Did Israelis force contraception on Ethiopian women? (UPDATE x2)
This troubling story has been all over the place, all from this Ha'aretz article claiming that Israeli officials admit to giving contraceptive injections to Ethiopian women without their permission.
But what does the article actually say?
A government official has for the first time acknowledged the practice of injecting women of Ethiopian origin with the long-acting contraceptive Depo-Provera.
Health Ministry Director General Prof. Ron Gamzu has instructed the four health maintenance organizations to stop the practice as a matter of course.
The ministry and other state agencies had previously denied knowledge or responsibility for the practice, which was first reported five years ago.
Gamzu's letter instructs all gynecologists in the HMOs "not to renew prescriptions for Depo-Provera for women of Ethiopian origin if for any reason there is concern that they might not understand the ramifications of the treatment."
He also instructed physicians to avail themselves of translators if need be.
Gamzu's letter came in response to a letter from Sharona Eliahu-Chai of the Association of Civil Rights in Israel, representing several women's rights and Ethiopian immigrants' groups. The letter demanded the injections cease immediately and that an investigation be launched into the practice.
About six weeks ago, on an Educational Television program journalist Gal Gabbay revealed the results of interviews with 35 Ethiopian immigrants. The women's testimony could help explain the almost 50-percent decline over the past 10 years in the birth rate of Israel's Ethiopian community. According to the program, while the women were still in transit camps in Ethiopia they were sometimes intimidated or threatened into taking the injection. "They told us they are inoculations," said one of the women interviewed. "They told us people who frequently give birth suffer. We took it every three months. We said we didn't want to."
First of all, Israeli doctors admitted offering Depo-Provera years ago to those who want it. In June 2008, the health minister of the time, Yaacov Ben Yezri, "said the high number of Ethiopians in Israel using the drug reflected a 'cultural preference' for injections among Ethiopians." Whether this is true or not, it shows that Ha'aretz is sloppy already in the first paragraph - they meant to claim that Israel acknowledged injecting the drug without permission.
But does that memo really say that?
The TV special that claimed that these women were coerced into taking the drug aired about six weeks ago. Isn't it possible that this memo was more to show caution that there might have been some women who misunderstood the use of the drug or the options they have for birth control? That's the way the quoted part reads to me. It certainly doesn't admit that Israeli doctors were conspiring to sterilize Ethiopian women, as Ha'aretz alleges - and as other media have willingly published.
Now let's look at the earlier article about the TV investigation:
Women who immigrated from Ethiopia eight years ago say they were told they would not be allowed into Israel unless they agreed to be injected with the long-acting birth control drug Depo Provera, according to an investigative report aired Saturday on the Israel Educational Television program "Vacuum."
The women say that while waiting in transit camps in Ethiopia prior to immigration they were placed in family planning workshops where they were coaxed into agreeing to the injection - a charge denied by both the Joint Distribution Committe, which ran the clinics, and the Health Ministry.
"We said we won't have the shot. They told us, if you don't you won't go to Israel And also you won't be allowed into the Joint (American Joint Distribution Committee) office, you won't get aid or medical care. We were afraid... We didn't have a choice. Without them and their aid we couldn't leave there. So we accepted the injection. It was only with their permission that we were allowed to leave," recounted Emawayish, who immigrated from Ethiopia eight years ago.
Emawayish was one of 35 women, whose stories were recorded by Sebba Reuven, that relate how they were coaxed and threatened into agreeing to receive the injectable birth control drug.
The birth rate among Israel's Ethiopian immigrant population has dropped nearly 20 percent in 10 years.
According to the report, the women were given the Depo Provera injections in the family planning workshops in transit camps, a practice that continued once they reached Israel. The women who were interviewed for the investigation reported that they were told at the transit camps that having many children would make their lives more difficult in Ethiopia and in Israel, and even that they would be barred from coming to Israel if they refused.
If true, this is indeed terrible. But the denials in that program were no less emphatic:
The Joint said in a response to "Vacuum" that its family planning workshops are among the services it provides to immigrants, who learn about spacing out their children's birth, "but we do not advise them to have small families. It is a matter of personal choice, but we tell them it is possible. The claims by the women according to which 'refusal to have the injection will bar them from medical care [and] economic aid and threaten their chances to immigrate to Israel are nonsense. The medical team does not intervene directly or indirectly in economic aid and the Joint is not involved in the aliyah procedures. With regard to the use of Depo Provera, studies indicate that is the most popular form of birth control among women in Ethiopia," the Joint said.
In its response to "Vacuum," the Health Ministry said it did not "recommend or try to encourage the use of Depo Provera, and that if these injections were used it was against our position. The Health Ministry provides individual family counseling in the framework of its well baby clinics and this advice is also provided by the physicians of the health maintenance organizations."
The Jewish Agency, which is responsible for Jewish immigration from abroad, said in response that it takes a harsh view of any effort to interfere in the family planning processes of Ethiopian immigrants, adding that "while the JA has never held family planning workshops for this group in Ethiopia or at immigrant absorption centers in Israel, the immigrant transit camp in Gondar, as the investigation noted, was previously operated by other agencies."
Three separate organizations on two continents are accused of performing the same reprehensible practice, a practice that would involve an unusual amount of collusion and conspiracy. But not one doctor from these agencies has come forward to verify the claims.
