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

譯者: Lilian Chiu 審譯者: Helen Chang

About eight years ago, I met a young woman.

大約八年前，我遇到了 一位年輕女子，

I'll call her Sophia.

我們就稱她為蘇菲亞。

And she showed me her newborn in her lap.

她讓我看了她膝上的嬰兒。

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

她對我說：

「這不在我的計畫中。」

She described how her unplanned pregnancy

她說明計畫外的懷孕 如何迫使她從社區大學退學，

forced her to drop out of community college,

how she then lost her job

接著她如何失去工作，

and was now living with her mother in Texas.

現在和她母親一起住在德州。

Sophia had already had two unplanned children

在第三個孩子出生之前蘇菲亞 就已經有兩個未預期的孩子了。

before this third child was born.

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

蘇菲亞的三次懷孕，都發生在 她服用避孕藥的期間。

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

這種避孕方式對她就是無效，

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

但別人就只提供她這一種方式。

Sophia's pregnancies weren't just unplanned.

蘇菲亞的懷孕不僅在計畫外， 她還主動計畫不要懷孕，

She actively planned not to become pregnant

and took precautions against it.

並做了事前預防措施。

But the only method she was ever offered failed her.

但別人提供她的 唯一方式讓她失望了。

In the US each year,

在美國，每年有 近半的懷孕是計畫外的。

nearly half of all pregnancies are unplanned.

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

我知道這個數字讓人難以置信。

And over the span of ten years,

在十年間，

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

估計會服用避孕藥的人 十個當中就有六個

will become accidentally pregnant.

會意外懷孕。

This is not just about uninformed teens.

這不只是青少女資訊不足的問題。

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

大部分意外懷孕的人 都是二十多歲的女子。

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

事實上，所有意外懷孕的 女性當中有大約一半有在避孕，

who are actually using birth control, like Sophia.

就像蘇菲亞。

Most people know about pills and condoms.

大部分人都知道避孕藥和保險套。

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

食品及藥物管理局其實 核准了十八種避孕方法，

each with different efficacy and side effect profiles,

每一種的功效和副作用都不盡相同，

some of which are 20 times more effective than others.

有的功效比其他的高二十倍。

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

你不知道這些，原因很簡單。

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

除了非常少數幾家 避孕規劃診所之外，

health care organizations don't educate people

健康照護機構並不會提供大眾 關於避孕選項的教育，

about all their birth control options

and don't make them easily available.

也不會讓這些選項很容易取得。

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

但我共同創辦的非營利機構 「上游」就是在做這件事。

We train community health centers, hospital practices,

我們訓練社區健康中心、

醫院診所、基層照護機構，

primary care facilities,

大部分人取得健康照護的地方，

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

to put patient centered needs first

教它們以病人為中心，

and provide best in class contraceptive care

並提供一流的避孕照護，

as a part of basic primary health care.

做為基礎基層健康照護的一部分。

(Applause)

（掌聲）

You know, when I first met Sophia,

自我初次見到蘇菲亞起， 多年來我就一直在傾聽

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

年輕人訴說他們在朝目標 邁進的過程中面臨什麼挑戰。

about the challenges they were facing achieving their goals.

我很驚訝，好多人的故事 都是某種版本的

And I was struck by how many of their stories

began with some version of,

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

「我發現我懷孕了，我得退學。」

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

或者「我讓我女友懷孕了， 我得辭掉我的工作。」

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

我沒有刻意去找這些故事， 卻仍然一直聽到。

And I came away from those conversations utterly convinced

在這些談話之後，我深深相信，

that lack of equitable access to contraception,

無法平等地取得避孕措施，

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

在需要時，不能得到 你想要的避孕方式，

with full information,

並了解完整資訊，

was a critical factor derailing the life trajectories

這是個非常重要的原因，導致 美國許多年輕人的人生大亂。

of many young people in this country.

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

當然，他們所面對的結構性 障礙並不只這一個，

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

但我漸漸相信，這是 不平等的主因之一，

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

且針對這個因素， 我們還能做點什麼。

Back to Sophia.

回到蘇菲亞，

She told me she faced countless barriers

她告訴我她在試圖取得另一種

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

更有效的避孕方法時面臨到一大堆難題。

After hearing from a friend about the IUD,

她從朋友那裡聽說了最有效的

one of the most effective methods of birth control,

避孕方法之一， 子宮內避孕器，之後，

she decided she wanted that method.

她便決定她要用那種方法。

So she ended up getting a day off from work,

最後，她請了一天的假，

borrowing a car

借了一台車，

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

開三小時的車到她的 健康中心去裝避孕器。

But when she got there,

但她到那裡時，

they told her that they had to order one for her

他們說他們必須要幫她訂一個，

and the sole provider they had who could place that method

而他們唯一能夠裝避孕器的 醫師只有星期二才有空。

was only available on Tuesdays.

