Why Birth Control Is Still a Big Idea

Contraceptives empower women -- and that's good news for the global health and development agenda.

I spent most of my time this year advocating for better access to family planning around the world. Early on, I told everybody who would listen that I wanted to help put contraceptives back on top of the global health and development agenda. Visiting women in developing countries, however, I realized that this framing didn't quite capture my message.

Contraceptives are tools, and the development agenda is an abstract construct. What was missing were human beings, the women across the world who have told me over and over again that having access to birth-control methods that work for them would change their futures. Now I tell people that I want to help put women at the center of global health and development work, and better contraceptives are one of their top priorities. Listening to women shouldn't still be a revolutionary idea in 2012, but it is.

When I visit family-planning wards at health clinics in African countries, there are always plenty of free condoms available. Condoms are vitally important, especially because they also help prevent the spread of sexually transmitted diseases like AIDS. But there's a problem: The overwhelming majority of African women can't rely on condoms for birth control because their husbands refuse to use them.

In the same way that American women prefer contraceptive pills, which they don't have to negotiate with their partners, African women favor contraceptive injections over condoms. But because of supply constraints, supply-chain problems, and outdated public policies, these injections are frequently out of stock. To take one example, in Kaduna, Nigeria, a city of some 1.5 million people, there were 226 days last year when not a single public health clinic had injections available.

If you are focused simply on making sure contraceptives are available, you can stockpile condoms and call it a day. But if your goal is helping women build the lives they want for themselves and their families, the bar is higher.

In the United States, especially this year, any occasion when contraceptives and public policy overlap seems to be an excuse to fight about other issues -- abortion or the meaning of religious freedom, for instance. But the fact is, literally 99 percent of women in the United States who have had sex use birth control at some point in their lives. What our behavior (if not our rhetoric) tells me is that contraceptives matter to us. They certainly mattered to me. I was able to go to college and business school. I was able to have a rewarding career at Microsoft. And then Bill and I were able to decide how many children to have (three) and when to have them (each three years apart), which I believe made us better parents.

These are some of the same reasons that contraceptives matter to women in developing countries. Like all parents, they want their children to grow up healthy and go to school. Contraceptives don't do all this, of course. They are a single link in a long chain that includes proper nutrition, vaccines, clean water, productive farms, and high-quality public schools. But they are the first link, and they give parents a much better opportunity to complete the chain. As one young mother in Kenya told me, "I want to bring every good thing to my child before I have another."

There are convincing data showing the long-term impact of contraceptives. The leading study, ongoing in Bangladesh for the past 35 years, proves that people who have access to and education about contraceptives have a higher quality of life in almost every conceivable way than those who don't. They are healthier, less likely to die in childbirth, and less likely to have children who die. They are better educated, with sons and daughters who have more schooling. And they are more prosperous: Their households have more total assets, including land, livestock, and savings. On an even larger scale, economists have argued convincingly that the so-called East Asian economic miracle of the 1980s was due in large part to parents in the region deciding to have fewer children.

Contraceptives unlock one of the most dormant but potentially powerful assets in development: women as decision-makers. When women have the power to make choices about their families, they tend to decide precisely what demographers, economists, and development experts recommend. They invest in the long-term human capital of their families. They don't do it because they're worried about GDP; they do it because they're worried about their children's futures. But the two fit together beautifully.

Today I tell people that I want to help put women at the center of global health and development work -- and that contraceptives are one of the best ways to do that. Because when women everywhere have the power to achieve their goals, they will be doing the majority of the work of development by themselves.



Defending Free Speech in the Digital Age

Across the world, the battle for free speech is pitting governments and corporations against activists and average citizens.

Freedom of speech is under threat around the world. On one side of this battle are governments and corporations seeking, to various degrees, to set limits on what is acceptable to say and what is not. On the other are ordinary citizens and activists demanding that their voices be heard -- voices that, in this new age of smartphones and social media, are harder than ever to silence, even as technology puts new implements of censorship into the hands of autocrats. In many cases, the battle is being joined in societies that are struggling with the powerful repercussions of free expression for the first time.

This year certainly saw great personal courage and selfless leadership in the struggle for free speech reminiscent of the bravery displayed in earlier decades, complete with familiar antagonists and tools of repression. Among Foreign Policy's 2012 Global Thinkers, there is Chen Guangcheng (No. 9), the blind human rights activist who made a harrowing escape from China and is now living in exile in New York; Ahlem Belhadj (No. 18), the Tunisian feminist leading the fight to make sure the revolution doesn't backfire on women as she tries to block attempts to revive polygamy and female circumcision, among other regressive measures; and Bassel Khartabil (No. 19), an innovative Syrian activist who defied President Bashar al-Assad and has not been heard from since his arrest in March. I also must mention Adela Navarro Bello (No. 76), whose Tijuana magazine is investigating the bank accounts and investments of Mexico's drug cartel bosses in a country where 40 journalists have been murdered or have disappeared in the past six years. (She travels with bodyguards.) And just as the underground rock bands of the 1980s rallied youth against a decaying Soviet Union with their lyrics of defiance, there are even punk rockers featured among these Global Thinkers, though Russian band Pussy Riot (No. 16) may legitimately claim to have no equal in the world of pop-culture protest.

