Shocking news has emerged from Israel, where journalists have been exploring why the birth rate among Ethiopian Jews living in Israel appears to be on the decline. Thousands of Jews of Ethiopian origin live and work in Israel, and evidence shows the immigrant women among them were coerced into taking Depo-Provera, a long-acting birth control medication designed to prevent pregnancy for up to three months. Women were told that they wouldn’t be allowed to enter the country without the injection, and once in Israel, many of them continued to use it.
Depo-Provera is extremely effective, but it comes at a cost. The medication is associated with loss of bone density, which can be difficult to treat, and may increase the risk of developing fractures and osteoporosis later in life. Women on the medication can also experience side effects like increased bleeding or a complete cessation of menstruation, bloating, mood swings and anxiety. Since it’s an injectable drug, they’re stuck with these symptoms until the three month dosage of hormones wears off. Most Israeli gynecologists don’t recommend it unless there’s a compelling medical reason to do, mirroring prescribing practices elsewhere in the world.
When Depo-Provera is used in Israel, it’s notable to look at who’s most likely to take the medication. Organization Isha L’Isha looked into this issue with concerns about who was being medicated and why, worried particularly about the potentially serious side effects of Depo-Provera and whether women were receiving adequate information about the drug so they could make informed choices about its use. The feminist group noted in 2009 that Depo-Provera wasn’t the first choice of birth control for most Israeli women, but that it was commonly used on women in custody and Ethiopian women.
In other words, the drug was used on vulnerable, low-income populations with fewer resources for education, and lower social standing. In addition to being pressured or coerced into using the medication, many may not have understood its risks and benefits, and by continuing to use it without taking precautions like adding calcium supplements to their diets to offset bone loss, they could have experienced permanent damage. Notably, the history of the development of this drug is itself rife with racism and abuses; it was tested on populations of low-income women of color around the world in dubious conditions.
Women taking Depo-Provera weren’t given information about side effects when the drug was administered, and were told simply to return for regular injections every three months. They received little to no gynecological support, including followups to check on symptoms, counseling if they had specific problems while on the medication, and assistance with going off the drug and recovering their fertility. Since it can take some time to reestablish fertility after stopping Depo-Provera, this third issue is of particular concern, and the apparent blanket policy of administering Depo-Provera to Ethiopian immigrants in Israel suggests that officials wanted to create a barrier to childbearing.
The Isha L’Isha study concluded that: “Birth policy in Israel over the years reflects a class-based and separatist agenda towards the various social groups in Israel.” Ethiopian immigrants have a much lower socioeconomic status, and the policy of strongly recommending Depo-Provera in preference to other birth control options, and providing it without education and support, is indicative of underlying racism.
The government has responded, issuing new guidelines for the dispensation of birth control prescriptions, but will this be enough? Significant social and class divides are an ongoing issue in Israel, and racism in the medical system (as well as elsewhere) cannot be neatly erased with a new set of guidelines. This case should be sparking concerns about other areas in policy and society where racism is allowed to pass unchecked.
Photo credit: Steve Evans