They told her to come back two weeks later.

他們要她兩週後再回來。

Even holding down two jobs,

即使有兩份工作，

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

她還是想辦法借了車，請了假， 跑了那趟三小時的路，

and get the day off,

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

卻又再次被告知當天不能裝避孕器。

They told her to come back a third time,

他們要她再來第三次，

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

但這次她無法再請假了。

Five months later, she did come back,

五個月後，她真的再去了一次，

this time unintentionally pregnant.

這次，她意外懷孕了。

Sophia's story demonstrates how unplanned pregnancy

蘇菲亞的故事呈現出 不在計畫中的懷孕根源於

is rooted in inequitable access to birth control.

無法平等取得避孕方法。

Sophia didn't know that many providers

蘇菲亞不知道許多醫生沒有受過 避孕藥以外的避孕方法的訓練。

aren't trained to offer contraception beyond the pill.

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

許多健康中心甚至不備有 所有的避孕方法，

所以可能要多次造訪和轉介 才能取得比較有效的避孕方法。

so it can take multiple visits and referrals

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

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

蘇菲亞不幸就是沒有 那麼多時間來做好避孕，

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

所以最後她只能妥協， 接受她唯一的選項。

Now instead of that experience,

現在，把那樣的經驗 換成這樣的想像：

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

想像到這樣的基層 醫療機構去看醫生，

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

首先，不論病人為什麼來尋求照護，

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

他們都會問一個看似 簡單的篩選用標準問題。

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

「你有計畫在明年懷孕嗎？」

The answer to that question opens up a whole dialogue

這個問題的答案能夠讓他們 開始暢談他們在乎／想要什麼。

about what they care about and what they want.

Second, if the answer is no,

再來，如果答案是否定的，

patients should be offered the full range of contraceptive methods

就會提供病人所有可得的避孕方法，

with full information,

以及完整的資訊，

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

讓他們能選擇對自己最好的方法。

And most importantly,

最重要的是，

they should be able to leave that visit

他們當次造訪就能帶著 他們選擇的避孕方法離開，

with the birth control method of their choice,

而不是被要求要再回來兩、三次。

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

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

重點是在於轉變基層 照護體系，賦權給病人。

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

各位不用想像，因為 我們已經做出來了。

We trained up the entire health care system in Delaware

我們訓練了德拉威州的整個 健康照護體系這樣運作。

to work this way.

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

我們努力，是因為調查指出，

剛開始時總數有超過半數的 懷孕在計劃之外；

that more than half of all pregnancies were unplanned.

Three years later,

三年後，

the percentage of births from unplanned pregnancies

計畫外懷孕的比例減少了 23 %，

dropped 23 percent.

The abortion rate dropped 37 percent,

墮胎率減少了 37%，

the largest decline of any state in the country.

是全美各州的最大降幅。

And within six years, infant mortality dropped 24 percent.

六年內，嬰兒死亡率減少了 24%。

(Cheers and applause)

（歡呼聲及掌聲）

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

「上游」現在在十四個州 努力，打算要擴展到全國。

(Cheers and applause)

（歡呼聲及掌聲）

It is unconscionable, unconscionable, that Sophia,

很不合理，

很不合理的是，蘇菲亞 和美國數百萬像她這樣的人

and millions like her in this country,

don't have access to birth control like this.

無法取得像這樣的避孕方法。

Especially in a post-Roe world.

特別是在羅訴韋德案後，

I think we can all agree

我想我們都認同，

that ensuring people have access to the birth control they need

確保大家能取得自己需要的 避孕方法來做好家庭規劃，

so they can plan their families

or decide if they want to have one or not,

或決定是否想要孩子，

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

並不是政治黨派的想法，

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

而是聰明、公平、賦權的 想法，對象是每個人。

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

如果我們在乎要讓追夢的 年輕人有最好的起跑點，

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

咱們就要確保他們能取得完全公平、

資訊完整、以人為本的避孕照護，

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

並將之納入到基層健康照護當中。

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

我們可以賦予像蘇菲亞這樣的 病人他們所需要的選擇和工具，

to become the intentional parents they want to be.

讓他們在想成為父母時才成為父母。

Access to best-in-class health care

取得優質健康照護

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

以及優質避孕照護 是個健康公平性的問題，

but it is so much more than that.

但它遠不只如此，

It's also a foundation of equal opportunity.

它也是平等機會的基礎。

Thank you.

謝謝。

(Cheers and applause)

（歡呼聲及掌聲）