The federal cabinet has cleared the way for the abolition of paragraph 219a. The doctor Dr. In an interview, Alicia Baier explains what the omission would mean for unwanted pregnant women and what women who want to have an abortion should know.
With the abolition of paragraph 219a, doctors could in future publicly and extensively inform about abortions in their practice without making themselves liable to prosecution. What will this change?
Alicia Baier: This deletion is a great success by many activists. The possibility that doctors will be able to provide factual information about abortion on their websites in the future will hopefully improve the information available for unwanted pregnant women. I think it is very important that direct exchange between patients and doctors will soon be possible.
Will doctors really provide broad information about abortions in the future? For example, there was already one List at the German Medical Association, which lists facilities that perform demolitions. For example, there are four practices from Munich – for a big city, these seem to be few contact points…
Alicia Baier is a doctor and founded the during her student days Medical Students for Choice Berlinwho campaign for better medical education on abortion. She is currently a board member of the association Doctors for Choice Germany, which she co-founded in 2019. The association consists of doctors and medical students and is committed to improving access to abortions.
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Abortion continues to be taboo and stigmatized, and the deletion of paragraph 219a will not change anything. Many doctors worry about being pilloried by anti-abortionists if they publicly admit to performing abortions. Some doctors also fear for their reputation among patients and colleagues. It is therefore to be feared that doctors who carry out abortions will not announce this on their practice website.
So isn’t it getting easier for women who want to have an abortion to find out more?
Only when we in society regard abortion as a normal medical procedure can doctors inform about the procedures on their websites without fear. Another problem: when women are looking for information about abortions, they quickly find themselves on the websites of abortion opponents. Some of the pages look very serious, but the information is not factual, but tendentious. These sites still exist and are misleading. Such deliberate misinformation should be prohibited by law, as France is doing with a regulation.
With a tool of “corrective” Users can search for public clinics in the area that perform abortions by postal code. If I enter my Hamburg postal code, I only find one clinic within a radius of 50 kilometers that is directly in Hamburg and stated in the survey that abortions are performed there. Do we need more clinics and practices that perform abortions?
Yes, we need more clinics and practices. Because: Since 2003, the number of facilities that carry out demolitions has fallen by half. Many doctors who still perform abortions are of retirement age, so it is to be expected that the range of care will continue to deteriorate. Correctiv’s research has shown that many public clinics do not perform abortions. Christian hospitals generally do not perform abortions, and neither do many private clinics. Basically, any gynecological practice could offer an abortion. But: Nine out of ten gynaecologists do not perform abortions.
A woman discovers that she is pregnant and decides that she wants to terminate the pregnancy. Which regulations does she have to observe?
After Clause 218 Abortion is still a criminal offense. A termination remains unpunished if there is a medical, a criminological or a counseling indication. Abortion is generally only permitted up to the twelfth week after conception. Unintentionally pregnant women are legally obliged to seek advice from a state-recognized body if there is no medical or criminal reason for an abortion. In a so-called pregnancy conflict counseling session. There must be at least three days between the consultation and the medical intervention.
How does such a consultation work? What do women have to consider?
First of all, women have to make sure that the counseling center is authorized to certify the conversation about the so-called pregnancy conflict counseling. Women need this certificate so that a doctor can perform the procedure. In general, the conversation should provide information about the costs, whether they will be covered and ideally also about the medical intervention. And if desired also about what support is available for parents. Counseling can also help in decision-making when women do not know whether or not to terminate the pregnancy.
The counseling process can vary greatly. There are counseling centers that first ask whether there is a need for counseling at all. If this is denied, women do not have to seek further advice and receive the necessary certificate. In other counseling centers, women may be asked about their reasons for having an abortion. There are also women who have had bad experiences during such counseling sessions and describe attempts to persuade them to continue with the pregnancy.
Who should a woman turn to first if she wants to terminate a pregnancy?
The first point of contact is your own gynecologist, who can inform unintentionally pregnant women in which week of pregnancy they are. In the best-case scenario, they can provide information about the procedure if they perform it themselves. As mentioned, women also have to make an appointment for a consultation.
Where and how else can I find a doctor’s office that performs abortions?
As described, the supply situation for abortions in Germany is poor, so finding a doctor is not easy. Some counseling centers such as Pro Familia provide information about facilities that carry out abortions. Another possibility is the incomplete one Address list of the German Medical Association. Or if paragraph 219a is dropped, also via the practice websites of doctors. In case of doubt, however, it can also be the case that women who want to terminate a pregnancy simply have to call all the gynecologists in their area to find out whether a practice performs abortions.
How can I end a pregnancy? What is the procedure for an abortion?
There is medical abortion (in Germany only possible up to the 9th week of pregnancy), unintentionally pregnant women take two medications two days apart and the pregnancy is virtually bled off. The drugs cause the lining of the uterus and the embryo to shed. This procedure is successful in around 95 percent of cases. A follow-up examination must be carried out after two weeks. Painful cramps, nausea and circulatory problems can occur.
The second common method is a surgical intervention under general or local anesthesia. In the suction a tube is inserted through the vagina into the uterus and the pregnancy tissue is suctioned out. Bleeding can vary in severity after an abortion and can last for two to three weeks. Another operational method is the curettage. It has been outdated for decades and is no longer recommended by the World Health Organization, but unfortunately it is still used in more than every tenth abortion in Germany.
How safe are the two common methods of abortion?
Both procedures have low complication rates and are very safe. The earlier in the course of pregnancy an abortion is performed, the safer the procedure.
Who bears the costs of an abortion?
The cost depends on the method, but it ranges from 300 to 600 euros. Abortion is not covered by health insurance in Germany, which means that those affected have to bear the costs themselves. Low earners can apply for cost coverage, but this is another bureaucratic hurdle.
What else is there to think about?
Depending on where you live, women may not be able to find a facility that performs abortions in their area. So you can expect long journeys and high travel costs. Several visits to a practice are often necessary because appointments are still being made for preliminary talks before the procedure. Since some practices only perform abortions on certain days or have a longer waiting list for patients, there may be delays.