For instance, in the 1960s, India adopted very specific numeric targets
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and they paid women to accept having an IUD placed in their bodies.
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Now, Indian women were really smart in this situation.
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When they went to get an IUD inserted, they got paid six rupees.
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And so what did they do?
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They waited a few hours or a few days,
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and they went to another service provider and had the IUD removed for one rupee.
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For decades in the United States,
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African-American women were sterilized without their consent.
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The procedure was so common
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it became known as the Mississippi appendectomy --
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a tragic chapter in my country's history.
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And as recently as the 1990s, in Peru,
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women from the Andes region were given anesthesia
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and they were sterilized without their knowledge.
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The most startling thing about this
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is that these coercive policies weren't even needed.
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They were carried out in places
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where parents already wanted to lower their family size.
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Because in region after region, again and again,
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parents have wanted to have smaller families.
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There's no reason to believe
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that African women have innately different desires.
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Given the option, they will have fewer children.
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The question is:
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will we invest in helping all women get what they want now?
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Or, are we going to condemn them to some century-long struggle,
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as if this was still revolutionary France
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and the best method was coitus interruptus?
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Empowering parents -- it doesn't need justification.
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But here's the thing -- our desire to bring every good thing to our children
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is a force for good throughout the world.
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It's what propels societies forward.
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In that same slum in Nairobi, I met a young businesswoman,
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and she was making backpacks out of her home.
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She and her young kids would go to the local jeans factory
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and collect scraps of denim.
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She'd create these backpacks and resell them.
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And when I talked with her, she had three children,
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and I asked her about her family.
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And she said she and her husband decided
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that they wanted to stop having children after their third one.
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And so when I asked her why, she simply said,
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"Well, because I couldn't run my business if I had another child."
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And she explained the income that she was getting out of her business
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afforded her to be able to give an education to all three of her children.
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She was incredibly optimistic about her family's future.
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This is the same mental calculus
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that hundreds of millions of men and women have gone through.
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And evidence proves that they have it exactly right.
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They are able to give their children more opportunities
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by exercising control over when they have them.
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In Bangladesh,
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there's a district called Matlab.
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It's where researchers have collected data on over 180,000 inhabitants since 1963.
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In the global health community,
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we like to say it's one of the longest pieces of research that's been running.
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We have so many great health statistics.
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In one of the studies, what did they do?
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Half the villagers were chosen to get contraceptives.
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They got education and access to contraception.
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Twenty years later, following those villages,
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what we learned is that they had a better quality of life than their neighbors.
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The families were healthier.
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The women were less likely to die in childbirth.
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Their children were less likely to die in the first thirty days of life.
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The children were better nourished.
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The families were also wealthier.
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The adult women's wages were higher.
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Households had more assets -- things like livestock or land or savings.
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Finally, their sons and daughters had more schooling.
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So when you multiply these types of effects over millions of families,
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the product can be large-scale economic development.
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People talk about the Asian economic miracle of the 1980s --
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but it wasn't really a miracle.
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One of the leading causes of economic growth across that region
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was this cultural trend towards smaller families.
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Sweeping changes start at the individual family level --
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the family making a decision about what's best for their children.
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When they make that change and that decision,
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those become sweeping regional and national trends.
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When families in sub-Saharan Africa are given the opportunity
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to make those decisions for themselves,
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I think it will help spark a virtuous cycle of development
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in communities across the continent.
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We can help poor families build a better future.
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We can insist that all people have the opportunity
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to learn about contraceptives
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and have access to the full variety of methods.
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I think the goal here is really clear:
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universal access to birth control that women want.
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And for that to happen, it means that both rich and poor governments alike
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must make contraception a total priority.
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We can do our part, in this room and globally,
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by talking about the hundreds of millions of families
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that don't have access to contraception today
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and what it would do to change their lives if they did have access.
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I think if Marianne and the members of her women's group
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can talk about this openly
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and have this discussion out amongst themselves and in public,
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we can, too.
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And we need to start now.
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Because like Marianne, we all want to bring every good thing to our children.
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And where is the controversy in that?
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Thank you.
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(Applause)
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Chris Anderson: Thank you.
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I have some questions for Melinda.
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(Applause ends)
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Thank you for your courage and everything else.
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So, Melinda, in the last few years
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I've heard a lot of smart people say something to the effect of,
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"We don't need to worry about the population issue anymore.
