Germany moves to reform abortion law

"I really struggled to find information online," said Verena, who was 22 when she found herself dealing with an unwanted pregnancy. "There was no easy way to find out which doctors perform abortions, where they are or how the procedure is performed."

Abortion is illegal in Germany and punishable by up to three years in prison. But women and their doctors do not face penalties if the pregnancy poses a health risk to the woman or in cases of rape. There is also a loophole under which an abortion may be carried out within the first 12 weeks of pregnancy (14 weeks since the last period) after mandatory counseling. However, many barriers remain.

One of the biggest hurdles to obtaining an abortion in Germany was paragraph 219a of the criminal code, which has its origins in Nazi-era social policy. It stated that anyone who publicly "offers, announces [or] advertises" abortion services can face penalties of up to two years' imprisonment or a fine.

Although a reform three years ago allowed doctors to state that they perform the procedure on their websites, they were still banned from giving medical detail. 

But on Friday, Germany's coalition government of the center-left Social Democrats and Greens and neoliberal Free Democrats pushed the motion to scrap 219a through parliament.

Under 219a, Kristina Hänel, a gynecologist in the western German city of Giessen who has performed abortions for 30 years, was sentenced in 2017 to pay a fine of €6,000 ($6,926) for offering abortion services on her website. The case triggered a heated debate in the country.

"If 219a is scrapped now, Germany takes a step in the right direction of providing information for patients," Hänel told DW ahead of the decision.

Five years ago, Verena found that the lack of readily available information meant hours of fruitless searching before calling a local clinic, where she was cryptically told to get in touch with one of three doctors in her area. But then she found there was no way to get information such as: are these doctors well-rated by fellow patients? What is the difference between a medical and surgical abortion? What is the after-care process like, and what are the possible side effects?

"When you Google abortion, you're taken to websites that warn you you'll definitely be depressed, traumatized and infertile. That isn't medical advice — it just makes you feel like the worst person in the world," she said, emphasizing the emotional toll of seeking even the most basic information.

Jana Maeffert, a gynecologist with the reproductive rights organization Doctors for Choice Germany, said the dearth of information could create dire circumstances for patients, who may find out too late that a clinic doesn't offer what they are looking for. For example, doctors cannot state on their website "whether they offer medical or surgical abortions or both. They can't say that you only operate until the 10th week of pregnancy, so a woman might drive all the way to your practice only to find out she cannot obtain an abortion there anymore," because she has already passed that point in her pregnancy.

Less access to abortion

To perform an abortion, the doctor needs to see a certificate proving that the pregnant woman has undergone counseling at least three days prior in a state-approved counseling center. There are numerous organizations offering counseling, during which the woman is informed of her options, where she might find additional psychological and financial help if she decides to have the baby or how to go about adoption.

Verena said getting an appointment for the mandatory counseling was nearly impossible. She recalled making call after call. This can turn out to be so time-consuming that it risks taking the pregnant woman over the line of her first trimester.

Finding a counseling appointment and a doctor is far from a given for many German women. Since 2003, the number of doctors willing to perform an abortion in Germany has tumbled by 40% — there are now only 1,200 practices in the country where a woman can legally obtain one, down from 2,000 some 20 years ago.

"In Germany, abortion is a taboo topic. For patients, and for doctors, too," said Maeffert. "If you practice medicine in a small town, you may well decide not to offer pregnancy termination because then you're labeled the 'abortion doctor' in your small community."

"Only one in 10 gynecologists in Germany performs abortions," Maeffert said, "not necessarily because they're against it, but because the barriers are so high."

Some patients, Maeffert said, "must travel 150 kilometers" (90 miles) to find a doctor, especially in rural and Catholic regions such as Bavaria. But, even in some major cities, the situation is critical. According to local media reports, in Stuttgart, not a single hospital offers abortions. In the city of Münster, the last doctor who offered pregnancy termination went into retirement in 2019.

Abortion rates at 25-year low

As the number of practices providing legal abortions has dwindled, fewer and fewer women have gotten one. The year 2021 saw the lowest rate of abortions in Germany since 1996, the first year statistics were collected on the subject. According to the Federal Statistical Office, some 94,000 abortions were carried out in 2021, a decrease in 5.4% on the previous year and part of a decadelong downward trend.

Meanwhile, doctors who perform abortions in Germany have begun to face the onslaught of active anti-choice activists who protest outside clinics, hold marches across major cities, send hate mail and take to social media with aggressive comments.

Maeffert, in Berlin, said she herself had not yet experienced such attacks. "But, for example, in parts of Bavaria ... protesters stand in front of the clinic all the time. ... It's horrible for the patients and the doctors," she said.

Political will for change

Some medical students have taken matters into their own hands, and have found creative ways to get the relevant training on how to perform the procedure. The so-called "Papaya Workshops," for example, use the fruit as a model for the female reproductive system.

While attending such a workshop is not sufficient for a doctor to be certified to perform surgical abortions, it closes a gap in German medical education, where students say that abortion is "discussed for 10 minutes, if at all," according to the advocacy group Medical Students for Choice.

According to Berlin's public broadcaster, rbb, the workshops are fully booked. One participant told rbb that she felt the workshop had given her "a better idea of how the procedure goes, what tools you use. I had imagined it as being a lot harder. I'm not so scared of it now."

Some doctors in Germany are also now prescribing the pills needed for medical abortion in a telemedicine project where the pregnant person takes medications at home under supervision by a doctor to induce a miscarriage and negate the need for surgery. This is not to be confused with the morning-after pill, which has been freely available in Germany since 2015.

Edited by: Rina Goldenberg

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