Ethiopian women and birth control: when a scoop becomes a smear
The more the story about Ethiopian women who were given birth control shots was repeated, the more warped and distorted it became.
The story of the dramatic drop in the birthrates of the Ethiopian Israeli community over the past decade and why it happened was a story that needed to be told. Those on the ground who work with the Ethiopian community who first observed and researched the phenomenon and Gal Gabai, the excellent television journalist whose show “Vacuum” broke the story to the Israeli public, deserve credit for pulling the story out of the realm of rumor and shadows.
However - as in the game of telephone, when the more a story is repeated, the more warped and distorted it becomes - the international coverage of this scandal is transforming a tale insensitivity, cultural condescension and, yes, perhaps a certain level of racism, into some kind of villainous genocidal plot of sterilization aimed at ethnic and racial cleansing.
What the original television program uncovered is an insensitivity to a traditional culture and imposing Western norms in what likely began as a well-meaning attempt to help families make an easier adjustment to the shock that was ahead of them when they moved to Israel and once they arrived. The stories women told painted a picture of being coaxed and strongly convinced that they should subject themselves to a Depo-Provera birth control shot every three months, without being offered other methods of family planning. They also recounted being told in educational workshops that Israelis had “small families” and that having many children in Israel would “make their life difficult.” Some said they were led to believe they would not be permitted to emigrate if they did not submit to the shots, others said that their objections to receiving them were ignored. Some women said they weren’t aware the shots were birth control - they thought they were vaccinations, and others said their complaints about disturbing side effects were ignored.
It is the latest chapter in the history of clumsy stumbles the Jewish Agency and the Israeli government have made in their enterprise to move communities to Israel. There is no large group of immigrants to Israel, particularly from Asia and Africa, who don’t have legitimate complaints of treatment of bureaucratic indifference and institutional inflexibility, laced with a heavy dose of cultural superiority and both hidden and outright racism.
Yes, indeed, the television story and the research on which it was based, found evidence that Ethiopian Jewish women, both while in transit in Addis Ababa preparing to emigrate, and after they arrived in absorption centers in Israel, were strongly encouraged to use Depo-Provera as a form of birth control. In Israel and other Western countries, this birth-control method tends to be restricted to those who are not mentally competent or responsible enough to take a daily birth-control pill. These Ethiopian women were clearly not encouraged strongly enough to consider other means of family planning, both when they began the injections in Ethiopia, and certainly later after they immigrated to Israel, their family planning practices should have been reassessed, not automatically continued. And certainly there was not enough careful examination of each individual medical case, causing suffering among those women with medical conditions exacerbated by the Depo-Provera.
When the story first came out as a result of the “Vacuum” broadcast in early December, it sparked a flurry of finger-pointing in various directions, as the JDC and the government all denied any executive decision to put Ethiopian women on Depo-Provera, and said if any such policy existed, the other guy must have done it.
The Jewish Agency, which is responsible for Jewish immigration from abroad, said in response to the first report 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."
Then, this past week, there was a ‘gotcha!’ moment, as far as the health ministry was involved.
As reported in Haaretz “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. Roni Gamzu has instructed the four health maintenance organizations to stop the practice as a matter of course ... 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.”
Gamzu’s action took place after a group of six human rights organizations requested that the Ministry “adopt a number of steps to ensure the practice will not continue” including “making enquiries about the medical condition of each woman and whether the drug is suitable for her circumstances, not to provide any injections without informing the women of the possible side-effects of the drug and providing information about alternative contraceptive methods” and “that a note be included in the patient’s medical records recording that conversation took place” and urged Gamzu “consider examining the background to the practice and to collect updated figures on the use of the contraceptive.”
It is was an appropriate action to take and his quick response was in order, so as to bring birth control in the Ethiopian community should be in line with the rest of Israeli women, making them in control of their decisions with full information as to the alternatives.
But the story has taken on a life of its own internationally. The words “forced” and “coercion” are being thrown around in the international coverage. Images of Mengele-level persecution of clueless, helpless victims being marched by force from camps to clinics to receive their injections have been conjured up, as the story has travelled from the Israeli media to the national mainstream media, to international and niche publications. The headlines run from the oversimplified to deliberately twisted:
The most hostile coverage refers inaccurately to “sterilization” - conveniently ignoring the fact that Depo-Provera is a three-month birth control injection, for which women must voluntarily go to a clinic to receive the shots. It is insulting to the intelligence of Ethiopian women to believe that they did this for years at a time against their will. Certainly, if there was a nefarious plot to stop them from having babies, there would have been a more efficient way to do it.
I believe the women who told their stories to Gal Gabbai. I also believe that the vast majority of the Ethiopian women who received Depo-Provera were aware it was birth control and received it willingly, wanting to be in control of deciding when to get pregnant. And some of them - it is unclear how many - preferred being injected at a clinic rather than having to take pills daily in the presence of other family members - husbands or mothers or in-laws - who might disapprove of that decision. I also believe that those who did not want to receive the shots and truly wanted to become pregnant were smart enough to stop receiving them. At least some of the drop in these birthrate is attributable to access to birth control and control over their childbearing that these women wanted.
What is likely true - and needs to be urgently corrected, is that those who do want to practice birth control understand that there are alternative methods that are safer with fewer side effects, and that no ethnic group, native or immigrant is ever systematically given Depo-Provera again.
As for those who suffered from negligent treatment in the past, it is appropriate for each women’s stories to be taken seriously and investigated, and if, at any point they were told that their immigration depended on receiving a birth control injection, that person or agency be held responsible. At the very least, these women are owed the respect of an apology; at most, compensation for their pain suffering if they received Depo-Provera for years and truly didn’t understand they had a choice about it.
But sadly, I fear that the frontal assault and demonization of the agencies who worked tirelessly to bring Ethiopian Jewry to Israel will lead to even stronger denials and defensiveness, which will only bolster the paranoid and hate-fueled conspiracy theories.
The victim in all this will be the truth - and once again, the Ethiopian women themselves.