With its coverage of the controversy surrounding Ethiopian women taking contraception shots, Ha'aretz yet again demonstrated its ability to shape and distort international media coverage about Israel. Ha'aretz covered an investigation by Israeli journalist Gal Gabai broadcasted on the "Vacuum" television program of Educational Television, and from there the story was carried around the globe. Unfortunately, the story that Gabai pedaled to her Israeli viewers, and which Talila Nesher of Ha'aretz relayed to her local and foreign readers, is riddled with problems.
In the Dec. 8, 2012 documentary
, Gal Gabai reports on a "systematic mechanism," as she puts it, in which Ethiopian women who wanted to immigrate to Israel were required to receive a contraceptive shot called Depo Provera while they were in transit camps in Ethiopia. According to Gabai's report, someone, it's not clear who, coerced the women to receive the shot. According to the report, alternative means of birth control were not explained to the women, nor were they told about side effects.
Gabai implies that the the 50 percent decrease in the birthrate among Ethiopian immigrants is solely the consequence of the use of Depo Provera and that there is a deliberate plan on the part of health care providers to decrease the number of Ethiopian children being born in Israel. She also implies that the administration of Depo-Provera to Ethiopian Jews is the result of racism toward this community.
Serious Omissions in Vacuum Story
These implications deserve further scrutiny for a number of reasons.
First, many women in Ethiopia want fewer children and want to increase the amount of time between births. This fact, which never surfaced in any of the reporting about the issue, undermines the notion that there is a systematic, nefarious campaign to force birth rates down in the Ethiopian Jewish community.
Second, there are at least two other factors (aside from the use of Depo Provera) that contribute to the decline in birth rates in Israel's community of Ethiopian Jews. Women in this community are having more abortions and getting married later. Again, these facts were not brought to light in the Vacuum's report about the issue.
Third, declining birth rates are universally understood to be associated with increased affluence and lower child mortality rates. In other words, declining birth rates is a phenomenon one would expect to see in a population moving from Ethiopia (where incomes are low and child death rates high) to Israel (where income is higher and child death rates low).
Lastly, there is evidence that some Ethiopian women prefer Depo Provera over other methods of birth control (such as oral contraception), because it allows them to prevent pregnancies without the knowledge of their husbands who want them to have children.
These omissions allowed Israel's adversaries to portray the Jewish State as engaging in an ugly form of ethnic cleansing against Ethiopian Jews. Ha'aretz should have caught these ommissions, but did not.
"Systematic Mechanism" or Sloppy Journalism?
Let's be clear. Our purpose is not to discount the claims of the Ethiopian women interviewed on Vacuum. The fact is that at least those interviewed by Gal Gabai did receive Depo Provera, a shot to prevent pregnancy which lasts for three months. Some of these women should probably have been given other forms of birth control.
The question remains: is there a factual basis supporting the claim of a "systematic mechanism," or is this simply journalistic sensationalism? Did Gal Gabai and Talila Nesher really research, check and expose all of the possible explanations for the Ethiopian women's claims, or did the two present only the most extreme and sensationalist possibility? Did they take an important subject worthy of coverage and ultimately, redress, and grossly overstate it?
One thing is sure -- the extremism of the public discourse has far outdone the original sources on this story. Two news articles and an Op-Ed which appeared in Ha'aretz following the "Vacuum" broadcast have set up a firestorm of coverage. The first news item, by Talila Nesher, appeared with the following headline and subheading:
Why is the birth rate in Israel's Ethiopian community declining?
Women say that while waiting in transit camps in Ethiopia they were coaxed into agreeing to injections of long-acting birth control drugs
The Dec. 11 Op-Ed
by Efrat Yardai appeared with the following headline and subheading:
As noted last week in our Snapshots blog
, editors were compelled to correct the grossly misleading subhead, and to note the correction at the end of the article, attributing the original headline to an "editing error." The new subhead is: "Israel's patronizing and inhumane treatment of Ethiopian women is nothing new."
The Op-Ed still ends with the notion that Israel was forcibly sterilizing Ethiopian women:
If they tried to sterilize me or take my children away, I think I would be talking nonsense too.
And the follow up article Jan. 28, a page-one article alleging that for Israeli officials "first time acknowledged the practice of injecting women of Ethiopian origin with the long-acting contraceptive Depo-Provera," is gaining traction in the mainstream media, including the Los Angeles Times. The headline in Ha'aretz's print edition follows:
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. Ron Gamzu has instructed the four health maintenance organizations to stop the practice as a matter of course.
