Why Is It So Hard to Get Effective Birth Control in the US? | Mark Edwards | TED

翻译人员: Mawlili Mu 校对人员: sylvia feng

About eight years ago, I met a young woman.

大约八年以前， 我遇到了一个年轻的女士。

I'll call her Sophia.

我会以索菲亚来代称她

And she showed me her newborn in her lap.

她向我展示了两腿中的新生儿。

And she said to me, "This wasn't my plan."

并跟我说

“这并不是我计划中的一部分。”

She described how her unplanned pregnancy

她描述了她未计划的怀孕

forced her to drop out of community college,

是如何迫使她从社区大学中退学，

how she then lost her job

失去工作，

and was now living with her mother in Texas.

并和她母亲一起住在德州。

Sophia had already had two unplanned children

在第三个孩子之前，

before this third child was born.

索菲亚已经有了两个未计划的孩子。

All three of Sofia's pregnancies occurred while she was on the pill.

索菲亚的三次怀孕 都在她吃避孕药的时候发生。

It was a birth control method that just didn't work for her,

这种避孕方式明显对她无效，

but it was the only method she'd ever been offered.

但是这是她可以使用 的唯一一种避孕方法。

Sophia's pregnancies weren't just unplanned.

索菲亚的怀孕并不只是计划外的。

She actively planned not to become pregnant

她刻意计划避免怀孕

and took precautions against it.

并使用了预防措施。

But the only method she was ever offered failed her.

但她仅有的一种方法并不奏效。

In the US each year,

在美国每年，

nearly half of all pregnancies are unplanned.

将近一半的怀孕都不是计划中的。

I know it's an astonishing number to get your head around.

我知道这个数字听起来很惊人。

And over the span of ten years,

并且在过去的10年内，

it's been estimated that six out of ten typical birth-control pill users

有人预估十分之六的避孕药使用者

will become accidentally pregnant.

会意外的怀孕。

This is not just about uninformed teens.

这并不仅仅是不懂事的年轻人。

Most unplanned pregnancies occur to women who are in their 20s.

大部分意外怀孕发生在 20多岁的女士身上。

In fact, about half of all unplanned pregnancies occur to women

事实上，接近一半的意外怀孕发生在

who are actually using birth control, like Sophia.

使用避孕药的女士身上， 就像索菲亚。

Most people know about pills and condoms.

大部分知道避孕药和避孕套。

There are actually 18 FDA-approved methods of birth control,

实际上有18个 FDA批准的避孕方式，

each with different efficacy and side effect profiles,

每一个都有不同的效果和副作用，

some of which are 20 times more effective than others.

有些方法的效果是其他的20倍。

The reason you don't know about this is simple.

你不知道它们的原因很简单。

Outside of specialty family planning clinics that are few and far between,

除了稀少的计划生育诊所，

health care organizations don't educate people

医疗中心并不提供

about all their birth control options

关于避孕方法的科普

and don't make them easily available.

也不轻易提供这些服务。

But this is what Upstream, the nonprofit I cofounded, does.

但这正是上游，

我建立的非营利组织，所做的事情。

We train community health centers, hospital practices,

我们为社区诊所，医院，

primary care facilities,

保荐机构，

the places where the vast majority of people get their health care,

大部分人看医生的地方，

to put patient centered needs first

提供科普，

and provide best in class contraceptive care

并把最好的避孕服务 像基本医疗一样提供。

as a part of basic primary health care.

做到了把患者的需求放到第一位。

(Applause)

（鼓掌）

You know, when I first met Sophia,

你知道，当我第一次遇见索菲亚时，

I'd been listening for years to what young people were saying

我已经花了很多年听年轻人分享

about the challenges they were facing achieving their goals.

他们在成功路上遇到的挫折。

And I was struck by how many of their stories

许多人故事的开头都是某种版本的

began with some version of,

“我怀孕了所以不得不退学。”

“Well, I found myself pregnant and I had to drop out of school.”

“我把我女友搞怀孕了 所以要放弃现在的工作。”

Or, “I got my girlfriend pregnant and I had to quit my job.”

对此我很惊讶。

I just kept hearing these stories, I wasn't looking for it.

我听到了太多我没想到的故事。

And I came away from those conversations utterly convinced

从这些故事中，我深刻地意识到了

that lack of equitable access to contraception,

这个国家中许多年轻人的生活，

the inability to get the birth control method you want, when you want it,

都因无法平等 的使用不同的避孕方法，

with full information,

无法在合适的时间 使用想用的避孕方法，

was a critical factor derailing the life trajectories

并全面的了解避孕，

of many young people in this country.

而收到严重的影响。

It's obviously not the only structural barrier they face, of course,

他们很明显还会面临 其他制度性问题，

but I really have come to believe that it is a major cause of inequality,

但我真的相信这是不平等 的主要一个原因，

and it's one we can actually do something about.

并且是一个我们可以改善的问题。

Back to Sophia.

回到索菲亚身上，

She told me she faced countless barriers

她告诉我她在寻求

trying to get another method of birth control that was more effective.

更有效的避孕方法时 遇到了无数个障碍。

After hearing from a friend about the IUD,

当她从一个朋友那里听到IUD，

one of the most effective methods of birth control,

最有效的避孕方式之一，

she decided she wanted that method.

她决定她想用这个方法。

So she ended up getting a day off from work,

所以她决定请一天假，

borrowing a car

接一辆车，

and driving the three hours to her health center to get one.

