Should gynaecologists need to be told not to give women contraceptive injections without establishing fully informed consent? Of course not. But that is what has happened in Israel after it was revealed in a report by a women’s rights organisation that Ethiopian women have been given injections of Depo-Provera without sufficient understanding of the purpose or side effects of the drug. Some Ethiopian women in transit camps were refused entry to the country if they refused the injection, and others wrongly believed they were being inoculated against disease. While Israeli demographers discuss the need to “preserve a clear and undisputed Jewish majority among Israel’s total population“, it may seem anomalous that women in the Jewish Ethiopian population are forced or coerced into using this highly effective contraceptive method.
However, the conclusions of the report, written by Hedva Eyal, are that the injections given to Ethiopian women are “a method of reducing the number of births in a community that is black and mostly poor”.
Many people may be unaware that the Israeli case is merely the tip of a global iceberg of human rights abuses in the field of reproductive health. Forced sterilisation of people with learning disabilities and people of minority ethnic groups was documented across Europe and the US in the 20th century. Under the state of emergency in India between 1975 and 1977, thousands of men and millions of women were bribed, coerced and sometimes forced to undergo sterilisation. As recently as 1996 in Peru, a demographic policy led to a sevenfold increase in sterilisations in just two years, effected through widespread violations of women’s rights. A provider explained: “Many [providers] did not inform women that they were going to be sterilised – they told them the procedure was something else. But I felt this was wrong. I preferred to offer women a bag of rice to convince them to accept the procedure and explained to them beforehand what was going to happen.”
And on into the 21st century. What litany of coercive practice would be complete without reference to China’s one-child policy, the violent implementation of which was highlighted in two particularly horrific cases last year? From Uzbekistan also come reports that doctors working to quotas have been sterilising women without their consent during caesareans. Likewise in 2010, HIV-positive South African women reported being sterilised while undergoing caesareans, abortions or shortly after childbirth without their knowledge. Others were made to consent under duress: “She [the nurse] snatched something that I wanted, you know? She made up a choice. She made up a choice for me.” These are just the abuses that spring to mind – many more are being reported around the world.
The flipside of these is the concerted attempt by reactionary groups to deny women access to reproductive and contraceptive healthcare altogether. Right now Republican politicians in the US are fighting for the right of employers to refuse women contraceptive cover in their health insurance, and clogging up state legislatures around the country with bills aimed at eradicating abortion services. It has taken 15 years to pass a reproductive health bill in the Philippines that will allow poor women access to affordable contraception for the first time: the Catholic church fought it every step of the way and began its campaign to overturn the bill minutes after it was passed. Meanwhile 47,000 women a year die from complications of unsafe abortion in countries where abortion is legally restricted, or where services are inadequate to meet their needs. In Latin America, women and doctors are imprisoned for having or providing abortions, and women such as Savita Halappanavar are dying unnecessarily because of laws that prevent the termination of pregnancies that are life-threatening – even when they are not viable.
These cases are all connected – whatever the detail, wherever they are happening. They are all indicative of a fundamental disregard for women’s lives. Forcing women to bear children, or preventing them from doing so, denying them life-saving treatment during pregnancy, or carrying out medical interventions without establishing informed consent, these all threaten women’s safety, dignity and bodily integrity. They are serious violations of women’s reproductive and human rights and must not be supported or countenanced by governments or doctors any more.