about something that should be a totally uncontroversial topic.

今天，我想跟大家談談

But, unfortunately, it's become incredibly controversial.

本來應該完全沒有爭議的話題。

This year, if you think about it,

但不幸的是，這話題大受爭議。

over a billion couples will have sex with one another.

今年，如果你想一下，

Couples like this one,

超過百萬對伴侶會有性行為。

and this one,

像這對，

and this one,

這一對，

and, yes,

還有這一對。

even this one.

是的，

(Laughter)

甚至這一對。

And my idea is this --

（笑聲）

all these men and women should be free to decide

我的信念是這樣，

whether they do or do not want to conceive a child.

所有男人女人 都應該可以自由決定

And they should be able to use one of these birth control methods

他們要不要懷孕生子。

to act on their decision.

他們應該可以用這些避孕法

Now, I think you'd have a hard time

按著自己的決定行事。

finding many people who disagree with this idea.

現在，我想你大概很難找到

Over one billion people use birth control without any hesitation at all.

太多不同意這個想法的人。

They want the power to plan their own lives

超過十億人毫不猶豫地避孕。

and to raise healthier, better educated and more prosperous families.

他們想要有計畫自己人生的權力，

But, for an idea that is so broadly accepted in private,

及撫養更健康、教育程度更高、 更富有的家庭。

birth control certainly generates a lot of opposition in public.

然而，節育這個在私底下 如此廣為接受的想法，

Some people think when we talk about contraception

在公眾顯然遭受很大反對。

that it's code for abortion,

有些人認為我們談的避孕，

which it's not.

是墮胎的代碼，

Some people -- let's be honest --

事實並非如此。

they're uncomfortable with the topic because it's about sex.

有些人 ──我們就打開天窗說亮話吧──

Some people worry

覺得這個話題令他們不自在， 因為這在談性行為。

that the real goal of family planning is to control populations.

有些人擔心

These are all side issues

家庭計畫的真正目的 是控制人口。

that have attached themselves to this core idea that men and women

但這些都是枝節的問題，

should be able to decide when they want to have a child.

攀附在這個核心信念上，

And as a result, birth control has almost completely and totally disappeared

即男人女人都應該 能決定什麼時候要有小孩。

from the global health agenda.

結果是，節育幾乎已完全

The victims of this paralysis are the people of sub-Saharan Africa

自全球衛生綱領上消失。

and South Asia.

這個癱瘓政策的受害者， 是撒哈拉沙漠以南的非洲人

Here in Germany, the proportion of people that use contraception

及南亞人。

is about 66 percent.

在德國這裡， 大眾使用避孕法的比例

That's about what you'd expect.

約為 66%。

In El Salvador, very similar, 66 percent.

這數字跟預期差不多。

Thailand, 64 percent.

在薩爾瓦多也很類似，66%。

But let's compare that to other places,

泰國，64%，

like Uttar Pradesh, one of the largest states in India.

但將此數字與其他地方相較，

In fact, if Uttar Pradesh was its own country,

如印度的大省「北方邦」。

it would be the fifth largest country in the world.

事實上，如果北方邦獨立，

Their contraception rate -- 29 percent.

會是世界上第五大國家。

Nigeria, the most populous country in Africa, 10 percent.

他們的避孕率，29%。

Chad, 2 percent.

奈及利亞，非洲人口 最密集的國家，10%。

Let's just take one country in Africa, Senegal.

查德，2%。

Their rate is about 12 percent.

就拿非洲的塞內加爾為例。

But why is it so low?

他們的避孕率約為 12%。

One reason is that the most popular contraceptives are rarely available.

但為什麼會這麼低？

Women in Africa will tell you over and over again

原因之一是拿不到 最普遍使用的避孕用品。

that what they prefer today is an injectable.

非洲女人會一再地告訴你，

They get it in their arm -- and they go about four times a year,

她們現在比較喜歡用注射法。

they have to get it every three months -- to get their injection.

她們在手臂上打一針， 一年打四次，

The reason women like it so much in Africa is they can hide it from their husbands,

她們必須每三個月打一次。

who sometimes want a lot of children.

非洲婦女這麼喜歡這種方法的原因 是她們可以向丈夫隱瞞，

The problem is every other time a woman goes into a clinic in Senegal,

丈夫有時候想要很多小孩。

that injection is stocked out.

問題是塞內加爾的女人去診所時，

It's stocked out 150 days out of the year.

