Behind the Headlines: Soviet Newcomers Pose Challenge for Israel’s Family Planning Clinics

One of the many quiet stories about the ways in which the massive immigration from the republics of the former Soviet Union is impacting Israel is its effect on the country’s family planning organizations.

Two non-governmental agencies, the Tel Aviv-based Israel Family Planning Association and Shiloh, in Jerusalem, do much of the outreach and educational work.

The Israel Family Planning Association provides professional education for doctors and has six Open Door information offices nationwide.

The Open Door offices primarily serve teenagers, counseling them and directing them to the appropriate health-care providers.

Shiloh, which operates more like Planned Parenthood in the United States, provides clinical services as well.

Adapting to the needs of immigrants from Russia and the other former Soviet republics involves much more than simply translating existing birth control literature and providing staff members who can speak their language.

The long-term goal is the complete re-education of the immigrants, for whom abortion has been the birth control method of choice.

“One hundred percent of Soviet women are estimated to have abortions,” according to Judith Abrahami-Einat, executive director of the Israel Family Planning Association.

In fact, women in the former Soviet Union have an average of two or three abortions. By contrast, the statistical average in Israel is half an abortion over a woman’s fertile years, said Dr. Eitan Sabatello, director of the demographic division of Israel’s Central Bureau of Statistics.

MISTRUST OF CONTRACEPTIVES

“There is a social and psychological acceptance of abortion among Soviets. It is seen as a routine and inevitable procedure,” Abrahami-Einat explained.

The Soviet medical establishment has convinced women that abortion is the safest method of birth control because its overall medical approach favors treatment over prevention, she said.

Withdrawal and the rhythm method are the two most popular forms of birth control practiced in the former Soviet republics. Condoms are unpopular and difficult to find.

Birth control pills and intrauterine devices are not only scarce in the republics, they are as rudimentary and dangerous as what was available in the West 20 years ago.

“Soviet women’s fear of those methods, in many cases, was legitimate,” said Joanne Zack-Pakes, director of Shiloh.

Changing their resistance to contraceptives is expected to take time.

“No change in attitude can be expected in less than three years, and even after living here 10 or 12 years, there is still an enormous gap between their family planning practices and others’,” said Abrahami-Einat.

Some shift in attitudes toward alternatives to abortion has been seen among Soviet immigrants who came to Israel in the 1970s, but they still seek abortions at a dramatically higher rate than other Israelis.

The trend is visible even among women who were born in the Soviet Union but raised in Israel.

In 1988, the latest year for which figures are available, women in their 20s who were born in the Soviet Union were 50 percent more likely to have abortions than other Israeli women of the same age.

MARRIED WOMEN NOT ELIGIBLE

When a woman wants to have an abortion in Israel, she must apply for approval from one of 27 committees around the country.

There are four sets of circumstances in which the law allows a woman an abortion: if she is under 18 or over 40; if the pregnancy is the result of rape or incest; if it is extramarital; or if the pregnancy is a threat to the woman’s health.

Women who are healthy, married and between the ages of 18 and 40 are not permitted to elect abortion under current Israeli law. And most of the new immigrants who become pregnant are healthy married women in that age range.

A concern voiced by family planning professionals is that women from the former Soviet Union will seek illegal abortions from immigrant doctors, many of whom are not licensed.

So far, that fear does not seem to have been borne out. There are an estimated 5,000 illegal abortions in Israel each year, according to Sabatello of the Central Bureau of Statistics, but there is no firm indication to date that immigrants from the former Soviet Union are raising the number substantially.

The reality is that most women who apply to the committees are approved. According to the 1991 Statistical Abstract of Israel, there were 19,121 applications for abortions in 1990, of which 17,020 were approved.

It is too early to tell if Israel’s abortion rate has increased since Soviet Jews began arriving here in large numbers at the end of 1989.

If Jews from Russia and the other republics continue to come to Israel in large numbers, Sabatello projects that the peak number of abortion applications will come in 1995, when “we may reach 10,000 more.”

Shiloh began a Russian Project last July to serve the new immigrants. The full-time education director, half-time counselor and part-time gynecologist working on the project all speak Russian, and two are recent immigrants themselves.

OTHER CONCERNS BESIDES FERTILITY

They reach the new immigrants by advertising in Russian-language newspapers, setting up information booths at the hotels where Russians are housed and making presentations on birth control at the Hebrew-language ulpan classes.

Shiloh has had 150 Russian clients since the project began. Half have come for contraception, and half because they suspect they are pregnant. A third of those women turned out to be pregnant, and all opted for abortions.

Clients typically visit the clinic five to seven times for counseling and examinations.

Clinics should not only educate immigrants about alternative birth control methods, they should make contraceptives available to them for free or at very low cost, Sabatello said.

“Most Soviet women want a small number of children,” she said. “But we shouldn’t forget that at the early stage of absorption, the women have problems other than fertility concerns. They may prefer to buy milk rather than birth control pills.”

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