NAZARETH, Israel // Health officials in Israel are subjecting many female Ethiopian immigrants to a controversial long-term birth control drug in what Israeli women's groups allege is a racist policy to reduce the number of black babies. The contraceptive, known as Depo Provera, which is given by injection every three months, is considered by many doctors as a birth control method of last resort because of problems treating its side effects.
However, according to a report published last week, use of the contraceptive by Israeli doctors has risen threefold over the past few years. Figures show that 57 per cent of Depo Provera users in Israel are Ethiopian, even though the community accounts for less than two per cent of the total population. About 90,000 Ethiopians have been brought to Israel under the Law of Return since the 1980s, but their Jewishness has subsequently been questioned by some rabbis and is doubted by many ordinary Israelis.
Ethiopians are reported to face widespread discrimination in jobs, housing and education and it recently emerged that their blood donations were routinely discarded. "This is about reducing the number of births in a community that is black and mostly poor," said Hedva Eyal, the author of the report by Woman to Woman, a feminist organisation based in Haifa, in northern Israel. "The unspoken policy is that only children who are white and Ashkenazi are wanted in Israel," she said, referring to the term for European Jews who founded Israel and continue to dominate its institutions.
Women's groups were alerted to the widespread use of Depo Provera in the Ethiopian community in 2008 when Rachel Mangoli, who runs a day care centre for 120 Ethiopian children in Bnei Braq, a suburb of Tel Aviv, observed that she had received only one new child in the previous three years. "I started to think about how strange the situation was after I had to send back donated baby clothes because there was no one in the community to give them to," she said.
She approached a local health clinic serving the 55 Ethiopian families in Bnei Braq and was told by the clinic manager that they had been instructed to administer Depo Provera injections to the women of child-bearing age, though he refused to say who had issued the order. Ms Mangoli, who interviewed the women, said: "They had not been told about alternative forms of contraception or about the side effects or given medical follow-ups." The women complained of a wide range of side effects associated with the drug, including headaches, abdominal pain, fatigue, nausea, loss of libido and general burning sensations.
Depo Provera is also known to decrease bone density, especially among dark-skinned women, which can lead to osteoporosis in later life. Doctors are concerned that it is difficult or impossible to help women who experience severe side effects because the drug is in their system for months after it is injected. The contraceptive's reputation has also been tarnished by its association with South Africa, where the apartheid government had used it, often coercively, to limit the fertility of black women.
Traditionally, its main uses have been for women who are regarded as incapable of controlling their own reproduction or monitor other forms of birth control, and for women who suffer severe problems during menstruation. Ms Eyal said she had been denied co-operation from government ministries, doctors and most of the health insurance companies while conducting her research. Clalit, the largest health company, however, did provide figures showing that 57 per cent of its Depo Provera users were Ethiopian compared with a handful of women in other ethnic groups.
The health ministry was unavailable for comment. When first questioned about Depo Provera 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. In fact, according to figures of the World Health Organisation, three-quarters of women in Ethiopia using birth control take the oral pill.
"The answers we received from officials demonstrated overt racism," Ms Eyal said. "They suggested that Ethiopian women should be treated not as individuals but as a collective group whose reproduction needs controlling." When Woman to Woman conducted an experiment by sending five non-Ethiopian women to doctors to ask for Depo Provera, all were told that it was prescribed only in highly unusual cases.
Ms Mangoli said it was extremely difficult to get immigrant Ethiopian families to speak out because they were afraid that their Jewishness was under suspicion and that they might be deported if they caused trouble. However, women interviewed anonymously for the report stated that officials at absorption centres in Ethiopia advised them to take Depo Provera because there would be no funds to support their children if they got pregnant in Israel.
This policy appears to conflict with the stated goals of the country's Demography Council, a group of experts charged with devising ways to persuade Jewish women to have more babies. The council was established in response to what is widely seen in Israel as a "demographic war" with Palestinians, or the need to maintain a Jewish majority in the region despite high Palestinian birth rates. In a speech marking the council's reconvening in 2002, the then social welfare minister, Shlomo Benizri, referred to "the beauty of the Jewish family that is blessed with many children".
Yali Hashash, a researcher at Haifa University, said attempts to restrict Ethiopian women's fertility echoed practices used against Jewish women who immigrated to Israel from such Arab countries as Iraq, Yemen and Morocco in the state's early years, in the 1950s and 1960s. Many, she said, had been encouraged to fit IUDs when the device was still experimental because Israel's leading gynecologists regarded Arab Jews as "primitive" and incapable of acting "responsibly".
Allegations of official racism towards Ethiopians gained prominence in 2006 when it was admitted that for many years all their blood donations had been discarded for fear that they might be contaminated with diseases. There have also been regular reports of Ethiopian children being denied places in schools or being forced to attend separate classes. In November a survey of employers in the main professions showed that 53 per cent preferred not to hire an Ethiopian.
Ruth Sinai, an Israeli social affairs reporter for Haaretz newspaper, wrote recently that the discrimination faced by the country's 120,000 Ethiopians reflected in particular "doubts on the part of the country's religious establishment about their Jewishness". @Email:firstname.lastname@example.org