The ministry and other state agencies had previously denied knowledge or responsibility for the practice, which was first reported five years ago.
Gamzus 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.
The Los Angeles Times, in contrast, reports that Gamzu's letter is not a confirmation of claims that Israel coerced Ethiopian women into taking the shots:
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
Moreover, even the Hebrew version
of the very same article notes that Dr. Gamzu's letter did not address the circulating charges that Ethiopian women were systematically coerced into taking shots against their will. The Hebrew article noted that the letter "did not take a position or confirm any information regarding claims about this matter. . ." In typical "Ha'aretz, Lost in Translation
" style, the English edition does not include this critical information, which in fact belies the article's claim that the state confirmed the charges first heard in "Vacuum."
s reports, as flawed as they were, have reached all corners of the world. Millions of readers have heard various versions of the story. The venues range from the mainstream, via, for example, the Huffington Post
's "Ethiopian Women Claim Israel Forced Them to Accept Birth Control Shots" to virulently anti-Semitic accusations regarding Zionist Dr. Mengeles in "State of Israel forced the sterilization of Ethiopian women
Ha'aretz Shocked By Demonization
Things got so bad that the newspaper itself tried to put a lid on the demonization by publishing a commentary
on Jan. 30, 2013 by Allison Kaplan Sommer. Sommer complained that Ha'aretz
was the innocent victim of a game of telephone in which the original story was distorted by other outlets. The way Sommer tells it, a story about insensitivity, cultural condescension and yes, perhaps a certain level of racism was transformed into some kind of villainous genocidal plot of sterilization aimed at ethnic and racial cleansing.
To buttress her claim, Sommer acknowledges what should have been evident all along that the vast majority of the Ethiopian women who use Depo Provera in Israel know what the drug was for, understand its side effects, and continue to use the medication anyways by their own choice.
Sommer writes that she believes 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. She continues:
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 mother-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 [sic] is attributable to access to birth control and control over their childbearing that these women wanted.
What Sommer is loath to admit is that Ha'aretzs distorted coverage of the controversy contributed to the demonization she decries. It is not as if the Israel-haters who used the controversy to demonize Israel took a well-researched and documented piece about the use of birth control in the Ethiopian community in Israel and distorted it to serve their own ideological purposes.
On the contrary, Ha'aretz contributed to the problem by relaying, without scrutiny, the allegations put forth by the original Vacuum piece.
"They Told You It is Forbidden In Israel"
The fiasco began with a a 24-minute report titled Where Are the Children? that was broadcast on Vacuum, an Israeli television show, on December 8, 2012.
Upon viewing the Gabai's "Vacuum" broadcast, which is the basis of Ha'aretz's coverage, it appears that Gabai ignored alternative options and contradictory information, which would have undermined her pre-determined thesis. She does this, in part, by asking leading questions and by placing words in the mouths of her interviewees:
A couple of examples follow (translation by CAMERA):
Leading Questions and Planting Words
Gabai: So they explained to you that its not good to have so many children in Israel
Ethiopian husband, identified as 'B': They didnt say that. But what they did say to us was if we have many children, it makes life difficult, there and also here. And so they explained the situation to us, and they also gave pills to whoever wanted. If you dont get the shot, you will forget, they said to them, and so they gave them the shot.
Gabai to Amaweesh Alana: Did you. . . did you feel that they did not want your children? That they did not want them to be born?
Alana: [does not answer, tears, wipes eyes]
Gabai: How many children do you have?
Women, identified as "Sh": Now? Four.
Gabai: Now four children?
Gabai: How many were born in Ethiopia?
Sh: In Ethiopia, three. In Israel, one.
Gabai: Will you have more children?
Sh: Of course.
Gabai: But they told you its forbidden in Israel.
Sh: No, why forbidden? There are loads of children. What, why forbidden?
Gabai also ignores the statements from experts, which contradict her thesis. For example, at 13:29 minutes Gabai asks and Israeli doctor "How is it possible that I never heard of this shot? That they never even offered it to me?" The response:
Dr. Danny Seideman [head of the Israeli Society for Contraception]: Given that most women in Israel take pills, among young women theres a tendency to give whats known. We certainly have a growing variety of contraceptives, but must of the doctors dont have time, an hour to give a woman a seminar on the topic of birth control. So a woman who comes from Africa will simply want to continue the same birth control which is, again, terrific and recommended, but there is no culture of taking pills. . . . .