Yet another denial was published in a blog when the report first came out, from a doctor at The Joint:
JDC runs the medical program in Gondar for potential immigrants to Israel. As part of this, we offer voluntary contraception to our population. Our clinic offers both birth control pills and injectable contraception. If a woman prefers another method of contraception such as implantable or tubal ligation, we send them to facilities down the road in the city of Gondar for this.
Women come to the program because they desire family planning. We present the various options to them and they choose. So women both choose to use contraception and choose their method. And choose when to discontinue contraception. It has always been that way in our program.
Right now we're caring for about 4500 potential immigrants to Israel. We average about 85 family planning visits each month.
We do not inform the Israeli authorities who is on family planning, and I have no idea what happens once they arrive in Israel.
Regarding the rate of 30% reported some years ago, we offered family planning to the population at a time when it was less available to the general public, and our population chose to use it.
At present, the rate of modern contraceptive use in Amhara Region is 33% indicating a significant demand, as contraceptive services have become more available to the public. Even now, there is an unmet demand for contraceptive services in this region of over 20%. To give you an idea of the rise in this service, in 2005, 15.7% used modern contraception in Amhara region.
Injectable contraceptives are the most desired throughout the country. They are easy, culturally preferred, and offer the ability to be on birth control without a woman informing her husband, which is an issue here.
I appreciate the chance to set this record straight.
Rick Hodes, MD, MACP
Medical Director, AJJDC-Ethiopia
Update 9:50 am CST I followed up with Dr. Hodes to make sure there was no mistake about what he was saying:
"So to be clear, you're saying that you personally never told any woman that she would have to take Depo-Provera shots in order to immigrate to Israel? The women claim that JDC workers from Israel told them they had to do it. Is that claim to the best of your knowledge false?"
Dr. Hodes replied:
To the best of my knowledge, this claim is 100% false.
Neither myself nor my staff have ever told any women in our program that they should take Depo-Provera for any reason. 100% of Depo-Provera shots are purely voluntary, and may be discontinued (or changed to another method) at any time.
In fact, we don't have JDC workers from Israel come and tell women these things.
So how can these contradictory claims be reconciled? The idea that the Joint, the Jewish Agency and the Health Ministry are all lying might work for anti-Israel conspiracy theorists, but it is hardly credible.
My guess - and it is only a guess - is that Ethiopian women were generally enthusiastic about the idea of birth control. And as Dr. Hodes says, the idea of injectable contraception was appealing to them - because they don't have to tell their husbands.
This is the key to understanding the story. The Ethiopian husbands would generally be averse to their wives taking birth control, so they must do it in secret - and the Depo-Provera is by far the best method to keep their husbands from knowing. They simply tell them that they were receiving inoculations or some other excuse.
Now, when the men start getting suspicious as to why they aren't having kids, how many of the wives will admit that they are secretly taking contraception? It is much easier to come up with a story about how it all happened without their knowledge, or how they were forced to do it against their will.
I am not denying that there is racism in Israel, just as there is everywhere else. I can certainly believe that some Israeli doctors may be more likely to recommend the Depo-Provera injection for black women than their whiter patients. I can believe that the frustration of not being able to communicate can result in sub-par care, and in not explaining the contraceptive options that they have. It is very possible that the doctors did not properly inform the women of the (sometimes serious) side effects that Depo-Provera has. The TV program helped expose these fissures in the care being given to Ethiopian women. This would naturally result in the Gamzu memo that Ha'aretz reported so eagerly.
The idea that doctors - especially in doctors who willingly travel to Ethiopia, people who would be among the most dedicated medical professionals on the planet - would conspire to effectively sterilize black women is simply not plausible.
Ha'aretz, and the gullible hateful media that follows it slavishly, was actively trying to demonize Israeli health officials and organizations that are dedicated to helping people - in order to report a scoop. The facts that we are aware of today, however, do not add up to the claims being made.
Perhaps my theory isn't 100% correct. I'm the first to admit that we don't have all the facts. But what I am suggesting fits the facts we do know much better than the yellow journalism being practiced in this case.
UPDATE: Mordy in the comments points to a 2005 study that says exactly what I was guessing:
Because contraceptives may introduce social discord, leading at times to intimate partners' violence amongst African couples, women of low bargaining powers often resort to family planning methods that are suitable to covert use.
Women can take injections of Depo-Provera while visiting a health facility and remain protected against unwanted pregnancies for three months. This may be done without their husband's knowledge and without the bother of having to remember to take the pill or to undergo clinical procedures that are involved when opting for implants or intrauterine devices. Consequently, a general pattern that has been observed in the contraceptive method mix in sub-Saharan Africa and elsewhere in the developing world is the predominance of injectables.
If a reporter visits one or fifty of these women and asks if they took the injections voluntarily, what do you think they would say?
UPDATE 2: Reuters did a tiny bit of actual reporting and asked Gamzu whether his memo was an admittance that Israel is forcibly giving the drug to Ethiopian women:
Ministry Director-General Roni Gamzu said the decision did not imply he accepted the allegations by the Association of Civil Rights in Israel (ACRI).
Ha'aretz' misinterpretation of the memo, as I wrote above, was the linchpin for the entire story.
This is looking more and more like Ha'aretz' version of the "Racist Jews steal organs from Arabs and Haitians" story that the anti-semites love to push.