常常發現注射劑缺貨。

So can you imagine the situation --

每年有 150 天缺貨。

she walks all this way to go get her injection.

你可以想像這種情況嗎？

She leaves her field, sometimes leaves her children,

她走了好長一段路去打避孕針。

and it's not there.

她得丟下她的田， 有時候還得丟下孩子，

And she doesn't know when it's going to be available again.

卻發現沒有藥。

This is the same story across the continent of Africa today.

她也不知道 什麼時候才會再進貨。

And so what we've created as a world has become a life-and-death crisis.

這樣的故事 每天都在非洲大陸上演。

There are 100,000 women [per year] who say they don't want to be pregnant

我們全體共創的問題 已經變成生死存亡的危機。

and they die in childbirth -- 100,000 women a year.

每年有十萬名婦女說 她們不想要懷孕，

There are another 600,000 women [per year]

結果死於難產。 每年十萬名婦女！

who say they didn't want to be pregnant in the first place,

每年還有六十萬名婦女

and they give birth to a baby

說她們其實不想懷孕，

and her baby dies in that first month of life.

但還是生下小孩，

I know everyone wants to save these mothers and these children.

小孩卻在頭一個月內死亡。

But somewhere along the way, we got confused by our own conversation.

我知道每個人都想拯救 這些母親及孩子，

And we stopped trying to save these lives.

但是在拯救之路上， 我們卻被自己的爭論困惑。

So if we're going to make progress on this issue,

然後我們就停止拯救這些生命。

we have to be really clear about what our agenda is.

所以，如果我們要在 這項議題上有進展，

We're not talking about abortion.

我們必須很清楚明瞭 我們的意圖是什麼。

We're not talking about population control.

我們不是在談墮胎。

What I'm talking about is giving women the power to save their lives,

我們不是在談人口控制。

to save their children's lives

我在談的是給女性拯救 自己生命的權力，

and to give their families the best possible future.

拯救自己孩子的生命，

Now, as a world,

並且給她們的家庭最好的未來。

there are lots of things we have to do in the global health community

那麼，從世界整體看，

if we want to make the world better in the future --

我們要為全球健康做很多事，

things like fight diseases.

如果我們想讓這個世界 有更美好的未來，

So many children today die of diarrhea, as you heard earlier, and pneumonia.

像對抗疾病這種就是要做的。

They kill literally millions of children a year.

你們之前聽到了， 今天有太多孩子死於腹瀉及肺炎。

We also need to help small farmers --

這兩種病一年會殺死 數百萬名孩童。

farmers who plow small plots of land in Africa --

我們也必須幫助非洲小農，

so that they can grow enough food to feed their children.

他們耕種小塊土地，

And we have to make sure that children are educated around the world.

如此他們才能種植 足夠的食物餵養孩子。

But one of the simplest and most transformative things we can do

我們必須確保 全世界孩童都能受教育。

is to give everybody access to birth control methods

但是還有一件既簡單 又能帶來改變的事，

that almost all Germans have access to and all Americans, at some point,

就是讓每一個人 都能取得節育的方法，

they use these tools during their life.

就像幾乎每位德國人、 美國人能拿到一樣，

And I think as long as we're really clear about what our agenda is,

他們在人生的某個階段 使用這些用品。

there's a global movement waiting to happen

我認為只要我們真的很清楚 我們的意圖是什麼，

and ready to get behind this totally uncontroversial idea.

就會產生全球性的運動，

When I grew up, I grew up in a Catholic home.

準備好支持這項 完全沒有爭議的想法。

I still consider myself a practicing Catholic.

我在天主教家庭長大。

My mom's great-uncle was a Jesuit priest.

我仍然視自己 為虔誠的天主教徒。

My great-aunt was a Dominican nun.

我母親的伯公是耶穌會修士。

She was a schoolteacher and a principal her entire life.

我的姑婆是道明會修女。

In fact, she's the one who taught me as a young girl how to read.

她教鞭執了一輩子。

I was very close to her.

事實上，她是我小時候 教我認字的人。

And I went to Catholic schools for my entire childhood

我跟她非常親。

until I left home to go to university.

我整個童年都讀天主教學校，

In my high school, Ursuline Academy,

直到我離家去讀大學。

the nuns made service and social justice a high priority in the school.

在我的高中，聖吳甦樂學園，

Today, in the [Gates] Foundation's work,

修女高度重視服務及社會正義。

I believe I'm applying the lessons that I learned in high school.

