In Wake of Controversial Birth Control Claims, Study Finds Lower Birthrates Among Ethiopian Immigrants

Authors of Knesset study stop short of attributing the difference to the controversial use of Depo-Provera contraceptive injections.

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A Knesset study prompted by news reports about the administration of contraceptive injections to Ethiopian immigrant women before and after their arrival in Israel shows that these women gave birth to significantly fewer children in Israel than their peers who came to Israel in the 1990s, before the practice became widespread.

But the authors of the study, which was commissioned from the Knesset Research and Information Center by MK Orly Levi-Abekasis ‏(Likud-Yisrael Beiteinu‏), said they could not substantiate a report by Gal Gabbai on Educational Television last year that claimed that women in immigrant transit camps in Ethiopia were given the contraceptive, Depo-Provera, against their will and were told that if they refused to receive the injections they would be denied the right to immigrate to Israel.

Depo-Provera provides effective contraceptive protection over a period of months to women who take the injection. It has the advantage that it does not require the women to take a daily pill and its effects are reversible. It appears to have become the preferred means of birth control among Ethiopian immigrants to Israel − birth control pills are more widely used by women in Israel in general − but in addition it appears to have driven down the number of children born to immigrants from Ethiopia to levels below the average family size of the general population of Israeli-born mothers.

The authors of the Knesset Research Center report cautioned that they do not claim to provide decisive information on the issue. They did, however, provide data from the Central Bureau of Statistics that show a marked decline in the number of children born to Ethiopian immigrant women who came to Israel between 2000 and 2010, the period during which the use of Depo-Provera became prevalent. In Ethiopia itself, the use of Depo-Provera has also became increasingly widespread, particularly since 2005.

By 2010, the average number of children born to Ethiopian immigrant women who arrived between 2000 and 2010 was 1.78. This was 38 percent below the average number of children, 2.88, of Israeli-born women. It was also 40 percent below the average number of children born to women who came to Israel in the 1990s − 2.95.

Levi-Abekasis is calling on State Comptroller Joseph Shapira to investigate the matter further, although she said she was being cautious not to accuse those involved of any deliberate policy directed at the Ethiopian women. “But we need to examine why there is no Health Ministry supervision of medical care both during the course of [the women’s] immigration to Israel and thereafter. The data from the [Knesset] report is disturbing, and should be looked into thoroughly, particularly when the responses from the ministries don’t coincide with figures from the field and don’t provide a real explanation for the phenomenon.”

The Knesset report noted that the Joint Distribution Committee, the Jewish organization that provided family planning courses to the women in transit camps prior to their immigration to Israel, did so without Israeli government oversight. Although Israeli government ministries are cited as saying that the Joint did so of its own accord, the report also cites evidence that government officials had asked the organization to continue its work.

The JDC said in response that its clinics in Ethiopia have provided a range of services, including family planning workshops. As with any other service, the workshops were available on a voluntary basis and were provided only to those women who wished to partake of them. They were provided in the local Amharic language by professional staff and were conducted with sensitivity to local custom, the Joint stated, adding that those women who wished to use contraceptives for family planning were provided a number of options, including contraceptive pills and the Depo-Provera injections.

The Joint said it did not share the information regarding which women participated in the family planning workshops in Ethiopia with medical authorities in Israel. It said that after the immigrants arrive in Israel the organization is not involved in their medical care, which is provided through immigrant absorption centers and Israel’s four health maintenance organizations.

In February, Haaretz reported that then-Deputy Health Minister Ya’akov Litzman had initiated an investigation into the administration of Depo-Provera to Ethiopian immigrant. And more recently Health Ministry Director General Roni Gamzu told the authors of the Knesset report that he would meet on the issue with MK Pnina Tamano-Shata ‏(Yesh Atid‏), who is herself an Ethiopian immigrant.

All of the HMOs have stated that they have no policy to specifically provide Depo-Provera to Ethiopian immigrant women. The two largest HMOs, Clalit and Maccabi, declined to provide the Knesset Research Center with data on the extent to which they had administered Depo-Provera to Ethiopian women immigrants, citing the filing in February of a class action suit by three immigrants from Ethiopia. The suit was also filed against the Meuhedet HMO, which nonetheless disclosed data on the use of Depo-Provera by its patients to the Knesset Research Center. Meuhedet and the fourth HMO, Leumit, said, however, that they did not have a breakdown based on the country of origin of their patients.

Meuhedet said among women patients in their child-bearing years, the number of women taking Depo-Provera increased from 56 in 1998 to 407 in 2012, with the most significant increase coming between 2010 and 2011. Data from Leumit also showed a substantial increase in the use of contraceptive injections.

According to research cited in the Knesset report based on a 2009 study by the Woman to Woman organization, use of Depo-Provera among Ethiopian-Israeli women of childbearing age increased markedly between 2000 and 2011. Relying on data at the time from Clalit and Maccabi, they said in 2000 the use of the pill was almost twice as prevalent among these women than were contraceptive injections, whereas by 2005, the number of women reporting using the injections at least once was 1.4 times as high as those using birth control pills. Critics of the data say, however, that it was based on individual interviews with nine women and group interviews with 30 others. 

Members of the Falashmura community in Ethiopia in 2013, waiting to immigrate to Israel Credit: Anshel Pfeffer

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