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About eight years ago, I met a young woman.
大约八年前，我遇到了一位年轻女子，
I'll call her Sophia.
我们就称她为苏菲亚。
And she showed me her newborn in her lap.
她让我看了她膝上的婴儿。
And she said to me, "This wasn't my plan."
她对我说：「这不在我的计划中。」
She described how her unplanned pregnancy forced her to drop out of community college, how she then lost her job and was now living with her mother in Texas.
她说明计划外的怀孕如何迫使她从社区大学退学，接着她如何失去工作，现在和她母亲一起住在德州。
Sophia had already had two unplanned children before this third child was born.
在第三个孩子出生之前苏菲亚就已经有两个未预期的孩子了。
All three of Sofia's pregnancies occurred while she was on the pill.
苏菲亚的三次怀孕，都发生在她服用避孕药的期间。
It was a birth control method that just didn't work for her, but it was the only method she'd ever been offered.
这种避孕方式对她就是无效，但别人就只提供她这一种方式。
Sophia's pregnancies weren't just unplanned.
苏菲亚的怀孕不仅在计划外，
She actively planned not to become pregnant and took precautions against it.
她还主动计划不要怀孕，并做了事前预防措施。
But the only method she was ever offered failed her.
但别人提供她的唯一方式让她失望了。
In the US each year, nearly half of all pregnancies are unplanned.
在美国，每年有近半的怀孕是计划外的。
I know it's an astonishing number to get your head around.
我知道这个数字让人难以置信。
And over the span of ten years, it's been estimated that six out of ten typical birth-control pill users will become accidentally pregnant.
在十年间，估计会服用避孕药的人十个当中就有六个会意外怀孕。
This is not just about uninformed teens.
这不只是青少女信息不足的问题。
Most unplanned pregnancies occur to women who are in their 20s.
大部分意外怀孕的人都是二十多岁的女子。
In fact, about half of all unplanned pregnancies occur to women who are actually using birth control, like Sophia.
事实上，所有意外怀孕的女性当中有大约一半有在避孕，就像苏菲亚。
Most people know about pills and condoms.
大部分人都知道避孕药和保险套。
There are actually 18 FDA-approved methods of birth control, each with different efficacy and side effect profiles, some of which are 20 times more effective than others.
食品及药物管理局其实核准了十八种避孕方法，每一种的功效和副作用都不尽相同，有的功效比其他的高二十倍。
The reason you don't know about this is simple.
你不知道这些，原因很简单。
Outside of specialty family planning clinics that are few and far between, health care organizations don't educate people about all their birth control options and don't make them easily available.
除了非常少数几家避孕规划诊所之外，健康照护机构并不会提供大众关于避孕选项的教育，也不会让这些选项很容易取得。
But this is what Upstream, the nonprofit I cofounded, does.
但我共同创办的非营利机构「上游」就是在做这件事。
We train community health centers, hospital practices, primary care facilities, the places where the vast majority of people get their health care, to put patient centered needs first and provide best in class contraceptive care as a part of basic primary health care.
我们训练社区健康中心、医院诊所、基层照护机构，大部分人取得健康照护的地方，教它们以病人为中心，并提供一流的避孕照护，做为基础基层健康照护的一部分。
You know, when I first met Sophia, I'd been listening for years to what young people were saying about the challenges they were facing achieving their goals.
自我初次见到苏菲亚起，多年来我就一直在倾听年轻人诉说他们在朝目标迈进的过程中面临什么挑战。
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.” Or, “I got my girlfriend pregnant and I had to quit my job.”
我很惊讶，好多人的故事都是某种版本的「我发现我怀孕了，我得退学。」或者「我让我女友怀孕了，我得辞掉我的工作。」
I just kept hearing these stories, I wasn't looking for it.
我没有刻意去找这些故事，却仍然一直听到。
And I came away from those conversations utterly convinced that lack of equitable access to contraception, the inability to get the birth control method you want, when you want it, with full information, was a critical factor derailing the life trajectories of many young people in this country.
在这些谈话之后，我深深相信，无法平等地取得避孕措施，在需要时，不能得到你想要的避孕方式，并了解完整信息，这是个非常重要的原因，导致美国许多年轻人的人生大乱。
It's obviously not the only structural barrier they face, of course, but I really have come to believe that it is a major cause of inequality, and it's one we can actually do something about.
当然，他们所面对的结构性障碍并不只这一个，但我渐渐相信，这是不平等的主因之一，且针对这个因素，我们还能做点什么。
Back to Sophia.
回到苏菲亚，
She told me she faced countless barriers trying to get another method of birth control that was more effective.
她告诉我她在试图取得另一种更有效的避孕方法时面临到一大堆难题。
After hearing from a friend about the IUD, one of the most effective methods of birth control, she decided she wanted that method.
她从朋友那里听说了最有效的避孕方法之一，子宫内避孕器，之后，她便决定她要用那种方法。
So she ended up getting a day off from work, borrowing a car and driving the three hours to her health center to get one.
最后，她请了一天的假，借了一台车，开三小时的车到她的健康中心去装避孕器。
But when she got there, they told her that they had to order one for her and the sole provider they had who could place that method was only available on Tuesdays.
但她到那里时，他们说他们必须要帮她订一个，而他们唯一能够装避孕器的医师只有星期二才有空。