前往三小时车程的医疗中心。

But when she got there,

但当她到那里时，

they told her that they had to order one for her

医护人员告诉她 这种方式需要提前预约

and the sole provider they had who could place that method

并且唯一一个提供这种服务的医生

was only available on Tuesdays.

只在周二有空。

They told her to come back two weeks later.

他们让她两周后再来。

Even holding down two jobs,

尽管拥有两份工作，

she managed to borrow that car and make that three-hour journey

她成功的又借到了一辆车， 驾驶三个小时，

and get the day off,

请一天假，

but was told once again they couldn't place it that day.

结果仍然不能 在两周后放置节育器。

They told her to come back a third time,

他们让她再来一次，

but this time, she couldn't get the time off.

但这次她抽不出时间。

Five months later, she did come back,

五个月后，她确实回来了，

this time unintentionally pregnant.

但她已经意外怀孕了。

Sophia's story demonstrates how unplanned pregnancy

索菲亚的故事体现了意外怀孕的源头

is rooted in inequitable access to birth control.

在不平等的避孕机会中。

Sophia didn't know that many providers

索菲亚不知道很多医生

aren't trained to offer contraception beyond the pill.

都没接受过避孕药意外的避孕训练。

Many health centers don't even stock the full range of methods,

很多医疗中心甚至没有 不同避孕器械的存货，

so it can take multiple visits and referrals

所以一个有效的避孕方法

to get one of the more effective methods of birth control.

需要病人跑好几次， 去不同的医院。

Sophia didn't have the privilege of that kind of time for birth control,

索菲亚没有那么多时间用来避孕，

so she ended up settling for the only option she had.

所以她只能服用避孕药。

Now instead of that experience,

除了索菲亚的经历，

imagine a regular doctor's visit in primary care like this.

想象一个这样的就诊经历。

First, no matter why a patient comes in for care,

首先，不管病人来就诊的原因，

they're asked a deceptively simple, standard screening question.

医生会以一个简单的问题开头

"Do you plan to become pregnant in the next year?"

“你想在一年内怀孕吗？”

The answer to that question opens up a whole dialogue

这个问题会引出一整个

about what they care about and what they want.

关于病人的需求的对话。

Second, if the answer is no,

如果答案是没有怀孕计划，

patients should be offered the full range of contraceptive methods

医生应该提供各种避孕方法的

with full information,

全面信息。

so they can really choose the method that works best for them.

所以他们可以选择 最适合自己的方法。

And most importantly,

最重要的是，

they should be able to leave that visit

他们应该能够在离开前

with the birth control method of their choice,

得到自己想要的避孕处理，

not be asked to come back two or three more times.

而不是被要求再来两次或者三次。

This is really about shifting the system of primary care to empower patients.

这是一个可以给病人 更多权力的医疗体系转变。

Well, you don't have to imagine it, we actually did this.

实际上，你并不需要想象， 我们做到了这一点。

We trained up the entire health care system in Delaware

我们以这种方式培训了特拉华州的

to work this way.

所有医疗系统。

We worked there because patient surveys showed, when we started,

我们在那里培训的原因是问卷表明，

that more than half of all pregnancies were unplanned.

超过一半的怀孕都是意外。

Three years later,

三年后，

the percentage of births from unplanned pregnancies

意外怀孕的比例

dropped 23 percent.

减少了百分之二十三。

The abortion rate dropped 37 percent,

堕胎率降级了百分之三十七，

the largest decline of any state in the country.

比美国任何一个州的下降率都要高。

And within six years, infant mortality dropped 24 percent.

六年内，婴儿死亡率 降低了百分之二十四。

(Cheers and applause)

（欢呼与掌声）

Upstream is now working in 14 states with plans to go national.

上游现在在14个州中提供服务， 并且计划扩张至全国范围。

(Cheers and applause)

（欢呼与掌声）

It is unconscionable, unconscionable, that Sophia,

美国真的，真的不应该有上百万个

and millions like her in this country,

像索菲亚一样

don't have access to birth control like this.

无法使用其他避孕方法的女人。

Especially in a post-Roe world.

尤其是在罗诉韦德案后的世界。

I think we can all agree

我认为我们都可以同意

that ensuring people have access to the birth control they need

为需要的人提供合适的避孕机会

so they can plan their families

来让他们合理的规划家庭

or decide if they want to have one or not,

或者决定想不想要孩子

isn't a blue, red or a purple-state idea.

不是一个政治观点。

It's a smart, just, empowering idea for everyone.

这对所有人都是一个机智的， 改革性的想法。

If we care about giving young people the best start at their dreams,

如果我们真的想让年轻人实现梦想，

let's make sure they have access to fully equitable, fully informed,

我们应该确保他们每一位 都能受到完整的，全面的，

patient-centered contraceptive care as a part of basic primary health care.

以病人为中心的避孕服务。

We can empower patients like Sophia with the choices and tools they need

我们可以给像索菲亚一样 的病人提供他们需要的信息

to become the intentional parents they want to be.

来在想当父母的时候成为父母。

Access to best-in-class health care

一流的医疗体系，

and best-in-class contraceptive care is a health equity issue,

头等的避孕服务 是医疗平等的一部分，

but it is so much more than that.

但它不仅仅是医疗平等，

It's also a foundation of equal opportunity.

也是一个平权的基本条件。

Thank you.

谢谢。

(Cheers and applause)

（欢呼与掌声）