今天，我在蓋茲基金會的工作，

So, in the tradition of Catholic scholars,

我相信那正是在 應用高中所學之道。

the nuns also taught us to question received teachings.

在天主教學者的傳統風氣下，

And one of the teachings that we girls and my peers questioned

修女也教導我們 要質疑接受到的教誨。

was is birth control really a sin?

我們女孩子及同學 常質疑的一項教條，

Because I think one of the reasons

就是節育真的是罪嗎？

we have this huge discomfort talking about contraception

因為我認為

is this lingering concern

我們對談論避孕會這麼不自在，

that if we separate sex from reproduction, we're going to promote promiscuity.

是因為這個想法在作怪，

And I think that's a reasonable question to be asked about contraception --

即如果我們把性與繁衍後代分開， 我們就在鼓勵淫亂。

what is its impact on sexual morality?

我想要談避孕的話， 接下來這個問題就得提出來談──

But, like most women,

避孕對性道德會產生什麼影響？

my decision about birth control had nothing to do with promiscuity.

但是，就像大多數女性，

I had a plan for my future. I wanted to go to college.

我決定要節育與淫亂完全無關。

I studied really hard in college,

我對未來有計畫。 我想去上大學。

and I was proud to be one of the very few female computer science graduates

我在大學非常認真讀書，

at my university.

我也很自傲自己是校內 電腦科學系少數女性畢業生之一。

I wanted to have a career, so I went on to business school

我想要發展事業， 所以我進了商學院，

and I became one of the youngest female executives at Microsoft.

我也成為微軟的 年輕女性高級主管一員。

I still remember, though, when I left my parents' home

但是我仍然記得在我離家，

to move across the country to start this new job at Microsoft.

橫跨美國大陸到微軟 開始新工作時的一景。

They had sacrificed a lot to give me five years of higher education.

他們犧牲了很多 讓我接受五年的高等教育。

But they said, as I left home --

但我離家時他們對我說

and I literally went down the front steps, down the porch at home --

──真的就在我走下前門 台階的時候──

and they said,

他們說：

"Even though you've had this great education,

「即使妳受了這麼好的教育，

if you decide to get married and have kids right away,

如果妳馬上就想結婚生小孩，

that's OK by us, too."

我們也不會反對。」

They wanted me to do the thing that would make me the very happiest.

他們想要我去做 讓自己最幸福的事。

I was free to decide what that would be.

我可以自由決定要做什麼。

It was an amazing feeling.

這感覺真好。

In fact, I did want to have kids --

事實上，我的確想要孩子，

but I wanted to have them when I was ready.

但我想在我準備好時再要。

And so now, Bill and I have three.

所以現在， 比爾和我有三個孩子。

And when our eldest daughter was born,

我的大女兒出生時，

we weren't, I would say, exactly sure how to be great parents.

我必須說我們不太清楚 怎麼當好父母。

Maybe some of you know that feeling.

可能在座有些人了解那種感覺。

And so we waited a little while before we had our second child.

所以我們等了一陣子 才懷第二個孩子。

And it's no accident that we have three children

我們有三個孩子，

that are spaced three years apart.

每個間隔三年並非偶然。

Now, as a mother, what do I want the very most for my children?

現在，身為母親， 我最想要給我的孩子什麼？

I want them to feel the way I did --

我想要他們 跟我當時的感覺一樣，

like they can do anything they want to do in life.

就是他們能做任何想做的事。

And so, what has struck me

所以，我很驚訝，

as I've travelled the last decade for the foundation around the world

當我過去十年為基金會 在全世界奔走時，

is that all women want that same thing.

看到所有的女性都有同樣的心願。

Last year, I was in Nairobi, in the slums, in one called Korogocho --

去年，我在奈洛比 一個叫科羅哥丘的貧民窟，

which literally means when translated, "standing shoulder to shoulder."

翻譯出來就是 「比肩繼踵 」的意思。

And I spoke with this women's group that's pictured here.

我與這張照片上的 當地婦女團體談話。

And the women talked very openly about their family life in the slums,

這些婦女非常公開地談論 她們在貧民窟中的生活

what it was like.

是什麼樣子。

And they talked quite intimately about what they did for birth control.

她們也很親密地談論 她們如何節育。

Marianne, in the center of the screen in the red sweater,

瑪莉安，螢幕中間穿紅色毛衣的，

she summed up that entire two-hour conversation

她總結這場兩小時的對話，

in a phrase that I will never forget.

說了句我永遠忘不了的話。

She said, "I want to bring every good thing to this child

她說：「我想先給這個孩子最好的一切，

before I have another."