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Family sizes are coming down naturally all over the world.
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We're going to peak at nine or 10 billion. And that's it."
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Are they wrong?
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Melinda Gates: If you look at the statistics across Africa,
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they are wrong.
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And I think we need to look at it, though, from a different lens.
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We need to look at it from the ground upwards.
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I think that's one of the reasons we got ourselves in so much trouble
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on this issue of contraception.
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We looked at it from top down
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and said we want to have different population numbers over time.
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Yes, we care about the planet. Yes, we need to make the right choices.
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But the choices have to be made at the family level.
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21:17
And it's only by giving people access and letting them choose what to do
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that you get those sweeping changes that we have seen globally --
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except for sub-Saharan Africa and those places in South Asia and Afghanistan.
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CA: Some people on the right in America
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21:34
and in many conservative cultures around the world
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might say something like this:
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"It's all very well to talk about saving lives and empowering women and so on.
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But, sex is sacred.
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What you're proposing is going to increase the likelihood
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21:52
that lots of sex happens outside marriage.
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And that is wrong."
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What would you say to them?
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MG: I would say that sex is absolutely sacred.
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And it's sacred in Germany, and it's sacred in the United States,
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and it's sacred in France and so many places around the world.
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22:08
And the fact that 98 percent of women in my country who are sexually experienced
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22:13
say they use birth control doesn't make sex any less sacred.
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It just means that they're getting to make choices about their lives.
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22:21
And I think in that choice,
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we're also honoring the sacredness of the family
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and the sacredness of the mother's life
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and the childrens' lives by saving their lives.
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To me, that's incredibly sacred, too.
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CA: So what is your foundation doing to promote this issue?
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And what could people here and people listening on the web --
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what would you like them to do?
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MG: I would say this -- join the conversation.
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We've listed the website up here. Join the conversation.
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22:50
Tell your story about how contraception has either changed your life
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or somebody's life that you know.
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22:55
And say that you're for this.
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22:57
We need a groundswell of people saying, "This makes sense.
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We've got to give all women access -- no matter where they live."
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23:03
And one of the things that we're going to do
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23:05
is do a large event July 11 in London,
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23:08
with a whole host of countries, a whole host of African nations,
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23:12
to all say we're putting this back on the global health agenda.
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23:15
We're going to commit resources to it,
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23:17
and we're going to do planning from the bottom up with governments
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23:20
to make sure that women are educated --
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23:22
so that if they want the tool, they have it,
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23:24
and that they have lots of options available
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23:27
either through their local healthcare worker
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23:29
or their local community rural clinic.
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CA: Melinda, I'm guessing that some of those nuns who taught you at school
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are going to see this TED Talk at some point.
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Are they going to be horrified, or are they cheering you on?
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23:43
MG: I know they're going to see the TED Talk
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because they know that I'm doing it and I plan to send it to them.
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23:48
And, you know, the nuns who taught me were incredibly progressive.
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23:51
I hope that they'll be very proud of me
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23:53
for living out what they taught us about social justice and service.
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I have come to feel incredibly passionate about this issue
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24:01
because of what I've seen in the developing world.
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And for me, this topic has become very close to heart
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24:09
because you meet these women and they are so often voiceless.
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And yet they shouldn't be --
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24:13
they should have a voice, they should have access.
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24:16
And so I hope they'll feel
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24:17
that I'm living out what I've learned from them
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and from the decades of work that I've already done at the foundation.
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24:24
CA: So, you and your team brought together today an amazing group of speakers
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24:29
to whom we're all grateful.
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Did you learn anything?
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(Laughter)
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MG: Oh my gosh, I learned so many things. I have so many follow-up questions.
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24:39
And I think a lot of this work is a journey.
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24:41
You heard the discussion about the journey through energy,
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24:45
or the journey through social design,
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24:47
or the journey in the coming and saying,
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24:49
"Why aren't there any women on this platform?"
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24:51
And I think for all of us who work on these development issues,
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you learn by talking to other people.
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24:56
You learn by doing. You learn by trying and making mistakes.
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24:59
And it's the questions you ask.
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Sometimes it's the questions you ask that helps lead to the answer
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the next person that can help you answer it.
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25:06
So I have lots of questions for the panelists from today.
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And I thought it was just an amazing day.
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CA: Melinda, thank you for inviting all of us on this journey with you.
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Thank you so much. MG: Great. Thanks, Chris.
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