Yet the impetus for revisiting free speech, as Foreign Policy urges us to do with this year-end issue, is precisely the opposite: not to dwell on the familiar, but to take stock of the sweeping changes before us and the profoundly altered dimensions of both free speech and the actions required to preserve it. This is a distinct moment in time when even our shared understanding of what constitutes expression is evolving right along with radical advances in communications technology. Many on this year's list -- from Twitter's in-house lawyer, Alexander Macgillivray (No. 66), to the U.S. naval lab researchers (No. 78) who created a safe, anonymous way for allowing those who might be silenced online to speak -- are struggling in different ways to help us define (and protect) this most fundamental of freedoms at a moment when the available tools for safeguarding speech have become much harder to identify, let alone employ. Increasingly, governments are using laws criminalizing the "defamation" of religion as a tool to repress free speech. The NGO Human Rights First documented more than 100 recent examples of "gross abuse" of such laws around the world, many of them in Muslim countries. Even U.N. Secretary-General Ban Ki-moon seemed to question free speech as an absolute right after the release of the video Innocence of Muslims sparked riots across the Islamic world, insisting that "when some people use this freedom of expression to provoke or humiliate some others' values and beliefs, then this cannot be protected."

Three changes in particular distinguish this era's tensions surrounding global free expression from the battles of the past:

First, progress in a globally interdependent society relies more than ever on the unimpeded flow of information. With national commerce and finance so thoroughly woven into the fabric of the modern global economy and countries finding themselves dependent on each other in fundamentally new ways, we have left behind the time when any single country, even the United States, could effectively address matters of great consequence on its own. Whether the problem is climate change, terrorism, or infectious disease, the solution requires international cooperation. In the post-World War II era, efforts to guarantee press freedom were seen as providing a shield against the formation of dictatorships, while now that purpose has been joined and perhaps superseded by the need to establish the necessary conditions for an expanding global marketplace.

Today, we quickly experience how censorship anywhere becomes censorship everywhere. In late October, after the New York Times featured an article on the vast wealth amassed by the family of Chinese Premier Wen Jiabao, the Chinese government blocked access to the newspaper's websites. The Times joined Bloomberg, whose investigation into the wealth of Xi Jinping, the man expected to become China's president, on the wrong side of the Great Firewall. At the same time, offensive speech anywhere can now be expected to have repercussions everywhere -- a new reality never more devastatingly apparent than in the furor following the video insulting the Prophet Mohammed. Taken together, these products of globalization and transformed communications technology are diminishing national power and leaving heads of state less secure in their ability to control the future, which in turn often leads to reinvigorated nationalism and bouts of serious censorship.

Advances in technology offer as well the promise of unprecedented human progress. The rise of a decentralized, atomistic, and truly global communications system has for the first time put within our reach an effective global marketplace of ideas that will be able to generate answers to urgent problems that one country acting alone cannot hope to solve. Those solutions, however, will not emerge unless there is a new global compact to ensure that censorship is defeated wherever it is found and that free speech is widely embraced by international bodies and the world's countries. Because protections for speech must be enforced across borders, it has become increasingly apparent that bilateral trade agreements, once serving as meaningful vehicles for advancing human rights and free expression, have lost much of their usefulness in this arena. Recent U.S. trade agreements with Panama, Guatemala, and South Korea, in fact, were notably silent on these matters. Yet none of this alters the reality that the importance of global free speech -- the benefits of achieving it and the cost of undervaluing it -- has never been greater.

Second, the very essence of modern life is the opportunity for people everywhere to speak, hear, persuade, change their minds, know what others are thinking, and think for themselves. Our great institutions of higher education, including the one I lead, bear a special social responsibility for educating people to possess a nimble cast of mind, able to grasp multiple perspectives and the full complexity of a subject. And for centuries, great societies of all types have understood that this kind of intellectual capacity is essential to progress. But never have critical thinking and tolerance been more important for individual well-being and for our collective prosperity.

The marketplaces of ideas and commerce are becoming inseparable as a consequence of the technology economy, with its premium on innovation and entrepreneurship. This means that the intellectual and material benefits of stronger global protections for speech, whether achieved through national laws or global conventions, will be enormous. When the number of people around the world who are engaged in the marketplace of ideas increases, we can expect a corresponding rise in the flow of innovation in both the academy and the economy. At Twitter, Macgillivray has been a modern crusader for this truth.

Politically, the surest way to ward off the spread of authoritarianism is to safeguard the public expression of diverse opinion and the democratic social interactions that result. The habit of open debate works as an antidote to the intolerance and fear that in too many parts of the world continue to support official policies of misogyny, as antiquated as they are repellant. Above all, the individuals selected as Foreign Policy's Global Thinkers share a profound insistence on speaking for themselves, listening to others, and changing the minds of opponents -- sometimes even their own (see No. 10). In this, they are the true faces of modernity.

Third, our legal tools for safeguarding free speech need to evolve to protect this way of life. The practical demands of the commercial marketplace and the prerogatives of economic integration suggest this can happen. This, in fact, is exactly why the Office of the U.S. Trade Representative, at the urging of America's leading digital businesses and other affected industries, has filed a formal inquiry with the World Trade Organization to address China's Internet censorship, the first time any country has made such a request through the WTO. Casting the need for sharing knowledge in this light, and then moving beyond the economic agenda to concerns about human rights and civil society, is likely to be more productive than a frontal campaign put solely in terms of values.

Winning may take time. Consider the lengthy constitutional and cultural journey traveled in the United States since the early part of the 20th century. The starting place was the First Amendment, yet only after several decades did Americans come to appreciate not simply the value of this liberty as it pertains to the individual, but also the benefits of building a tolerant society. In the course of America's ongoing experiment with virtually unrestricted expression, the country has tacked between more and less protection for speech while moving steadily over time in the direction of openness.

There is no reason to expect that the world will move more quickly or more cleanly to develop a global public forum. But with historic forces working to drive us in that direction and exceptional individuals like Foreign Policy's Global Thinkers committed to the cause, the eventual outcome is not in doubt.