Ethiopian birth control?

A program aired on Israel Educational Television on Sunday revealed that Ethiopian Jewish women awaiting aliya were given long-lasting birth-control while in transit camps. According to the report, the clinics were run by the Joint Distribution Committee and Israel’s Health Ministry.

The drug, administered every 12 weeks, is known as Depo-Provera, a hormonal, injectable contraceptive known as the “birth-control shot.” Although it has existed for around 30 years, it is not widely used. Only about five percent of women elect to use this method of birth control in the US.

Yet it appears that it was chosen as an easy and effective choice for women in Ethiopia about to emigrate. According to the report, the practice of providing Depo-Provera disproportionately to Ethiopian women was continued after their arrival in Israel.

The central question this raises is to what degree the women were provided with an informed choice. Also, was the decision to administer this shot tinged with racism and paternalism? One Ethiopian woman claimed, in an interview with Haaretz: “We said we won’t have the shot. They told us, if you don’t, you won’t go to Israel.... We didn’t have a choice.”

The Joint responded, “We do not advise them to have small families. It is a matter of personal choice.... The claims by the women, according to which refusal to have the injection would 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 aliya procedures.”

But if those administering the shot were not involved in immigration, this doesn’t mean that the mostly poor, vulnerable and sometimes illiterate women were not made to feel that they had little choice in the matter.

Were the women provided, for instance, with the same information that an Israeli woman would expect to receive from her health-care professional? Were they told that not only would the shot prevent pregnancy for three months, but that it is linked to weight gain?

The Journal of Medical Ethics published a report addressing this issue in 1984, in which the authors noted, “Depo-Provera has been damned as an example of Malthusian enthusiasts foisting unsolicited and questionable therapies on other people hence creating unwarranted risks especially for the poor and those least able to understand the benefit/ risk considerations.”

Travel writer Frosty Woolridge reported that in Haiti, aid groups discussed making Depo-Provera injections free to women because “Haitians need to bring their fertility down to European rates.”

In 2008, according to an article in The National, Rachel Mangoli – who ran a day-care center for Ethiopian children in Bnei Brak – was told by a family clinic that it had been told to provide Ethiopian women with the long-term birth control vaccination.

Feminist organization Woman to Woman reported in 2010 that 57 percent of women receiving Depo-Provera in Israel were Ethiopian, even though they made up only 2 percent of the population.

Unanswered questions remain and it is imperative that the organizations involved in the aliya of Ethiopian Jews – including the North American Conference on Ethiopian Jews, the Joint, the Health Ministry and the Jewish Agency – provide clear answers.

It isn’t enough to shirk responsibility and claim that the women are not telling the truth. What would motivate these women, after having made aliya, to lie? If, as they say, they felt pressured to take a birth-control shot that they did not fully understand the ramifications of, and they were then encouraged to keep taking it in Israel, a system should now be put in place to make sure that women in their circumstances receive the same information and are presented with the same choices as immigrants from North America, haredi women or Arab women in Israel.

Attempts to limit population growth in places such as China and the controversial sterilization program carried out by Indira Gandhi in India in 1975 are hallmarks of coercive population control. It is neither the job of the government nor an NGO to decide on an individual’s future family.

The right to make one’s own family-planning decisions is essential in a free society. All of those involved in Ethiopian aliya must now ensure that this right remains at the forefront of any administration of birth-control methods.