再生下一個孩子。」

And I thought -- that's it.

我就想，就是這樣。

That's universal.

這是普世皆然的想法。

We all want to bring every good thing to our children.

我們都想給孩子最好的一切。

But what's not universal is our ability to provide every good thing.

但是怎麼給他們最好的 卻非普世皆然。

So many women suffer from domestic violence.

許多婦女遭受家暴。

And they can't even broach the subject of contraception,

她們甚至無法提出避孕的話題，

even inside their own marriage.

即使已經結婚了也不行。

There are many women who lack basic education.

很多女性沒有受過基本教育。

Even many of the women who do have knowledge and do have power

甚至許多受過教育、 有能力的女性

don't have access to contraceptives.

也無法拿到避孕品。

For 250 years, parents around the world

250 年來，全世界的父母

have been deciding to have smaller families.

都決定要小一點的家庭。

This trend has been steady for a quarter of a millennium,

這種潮流在過去 250 年來都是如此，

across cultures and across geographies,

無論文化、無論地理位置，

with the glaring exception of sub-Saharan Africa and South Asia.

只有一個很明顯的例外， 就是撒哈拉以南的非洲及南亞。

The French started bringing down their family size in the mid-1700s.

法國自 18 世紀中 開始減少家庭人口。

And over the next 150 years, this trend spread all across Europe.

接下來 150 年 這個潮流席捲歐洲。

The surprising thing to me, as I learned this history,

我在讀這段歷史時很驚訝

was that it spread not along socioeconomic lines but around cultural lines.

這不是以社經地位傳播， 而是以文化為基礎傳播。

People who spoke the same language made that change as a group.

說同樣語言的人 以團體的形式做出改變。

They made the same choice for their family,

他們為了家庭做出相同的決定，

whether they were rich or whether they were poor.

無論他們是富是貧。

The reason that trend toward smaller families spread

小家庭趨勢能廣傳的原因，

was that this whole way was driven by an idea --

是整件事受這個想法驅使，

the idea that couples can exercise conscious control

就是夫婦能實行節育，

over how many children they have.

自行決定他們要有多少孩子。

This is a very powerful idea.

這是很有影響力的想法。

It means that parents have the ability to affect the future,

這意味著父母能影響未來，

not just accept it as it is.

而非被動的接受。

In France, the average family size went down every decade

在法國，平均家庭人口數 每十年就縮小一次，

for 150 years in a row until it stabilized.

持續了 150 年，直到穩定為止。

It took so long back then because the contraceptives weren't that good.

要花這麼長的時間是因為 過去的避孕效果不太好。

In Germany, this transition started in the 1880s, and it took just 50 years

德國於 1880 年代開始轉變， 然後只花了 50 年

for family size to stabilize in this country.

就使這個國家的家庭人數達到穩定。

And in Asia and Latin America, the transition started in the 1960s,

在亞洲及南美， 轉變始於 1960 年代，

and it happened much faster because of modern contraception.

由於現代化的避孕法， 這種轉變發展更快。

I think, as we go through this history, it's important to pause for a moment

我認為，在我們討論歷史的同時， 我們必須暫停一下，

and to remember why this has become such a contentious issue.

並回想為什麼這會變成 如此受爭論的議題。

It's because some family planning programs

這是因為某些家庭計畫

resorted to unfortunate incentives and coercive policies.

使出不適宜的誘因和高壓政策。

For instance, in the 1960s, India adopted very specific numeric targets

例如在 1960 年代， 印度採用非常具體的數字目標，

and they paid women to accept having an IUD placed in their bodies.

而且他們還付錢給女性， 讓她們在體內裝上子宮環。

Now, Indian women were really smart in this situation.

印度女性在這方面真的很精明。

When they went to get an IUD inserted, they got paid six rupees.

她們每次去裝子宮環， 就會得到六盧比。

And so what did they do?

所以她們怎麼做呢？

They waited a few hours or a few days,

她們會等幾小時或幾天，

and they went to another service provider and had the IUD removed for one rupee.

然後去另一家醫院 付一盧比取出子宮環。

For decades in the United States,

美國曾有數十年的歷史，

African-American women were sterilized without their consent.

非裔女性未經同意 就被強迫絕育。

The procedure was so common

這項手術普遍到

it became known as the Mississippi appendectomy --

被稱為「密西西比闌尾切除術」，

a tragic chapter in my country's history.

真是我國歷史上悲慘的一章。