Abortion Access in Germany

Having an unwanted pregnancy can be a stressful experience, and navigating the legal and medical system in Germany when seeking an abortion can be daunting.  The driving motivation behind Spinelly coaching is empowering individuals, and towards that end I have compiled some resources to help anyone who is looking for support in this process.  Coaching and My Body My Choice program is available to support and guide you through the process, please reach out. 

For the purpose of this explanation, when we use “anyone seeking an abortion” or “pregnant people” or similar phrases, I am referring to any body which contains a uterus. Oftentimes, standard medical and legal procedures identify people with uteruses as “women,” but we want to be inclusive of all gender identities.  More than anything, we believe that individuals should be able to decide what is best for their bodies, and that each person’s needs and circumstances are unique – the decision to have an abortion should ultimately be up to the individual who is pregnant.

Important Note – Abortions are only legal in Germany until the 12th week of pregnancy

German law defines the date of pregnancy as beginning on the last day of the period, so many individuals may not realize they are pregnant until well into this timeline.  The option to have a non-surgical (using medication instead of surgery) abortion is only available until the 9th week of pregnancy.

Step One: Beratungsschein 

Anyone wishing to have an abortion must receive a certification form (Beratungsschein) from an authorized counselor. Essentially, this form states that the pregnant individual has attended counseling.  The nature of each counseling session will vary based on the counselor and the individual. From a legal perspective the counseling should be focused on ensuring that the person seeking an abortion is informed about the steps involved in the process and is certain of their decision before proceeding.  At the end of the meeting the counselor will sign your Beratungsschein and give it to you. This legally mandated counseling session is free of charge.

It is essential not to lose the Beratungsschein as you will have the only copy (for privacy reasons the counselor is not allowed to retain a copy) and this form must be given to the gynecologist before they are legally allowed to begin the procedure. 

German law requires that individuals wait three days between receiving the Beratungsschein and having the procedure. From a legal perspective this is intended to give the individual time to consider their decision further before proceeding.  If you lose the Beratungsschein during the waiting period you must go back to the counselor to receive a new one and you will have to wait an additional three days. Some people may find this waiting period to be particularly stressful, so it’s important to have a strong network or someone you can reach out to during this time for support.

Important Note – Depending on where you go for counseling you may need a pregnancy certificate (Schwangerschaftsbescheinigung) from a gynecologist before being able to receive the Beratungsschein. 

This is not a legal requirement.  Many practices will allow you to have the counseling session if you tell them you had a positive test on a home test, so if they are asking you to go through extra steps it may be an indication that they’re intentionally making the process more difficult than it needs to be, and that (if you live in an area with multiple providers) leaving and finding another practice may be beneficial.  Balance is a provider that is trusted. 

Step Two: Gynecological Examination

Before proceeding with the abortion, a full gynecological examination will be performed, including an ultrasound.  From a legal perspective the ultrasound is to ensure that the pregnancy falls within the first 12 weeks and is not in a more advanced stage of development.  You do not have to look at the ultrasound if you do not wish to see it. During the examination the doctor will also give you information about birth control options after the procedure is completed. 

Be sure to bring documentation about your blood group/type – the doctor needs to know this is in case there is a medical emergency during the procedure. If you don’t have any documentation or don’t know your blood type call ahead to ask what you should do.

Step Three: Abortion Procedure 

The Abortion Pill

This medical procedure is available to women who are up to nine weeks pregnant. Day one of the pregnancy is counted from the first day of the last period. This is the non-surgical method for ending a pregnancy in its early stages, and it is considered the safest and least invasive means to have an abortion. 

Mifegyne is the abortion pill containing the active ingredient mifepristone. Mifepristone blocks the action of the hormone progesterone, which is essential for the maintenance of the pregnancy. This essentially tells the body it is no longer pregnant. You will take this pill while at the doctor’s office.  Depending on your doctor’s advice, you may be able to go home at this point. If your doctor deems it necessary, you may need to wait in the office for a few hours so that they can monitor your progress. Plan to spend the day resting somewhere comfortable, the physical effects of mifepristone can cause bleeding and cramping that may last for several hours. 

