Amid controversy, Israel issues new birth-control guidelines

JERUSALEM -- Rocked by a scandal involving birth-control treatments for Ethiopian Jews, Israel’s health ministry issued new guidelines on the use of the injections known commercially as Depo-Provera.

In a recent letter to the country’s four HMOs reported Sunday, Ron Gamzu, director general of the health ministry, instructed gynecologists against renewing prescriptions in cases where the patient does not fully understand the treatment’s implications.

The ministry’s new policy comes in response to a controversy exposed last month by local investigative journalist Gal Gabbay, who reported that Jewish Ethiopian women awaiting emigration to Israel in transit camps in Ethiopia were coaxed into the treatment with little medical explanation and led to understand this was a condition for moving to Israel.

Around 120,000 Jews from Ethiopian origin live in Israel; roughly a third of them are Israeli born. In 2010, the government decided to bring to Israel the 2,000 Jews remaining in the African country and close the transit camps currently run by the Jewish Agency For Israel by the end of this year.

Immigrant women told the reporter this was the standard practice in the transit camps run by Jewish and Israeli agencies in Ethiopia in the last decade. Many women continued the course of treatment in Israel, where a sharp decline in birth rate has been noted among the Ethiopian community over the past decade.

Depo-Provera, the brand name of a long-acting contraceptive injection, is a highly effective method of birth control but possible side effects include a decrease in bone density that puts women at increased risk for osteoporosis and fractures later on. That and other side effects are not immediately reversible, and returning to fertility can be a lengthy process. In addition, withdrawal symptoms can be acute.

Relatively few healthy women in Israel choose the injection without specific medical reasons.

The expose sparked claims of mistreatment and racism, and prompted rights organizations to file official protests. The ministry official’s letter stressed the new guidelines did not constitute a position on the claims and relate to all women, not just those from Ethiopian.

Doctors will be required to ensure the patients seeking birth control of their own free will and understand the treatment. Where needed, consultation will be aided by medical translation services and cultural facilitators from the Ethiopian community.

Ziva Mekonen-Dego, chief executive of the Israel Assn. for Ethiopian Jews, welcomed the ministry’s response but said this was the bare minimum. “We expect the health ministry to take full responsibility for the women,” she said. Together with the Association for Civil Rights in Israel, the organizations demand the ministry assemble a team of health-care professionals and cultural facilitators to supervise the women’s medical and emotional welfare.

The health ministry has denied responsibility for the practice but Mekonen-Dego noted the authorities were aware of the high rates of this treatment among such a small population. “This suggests that the ministry collaborated with a racist policy applied to a weakened population and perhaps even guided it,” she said. “I am still shocked by this.”

Depo-Provera is sometimes the preferred method of birth control chosen for institutionalized women or recommended for individuals deemed incapable of following a daily regime.

Mekonen-Dego -- a social worker by profession who was born in Ethiopia -- said “the suggestion Ethiopian women can’t be trusted with responsibility for their own health is outrageous.”

In 2009, a local feminist group named Isha L’Isha researched the prescription policy in Israel and found that 60% of the injections in one HMO were prescribed to Ethiopian women. The other high-use group: women in various forms of custody.

As head of the organization’s Women and Medical Technologies project, Hedva Eyal said their report was met with disinterest, even slammed doors. “The ease with which a woman’s testimony is dismissed -- certainly that of a black woman and a poor black woman at that -- is shocking,” Eyal said.

Pleased with the first official response to the issue, Eyal said the bottom line was that “decisions about women’s health and fertility can and must be made by the women alone.” For that, they must have full and fair access to all relevant information “and that did not seem to have been the case,” she said.

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