Abortions: Germany before relaxation of paragraph 219a

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Paragraph 219a has existed in Germany since the Nazi era, prohibiting doctors from providing specific information about an abortion. It should fall now. However, hurdles remain for women.

Protest for a right to abortion in Munich

“I found really bad information online,” says Verena, who became pregnant unintentionally at the age of 22. “I couldn't research a doctor who performs abortions, couldn't find out who is in my area or what methods they use.”

Abortions are not officially allowed in Germany, are considered a criminal offense and can be performed with up to three years in prison. Unless the pregnancy poses a health risk to the woman or is the result of rape. An abortion before the 12th week of pregnancy after mandatory counseling is also exempt from punishment.

But the road to an abortion is still rocky. One of the biggest obstacles is Section 219a of the Criminal Code. It has its origins in National Socialism and states that “anyone who publicly offers, announces, praises means, objects or procedures that are suitable for abortion or makes statements of such content”  with up to two years imprisonment or one fine can be imposed. The paragraph is better known as the so-called advertising ban for abortions.

Verena is now open about her abortion< /p>

Three years ago, 219a was reformed and doctors are now allowed to announce that they are performing abortions. However, they are not allowed to mention the details, such as which treatment methods are used, in writing, for example on their websites. This Friday, the Bundestag will advise and decide whether paragraph 219a should be completely abolished. It's quite possible that he will be history then.

 

For Kristina Hänel that would be “a great success”, as she says. The 65-year-old general practitioner was convicted because she stated on her website that she performed abortions. She paid the fine – and lodged a complaint against it with the Federal Constitutional Court. If paragraph 219a were to fall, something would change in her everyday work: “For a year now, I had to remove the information from the website after I was finally convicted,” Hänel told DW.

“Now the women could read again that they should bring pads and towels with them and that they shouldn't eat anything two hours beforehand. They're told all that on the phone, but in our practice it's a relief when they really do that have read and are also informed beforehand. If the 219a really falls now, then we have taken a good step towards information for patients.”

The Union faction in the Bundestag sees it differently. The conservatives of the CDU and CSU reject the planned abolition of the advertising ban for abortions. It is an “important part of the life protection concept” and should above all counteract the commercialization and social normalization of abortion.

Left alone with a bad conscience

When Verena found out six years ago that she was pregnant, she found out how scarce information about abortions was. She spent hours searching the internet, she says, before contacting a local clinic. There she was told three names of doctors who she should call. But many questions remained unanswered for her: How are the doctors rated by other patients? What is the difference between medical and surgical abortion? What is the follow-up treatment like?

All answers that might have taken away her fear in a situation in which she felt left alone anyway. “If you google abortion, you'll come up with websites that suggest you'll definitely be depressed, traumatized and infertile afterwards. This isn't medical advice, it just makes you feel like the worst person alive .”

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#entr_en: “We've had an abortion”

Jana Maeffert is a gynecologist at the organization Doctors for Choice Germany, which advocates self-determined family planning. Maeffert explains that the lack of information can have terrible consequences for patients, who may find out too late that a clinic does not offer what they are looking for. For example, doctors are not allowed to state on their website whether “they perform medical abortions, surgical abortions, or both. They are not allowed to state that they only operated up to the tenth week of pregnancy, so a woman might drive all the way to the office only to find out that she is no longer allowed to have an abortion there.”

Access to abortions decreased

In order to carry out an abortion, the doctor must have proof that the pregnant woman has undergone state-approved counseling at least three days previously. There are a variety of organizations that offer such counseling, but it can still take time to get an appointment with them. Verena remembers that she had to make call after call before she finally got an appointment. This can sometimes take so long that women risk exceeding the first trimester of their pregnancy.

The fact that Verena finally found a counseling center and a doctor is not a matter of course. Since 2003, the number of doctors performing abortions has fallen by 40 percent. There are now only 1,200 practices in Germany where a woman can have an abortion without being punished. 20 years ago there were still 2000 practices.

Jana Maeffert criticizes, among other things, the poor supply situation for abortions in Germany

“In Germany, abortions are taboo. For patients and also for doctors,” says gynecologist Jana Maeffert. “If you have a practice in a small town, there's a good chance they'll decide against providing abortion services because you might be dubbed the 'abortion doctor' in their small community.” And she adds: “Only one in ten gynecologists in Germany offers abortions. Not necessarily because they refuse them, but because the hurdles are so high.”

Some patients, says Maeffert, have to travel 150 kilometers to find a doctor. This applies in particular to rural and Catholic regions in Bavaria. But even in some big cities the situation is no different. According to local media, there is not a single hospital in Stuttgart that performs abortions. And in Münster, the last doctor who still offered abortions retired in 2019.

Abortion rates at an all-time low

With the disappearance of surgeries offering abortions, the number of women performing abortions also fell. The year 2021 brought the lowest rate of abortions since 1996. According to the Federal Statistical Office, it was around 94,000. In the first quarter of 2022, however, the number rose slightly by 4.8 percent compared to the same period last year.

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Abortion in Europe – despised, concealed, forbidden

Meanwhile, doctors providing abortion are coming under attack from anti-abortionists who are protesting outside clinics, marching in major cities, sending hate messages and posting aggressive comments on social media. Kristina Hänel has known this for years, she says. She doesn't have police protection, but before every lecture she gives, she talks to the police. She herself will soon be retiring, but the threats are even more of a burden for younger women: “Of course, this also means that nobody puts themselves in this situation voluntarily. Especially not a, maybe young, doctor who has children, who has a family to look after. She just won't want to put herself through that.”

Political will for change

In the meantime, some medical students have taken the problem into their own hands. You've found a creative way to create an illustrative training session on the abortion procedure. In so-called “papaya workshops” they use the fruit to simulate the female reproductive system. Such training is not mandatory in order to be able to offer abortions, but the workshops close a gap in the German health system. According to the organization Medical Students for Choice, the subject of abortion is “only ten minutes, if at all” covered in the course.

Some doctors in Germany are now also prescribing the pills needed for a medical abortion as part of a telemedicine project in which the pregnant woman takes medication at home but under the supervision of a doctor to induce an abortion and avoid surgery. This is not to be confused with the “morning after pill”, which has been freely available in Germany since 2015.

So there are various options for an abortion in Germany. However, it remains difficult to get all the information and complete the process within the first 12 weeks of pregnancy.

This could change, at least a little, if the new federal government keeps its promise to abolish paragraph 219a. This would enable doctors to publish comprehensive, medically correct information for women who want to have an abortion on the Internet.

Collaboration: Lisa Hänel (Editor's note: The editor is not involved related to the protagonist in the post.)