Gabai: And also when we are speaking of Ethiopian women, so we dont trust them to take their pills every day, so we steer them. . .
Dr. Seideman: I dont think that anyone . . .Im not sure that theres this patronizing. I dont think anyone is investing in this that kind of energy, yes? Carrying out a poll, will they forget, wont they forget. I think its just simply something cultural from Africa.
Gabai: The figure for the birth rate of Ethiopian immigrants dropped by 50 percent in the last ten years.
Dr. Seideman: Thats a fascinating figure. One possibility is . . . and I hope this is a good explanation is that they are more educated today, and that they want to have a career and not just have children. Another possibility is that they are so poor, yes? That they fear they wont be able to support the children. I think thats a patronizing attitude. I have not met Ethiopian women, not intelligent, who didnt . . . that would have wanted a child but couldnt because of the shots.
Gabai: So how do you explain the fact that Ethiopian woman give testimony about the giving of Depo Prevaro to prevent pregnancies? Shots. Not pills, not other contraceptives, without giving alternatives, to prevent pregnancies already in the transit camps with the explanation that in Israel it is forbidden to have many children.
David Yaso, Director of the Ethiopian Immigrants Department, Absorption Ministry, and himself an Ethiopian immigrant: I dont believe that they are going into these things, that if you move to Israel, you wont have kids. . .
With these exchanges Gabai suggests that providing Depo Provera to Ethiopian women is a racist, coercive policy, despite evidence (discussed below) that indicates Ethiopian women prefer the medicine.
In fact, at least two women who appeared in the program indicated that they choose their birth control method by their own free will. One woman (3:40 minutes) says she deliberately chooses not to take pills but to receive the shot, and another woman testifies (16:30) that she decided to stop taking the shot after six months.
Family Planning or Decreasing the Birth Rate?
In one particular sentence, Gabai reveals her apparent ignorance about the frameworks in which the women received the shots. A deeper understanding of these settings would have enabled a totally different understanding of what happened in Ethiopia.
At 4:45 minutes into the program, Gabai terms family planning workshops in Ethiopia a "euphemism for decreasing the birth rate," as if this is a negative, even nefarious, project. But the notion of "family planning" is widely accepted throughout the world, in developed countries and less developed countries. The American Department of Health defines family planning services as "Educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved."
The world's largest organization which deals with family planning is the United Nations Population Fund, which operates in some 150 counties. Among other goals, the organiztion "advocates the right of all people to voluntarily decide the number and timing of their children. It supports programmes that improve access to and affordability of family planning services, offer a broad selection of choices, reflect high standards of care, are sensitive to cultural conditions, provide sufficient information about their use and address other reproductive health needs of women."
In other words, just like the thousands of other family planning programs around the world, there is nothing nefarious in the family planning workshops that Ethiopian women attend as they wait to immigrate to Israel. The Joint Distribution Committee, a Jewish humanitarian which has been operating for nearly a century all around the world, runs these workshops. The Ethiopian project is headed by Dr. Rick Hodes, an American who has lived and worked in Ethiopia for more than 20 years. In his clinic, in addition to the Jews waiting to move to Israel, he also treats other locals and refugees from other parts Africa who suffer from heart problems, spinal problems and cancer.
Gabai mentions Dr. Hodes only when she invokes, without any context at all, a letter that he received from the Israeli Ministry of Health in 2001. According to Gabai, the ministry "encourages the doctor in his mission and notes that among the general population in Ethiopia less than five percent use any kind of birth control, Dr. Rick reached 30 percent with his family planning project."
Many Ethiopian Women Want Fewer Children
Gabai presents this letter in a sinister light, but what she failed to mention is that many women living in Ethiopia want birth control but are unable to get it. According to a report published by USAID in January 2007, thirty-four percent of Ethiopian women want family planning services to either increase the amount of time between births or to limit out right the number of children they have.
That many Ethiopian women want, but cannot get, birth control shouldnt come as any surprise given that this same report indicates that between 2000 and 2005, the number of women of child bearing age (15-49) who did not want to have any more children increased substantially (32 percent in 2000, 42 percent in 2005). In urban areas, the numbers are higher (40 percent in 2000, 48 in 2005). Moreover, the ideal family size desired by women of childbearing age decreased over this same time frame (5.3 children in 2000, 4.5 in 2005).