Misoprostol is taken a few days after the mifegyne to induce a strong period and remove all of the remaining lining in the uterus.  Most doctors will let you self-administer Misoprostol at home. Again it will be important to find somewhere comfortable – expect more bleeding and cramps.  Many people report that the experience is like an extremely condensed and strong period, so being in a safe, clean space with comforting help at hand is recommended.  If possible, planning to take a couple days off work is advised.

Surgical 

The surgical method, also called vacuum aspiration, is performed under general anesthesia or with local anesthesia of the cervix. This can be done up to twelve weeks into the pregnancy, and you will be admitted in the hospital or other medical facility for the duration of the procedure and initial recovery. While you are under anesthesia the doctor is able to implant an IUD if you choose to use this form of birth control in the future.

After the procedure it is common to feel some pain, cramping, and nausea.  Resting somewhere comfortable with loving support at hand is advisable, you may need to take a few days off work if possible.

Abortion Costs 

The cost of abortion is not covered by statutory health insurances in Germany. The cost of an abortion ranges from 200€ to 570€ depending on the type of procedure. If you choose the surgical route and you are admitted to the hospital, you have to pay the daily rate yourself. 

If you are low income and make below 1179€ net income (the limit increases by 279€ for each child living in your household) you are eligible to have the abortion costs covered by the federal state.  To do this you must receive an “Antrag auf Kostenübernahme stellen” (request for reimbursement) from your health insurance prior to having the procedure. You can expect to spend an hour or two at your insurance office to get the necessary forms completed, but it will be done in one visit.   If you go to your insurance for cost reimbursement, be sure to take with you a proof of your monthly income from the previous several months to prove your financial need.  

Once you are approved by the health insurance company, you will be given a written proof that costs are covered to give to the doctor who is performing the procedure. The health insurance company will ask which procedure you are having (medical or surgical), as this will impact how much they cover.  One thing to take into consideration – even if you’ve decided to have a medical (pill) abortion instead of surgery, it may still be wise to fill out the form for having a surgical abortion. This way if there are any complications and you are pushed past the nine weeks/your health situation changes and surgery becomes necessary the costs will still be covered. If you end up having a medical procedure (pills) the doctor can fill in a correction when they file their claim, saving you from having to make extra trips to the insurance office.

Step Four: Follow Up

A week or so after the procedure you will have a gynecological examination to confirm the abortion was successful. This will be the exact same as your first gynecological exam, including another ultrasound. The doctor will also provide you with any birth control you may have requested in the previous consultation.

Optional Step Five: Follow-up Counseling 

If you find that after the procedure you are struggling, need someone to listen, talk to and be heard or any other form of additional support please reach out as Charity Smith able to provide you this support which can be provided both in-person (Berlin) and online.

No matter your reasons for choosing to have an abortion, you are entitled to your feelings afterwards and it is healthy to seek support.  

Resources:

Balance Schwangerschaftsberatung

Balance provides all services within one location (Beratungsschein, Gynecological Examination, Abortion Procdure, and follow up). They are super supportive throughout the process.

Balance Schwangerschaftsberatung website

Pro Familia 

German Family planning, sex education and sexual counseling and advice service.

Pro Familia website

Further information

Information from the Berlin Senate can be found at Schwangerschaftskonfliktberatung (Pregnancy conflict counseling).

Legal information  from the Bundesministerium für Familie, Senioren, Frauen und Jugend, Schwangerschaftsberatung § 218 (Pregnancy counseling § 218)

Podcast

Amanda Palmer on Abortion

Online Access to Abortion

Do you live in a region of the world where you are not able to access abortion? Here are resources for you, they provide access to medical prodecures for abortion via mail. 

Organizations to avoid

Warning – Research Your Care Provider Before Contacting Them! 

Avoid Pro Femina, a Berlin-based organization which claims to support individuals seeking abortion but has been accused of pressuring individuals into keeping unwanted pregnancies.

More information can be found in the article Berlin: Jusos wollen Pro Femina verbieten by Die Tagespost.