Women's activists and a series of media reports contend that Ethiopian women who immigrated to Israel over the past two decades were coerced into taking a controversial birth control drug without being properly informed of its side effects or being offered alternative contraceptives.
While the allegations have been strongly denied by the government, it remains unclear why so many Ethiopian women were receiving Depo-Provera, a long-acting birth control injection that is rarely prescribed to other Israelis.
Israel's Health Ministry has denied any wrongdoing and ruled out an investigation. Nonetheless, last month it ordered the country's HMOs to stop prescribing the drug to Ethiopians unless they are fully aware of the potential side effects, which can include decreased bone mineral density and difficulty getting pregnant for up to two years after the injections stop.
The controversy has shined a fresh light on the Ethiopian community and its place in modern Israel. Believed to be descendants of the lost Israelite tribe of Dan, Ethiopian Jews spent millennia isolated from the rest of the Jewish world. Israel began rescuing groups of Ethiopian Jews from war and famine in clandestine operations in the 1980s, and larger numbers followed in the 1990s.
Today, some 120,000 people of Ethiopian descent live in Israel. Yet two decades after first arriving, Israel's Ethiopian population continues to struggle. Many work in low-paying menial jobs as security guards and cleaners, and roughly 41 percent of Ethiopian families live in poverty.
While the younger generation has made some gains, it is still struggling compared to other Israelis and many say they still face discrimination. The latest birth control controversy has taken these grievances to new heights.
"This story reeks of racism," said Itzik Dasa, the head of Tebeka, an Ethiopian legal aid group that along with five other rights organizations is collecting testimonies from dozens of Ethiopian women, with the aim of taking the matter to court.
Dasa doesn't think Israel necessarily imposed a policy aimed at reducing birth rates among Ethiopian women, but rather that underlying racist sentiment allowed the matter to perpetuate unchecked.
Shlomo Molla, a former Israeli lawmaker and Ethiopian immigrant, said he believes the Health Ministry continued to give the women the injections, which were first administered in Ethiopian transit camps, once they arrived in Israel out of negligence.
"It was a failure of the Health Ministry. It shouldn't have given the women what they received in Ethiopia automatically," he said.
Depo-Provera has been used under controversial circumstances in the past. Testing and use was limited almost exclusively to women in developing countries and poor women in the United States, leading to charges that the test subjects were coerced or ill-informed.
The accusations in Israel first emerged in 2008, when the Yediot Ahronot newspaper published a report showing a disproportionate number of Ethiopian women were receiving injections of Depo-Provera, which is administered once every three months instead of as a daily pill.
The issue resurfaced in December when an investigative TV report claimed that Ethiopian women were told before they immigrated that raising children in Israel is expensive and that they should use birth control to ease the transition. The TV report interviewed more than 30 women, some of whom said they feared they wouldn't be allowed to immigrate if they didn't take the drug.
Some said they were not offered any other form of contraceptive and were not told its side effects. The report, broadcast on the state-run educational channel, concluded there was a deliberate plan to keep down Ethiopian birthrates.
One immigrant, speaking to The Associated Press, said she was offered both the pill and Depo Provera injections by employees of the Joint Distribution Committee, a Jewish humanitarian organization that runs a clinic in the Ethiopian city of Gondar. She said she felt pressured to take a contraceptive — and chose the injection because she thought the pill would be more expensive.
The 42-year-old Jerusalem resident, who works as a cleaner at an assisted living center for seniors, said she switched to the pill once the side effects became unpleasant, about three years after she started the injections. Today, she and two other women are suing their HMO, alleging they were not informed about side effects. She spoke on condition of anonymity because the issue is sensitive within her family and community.
Dr. Rick Hodes, who runs the JDC clinic in Gondar, said the group offers family planning as part of the U.N.'s Millennium Development Goals, one of which is universal access to reproductive health.
"I do not know why offering family planning would be considered negative or even controversial, especially since our JDC program is 100 percent voluntary," he said in an email. The clinic, like others in Africa that are internationally funded, offers both the pill and the injection.
Israeli officials deny there was ever a plan to reduce the Ethiopian birth rate. Yet critics say the Health Ministry directive last month ordering HMOs to stop prescribing the injection to Ethiopian women was an admission of guilt.
"There was a clear trend to give these women Depo-Provera," said Hedva Eyal, who wrote a 2009 report on the matter for the women's activist group Isha L'Isha. "The result is control over their fertility, which means fewer children."
Eyal and others point to official figures that show the Ethiopian birth rate plummeted from 4.6 children in 1996 to 2.5 in 2011 — lower than the Israeli average of 2.9.
Molla, the Ethiopian immigrant and former legislator, said the decline is likely due to the realities of everyday life in Israel, where it can be difficult to have as many children as in Ethiopia.
The Depo-Provera affair is just the latest clash Israel has had with its Ethiopian community.
Last year, Israel's rabbis began working to phase out the community's clergy, whose religious practices are at odds with the rabbinate's Orthodox Judaism, sparking large protests. In the late 1990s, it was discovered that Israel's health services were throwing out Ethiopian-Israelis' blood donations over fears of diseases contracted in Africa.
Dasa hopes his group's investigation will provide answers — and lessons for the future.
"We as a state should be learning from the mistakes of the past," he said, "and shouldn't make the same ones again."