These statistics highlight how Gabai portays family planning, which USAID describes as an unmet need in Ethiopia, as something nefarious when the variable of the Jewish state is introduced into the discussion.
In the modern world, declining birth rates are associated with greater affluence and an improvement in the status of women for obvious reasons. When women have fewer children and have them farther apart, their health improves as does their opportunity to learn and participate in the workforce. High fertility rates are also associated with high levels of child mortality, which thankfully, is not a problem in Israel. Any immigrant from Ethiopia would have to take these factors into account when making aliya. A paragraph from an article written by demographic researcher Petra Naihmas (link and citation below) is instructive:
Ethiopian immigrants arrived from a rural less developed country, where traditionally children have an important economic role to play. Obviously, within a developed urban economy, children are a net economic burden upon the parents until early adulthood and there is an emphasis on the future returns to investment in the education of children. Thus the economic incentive to reduce fertility exists. Additionally, infant and child mortality rates are low in Israel especially in comparison with Ethiopia (7 and 179 death of children under 5 per thousand live births in Israel and Ethiopia respectively (World Bank, 2003)). Thus couples need to give birth to less children as insurance for death in early adulthood.
There is another problem. Gabai attributes a malicious intent to the letter, as she does to Hodes' entire project, but she never bothered to speak with its recipient personally to to request his response.
Had she done so, perhaps she might have learned the information that Dr. Hodes shared in a Dec. 10 statement (two days after the segment was broadcast). Given that he is the main target of Gabai's charges, it is worth a careful read:
JDC runs the medical program in Gondar for potential immigrants to Israel. As part of this, we offer voluntary contraception to our population. Our clinic offers both birth control pills and injectablecontraception. If a woman prefers another method of contraception such as implantable or tubal ligation, we send them to facilities down the road in the city of Gondar for this.
Women come to the program because they desire family planning. We present the various options to them and they choose. So women both choose to use contraception and choose their method. And choose when to discontinue contraception. It has always been that way in our program.
Right now were caring for about 4500 potential immigrants to Israel. We average about 85 family planning visits each month.
We do not inform the Israeli authorities who is on family planning, and I have no idea what happens once they arrive in Israel.
Regarding the rate of 30% reported some years ago, we offered family planning to the population at a time when it was less available to the general public, and our population chose to use it.
At present, the rate of modern contraceptive use in Amhara Region is 33% indicating a significant demand, as contraceptive services have become more available to the public. Even now, there is an unmet demand for contraceptive services in this region of over 20%. To give you an idea of the rise in this service, in 2005, 15.7% used modern contraception in Amhara region.
Injectable contraceptives are the most desired throughout the country. They are easy, culturally preferred, and offer the ability to be on birth control without a woman informing her husband, which is an issue here.
The interviewer follows up, and Dr. Hodes responds:
So to be clear, you're saying that you personally never told any woman that she would have to take Depo-Provera shots in order to immigrate to Israel? The women claim that JDC workers from Israel told them they had to do it. Is that claim to the best of your knowledge false.Hodes: To the best of my knowledge, this claim is 100% false.
Neither myself nor my staff have ever told any women in our program that they should take Depo-Provera for any reason. 100% of Depo-Provera shots are purely voluntary, and may be discontinued (or changed to another method) at any time.
In fact, we don't have JDC workers from Israel come and tell women these things.
The JDC spokeswoman in Israel confirmed Dr. Hodes' statement for CAMERA.
What Gabai and Ha'aretz Don't Report
In addition to his unequivocal denial, Dr. Hodes raises two important points. First, the contraception shot is a widely used birth control method in Ethiopia. Second, Ethiopian women sometimes request the shot so that their husbands will not know that they are taking birth control. This complex factor is completely off Gabai's (and Ha'aretz's) radar.
A 2005 study carried out by Family Health International (and noted first by blogger Elder of Ziyon) sheds more light than Gabai does on the use of birth control among the general Ethiopian population:
Because contraceptives may introduce social discord, leading at times to intimate partners violence amongst African couples, women of low bargaining powers often resort to family planning methods that are suitable to covert use.
Women can take injections of Depo-Provera while visiting a health facility and remain protected against unwanted pregnancies for three months. This may be done without their husbands knowledge and without the bother of having to remember to take the pill or to undergo clinical procedures that are involved when opting for implants or intrauterine devices. Consequently, a general pattern that has been observed in the contraceptive method mix in sub-Saharan Africa and elsewhere in the developing world is the predominance of injectables.
