Steps to Abortion
Abortion in Germany
Suddenly, Your Body Is Not Yours
Getting an abortion in Germany is, generally speaking, a criminal offense – albeit under certain conditions exempt from prosecution. For many, the path to ending an unwanted pregnancy within legal grounds is riddled by a lack of resources, unprofessional doctors and bureaucratic hurdles.
A new investigation from CORRECTIV.Lokal – a network which supports investigative journalism on the local level – sheds light on how the German medical system often fails people seeking abortions. Through a crowd-sourced survey, 1,505 people shared their experiences. In their responses and in interviews, many discussed the heavy psychological toll of having an abortion in a country where the topic is seen as taboo.
We also partnered with dozens of local journalists and the transparency initiative FragDenStaat to ask all 309 public hospitals in Germany with gynecology departments whether they perform abortions: Less than 60% said yes.
A Controversial Legal Situation
Every day, about 270 people get an abortion in Germany. When the life of a pregnant person is in danger or if the pregnancy is the result of rape or abuse, it is not considered a felony. But such situations are the minority.
In 2020, nearly 100,000 abortions were performed in Germany — 96,000 of which were done for reasons outside of medical necessity, rape or abuse. In these instances, getting an abortion is considered a crime, but still possible without penalty if certain conditions are met: The pregnant person must attend a statutory counseling session at a state-approved center, after which they receive a certificate. Then, after a three-day waiting period, they can get an abortion – as long as it is in the first 12-weeks of the pregnancy.
Germany is one of the few countries in the European Union to mandate both counseling and a waiting period before allowing an abortion, according to the Center for Reproductive Rights. When those requirements aren’t met, both the doctor and the pregnant person may face a fine or prison time.
Many European countries known for having a progressive stance on abortions have similarly restrictive policies that require additional steps before accessing care. The situation is particularly bad to the east of Germany in Poland, where there have been ongoing protests over a near-total abortion ban enacted last year.
— Hesse, 2020
The situation is further complicated by a law forbidding doctors from sharing information about abortions online.
Paragraph 219a of the German penal code, which bans the advertisement of abortions, forbids medical professionals from sharing information on their websites about the methods and costs. Until March 2019, the law also forbade doctors from publishing online that they perform abortions.
The German Federal Cabinet announced last week a motion to completely repeal the law. The bill, which must still be debated on the Bundestag floor, could take months to go into effect. Until then, the advertisement ban will remain in effect.
Just over 230 people who participated in the survey said they had difficulty finding where to get an abortion or finding information about the procedure. Many said they came across websites from anti-abortion activists before they could find factual information sources.
There can be many obstacles to getting an abortion with a counseling certificate. About one in five survey participants spoke of grievances against counseling personnel. Of them, 100 said they had been pressured to continue the pregnancy. Many said they felt the counseling staff was aggressive and a dozen recounted being insulted or blamed.
The content of the talks is regulated by a legal framework. According to the Pregnancy Conflict Act, the counseling should serve to protect unborn life. Pregnant people are expected to share their reasons for a possible abortion.
In the end, it is up to the counselor to decide whether a certificate is issued or if more conversations are necessary.
An abortion can cost up to 600 euros in Germany. For people who get one with a counseling certificate, the expense is not covered by public health insurance.
Exceptions can be made for low-income people or people receiving welfare benefits. In such cases, the pregnant person must submit an application to their health insurance and get it approved before the abortion. Then the federal state assumes the cost. Since a pregnancy may only be terminated within the first 12 weeks, this puts a lot of pressure on individuals.
— North Rhine-Westphalia, 2016
Finding a Practice
Finding a Practice
Numerous studies show that the number of practices and hospitals in Germany that carry out abortions is declining. Even in larger cities, it can be difficult to find a doctor to do the procedure.
In 2003, there were roughly 2,050 clinics and hospitals that performed abortions, according to the Federal Statistical Office. In the middle of 2021, that number had sunk by nearly 50% to 1,100.