So what, then, is the real story behind the contraception shots that women from Ethiopian received? Based on this research, it at least seems likely that the shots were not given with malicious intent, nor was a "systematic mechanism" involved. Family planning programs are widely accepted around the world, and they serve populations well beyond the Ethiopian Jews seeking to immigrate to Israel. The director of the clinic in Ethiopia testifies that the women come to the clinic of their own free will and it they choose their birth control method. In addition, the director of the Ethiopian clinic, as well as the head of the Israeli Society for Contraception, and also the 2005 study all confirm that the most popular birth control method among African women, including Ethiopian, is the shot. One of the main reasons for its popularity is the women's desire to conceal the contraception use from their husbands.
Likewise, it seems reasonable to assume that a large number of the women continue to receive the shot in Israel, because it is what they're used to, or as the head of the Israeli Society for Contraception put it: "a woman who comes from Africa will simply want to continue the same birth control which is, again, terrific and recommended, but there is no culture of taking pills."
Seideman may be overstating the case in stating that there "is not culture of taking pills" in Africa, but what is clear is that Depo Provera is widely used in Ethiopia. Writing in The Ottawa Citizen on April 9, 2006, Shelley Page reported on a shortage of birth control medicines in Ethiopia caused by American aid policy regarding family planning. She wrote of how Getachew Bekele, the Ethiopian director of a London-based family planning organization, was "looking for condoms, three million of them." Page continues: "He also needs more than five million shots of the injectable contraceptive Depo Provera, 22,000 IUDs, and almost seven million packages of birth control pills." Why would a family-planning official be on the look out for 5 million shots of Depo Provera if it was not popular in Ethiopia?
Decline in Birth Rate Result of Multiple Factors
One implication put forth in the "Vacuum" report is that a 50 percent decline in fertility experienced by Ethiopian Jews who have immigrated to Israel is exclusively due to the use of Depo Provera. Here is what "Vacuum" host Gabai said to her viewers early on in the segment:
In the last decade, 50,000 Ethiopians have come to Israel. This is also a decade in which there was the most dramatic increase in the birthrate among the immigrants a decrease of almost 50 percent. The Depo Provera shot is the most widespread birth control that women were exposed to in the transit camps in Ethiopia.
Gabais implication is that the use of Depo Provera single-handedly caused the reduction of fertility on the part of Ethiopian women in Israel. Gabai encourages her viewers to embrace this conclusion in an interview with Rachel Mangoli, the head of the Pardes Katz Branch of WIZO in Israel. During the interview, Mangoli says that when young children stopped entering a childhood enrichment program she was running, she realized that a whole generation [of Ethiopians] was not being born.
With this statement, Mangoli suggests that Ethiopian Jews have stopped having babies altogether. This is clearly hyperbole that Gabai should have challenged.
Such hyperbole notwithstanding, there has, in fact, been a reduction in the fertility of Ethiopian women who immigrated to Israel. But attributing this decline solely to the use of Depo Provera is ridiculous.
In a 2004 article published in Demographic Research, a peer-reviewed journal published by the Max Planck Institute for Demographic Research in Germany, researcher Petra Nahmias reports that an increase in the number of abortions in this community is an important factor in bringing about this decline of fertility. She writes: It would appear that abortions are being increasingly relied upon as a form of pregnancy control, especially among younger Ethiopian women.
Another factor contributing to the decline in fertility of Ethiopian women is that they are getting married later in life and as a result, having fewer children, Nahmias reports. The increase in median age of first marriage is particularly impressive for new Ethiopian immigrants, which increased by 6 years between 1990 and 2000."
No where in her report did Gabai mention these factors, but instead left her viewers with the impression that the decline in fertility was solely the result of Depo Provera.
This is an egregious journalistic failure that should have been uncovered in Ha'aretz's subsequent coverage.
Is it possible that some of the women did not fully understand the explanations at the JDC clinics in Ethiopia? Absolutely. Is it possible that some of the JDC employees were negligent? Again, this is also a possibility. But does a "systematic mechanism" exist? There is simply no evidence of this. And yet Gabai's and Nesher's musings simply did not attempt to consider any other options.
Unfortunately, though, in-depth research, which Vacuum and Ha'aretz failed to undertake, will not convince any of the countless readers who have already received yet another "reason" to believe that Israel is nothing more than a new version of the Third Reich.
For the Hebrew version of this article, please see Presspectiva.