Together with the transparency initiative FragDenStaat and dozens of local journalists, CORRECTIV.Lokal asked all public hospitals with gynecology departments in Germany if they do abortions. Less than 60% said yes.
When it comes to counseling certificates – which accounted for 96% of all abortions in 2020 – the number is lower. Just 2 out of 5 hospitals will do the procedure when there is no medical necessity or outside of situations of rape or abuse. In some cases, upholding Christian ideals or being a “baby-friendly” hospital were offered as an explanation.
In survey responses and in interviews, people said it was difficult to call multiple practices, each time having to repeat that they decided to get an abortion and sometimes facing degrading comments.
Finding a doctor was very difficult. First, it was vacation time and two of the three doctors were on holidays. The other one, who had time, was so unfriendly on the phone that you thought you were making an appointment at the slaughterhouse. The other doctors in the area didn’t do it at the seventh week of the pregnancy with a pill. So I had to drive almost 200 kilometers (124 miles) to another state to find a doctor who would do the procedure.
— Bavaria, 2021
If the availability of healthcare in a region is bad, then people may have to travel lengthy distances in order to get an abortion. Thirteen percent of survey participants said they traveled more than 50 km (31 miles) to a practice or hospital for the procedure. The majority said they had traveled no more than 10 km, or roughly six miles.
In Bavaria, a predominantly catholic and the second-most populated federal state in Germany, the situation is particularly bad. Only nine out of 83 public hospitals with gynecology departments will do an abortion with a counseling certificate. In Regensburg, a city in central Bavaria, the nearest such hospital is over 100 km away.
Our survey found that nearly one in three people who had an abortion in Bavaria traveled more than 50 km to the procedure.
The journey back can be especially difficult. After an abortion, people often experience bleeding, pain, circulatory issues and nausea. Some people said they had to rely on the support of friends and family and would not have been able to make the trip alone.
There are two possible methods for carrying out an abortion: With medication or through an operation.
In Germany, medical abortions may be performed up to the ninth week of a pregnancy. It can take several days to be successful. With surgical abortions, the procedure lasts about fifteen minutes. The latter is often performed under general anesthesia.
Abortions should be a straightforward and safe procedure as long as the medical staff is well trained. But more than 350 respondents said they experienced poor medical care. Dozens reported a lack of privacy during the procedure, such as waking up with ten others in the same room.
About one in four respondents said medical staff behaved unprofessionally. Just over 50 said they were humiliated or insulted. Others said they were snapped at, refused painkillers or discharged as quickly as possible despite physical discomfort after the procedure.
Abandoned in aftercare
It is the general medical recommendation that a follow-up be held two weeks after an abortion to check whether the procedure was successful and for any complications.
Fifteen percent of survey participants said they had received poor aftercare or none altogether. As a result, complications were often detected late.
Some of those affected said they were traumatized by the treatment they received. That they have difficulty trusting gynecologists, or no longer trust them at all. That they no longer go to the doctor for symptoms and stopped attending preventative care appointments. Because the fear of being treated so degradingly again is too great.
— North Rhine-Westphalia, 2020
This project is a cooperation between CORRECTIV.Lokal, dozens of local journalists and the transparency initiative FragDenStaat. Together, we wrote press requests to all 309 publicly-owned hospitals in Germany with gynecology departments. The list of public hospitals was compiled from the 2019 directory of hospitals from the Federal Statistical Office.
Our research on abortion is available in German as a three-part series, including a searchable database of abortion policies by hospital. On the project page, you can also find stories published by our local media partners.
Authors: Max Donheiser and Miriam Lenz
Reporting and editorial collaboration: Antonia Groß, Emilia Garbsch, Hatice Kahraman, Jonathan Sachse, Olaya Argüeso, Pia Siber and Sophia Stahl
Fact-checking: Jonathan Sachse
Illustration: Mohamed Anwar
Design: Belén Ríos Falcón
Animation: Mustafa Nada