Demands

Problem: 

Sexual and contraceptive education in schools is often inadequate and/or one-sided. In some schools, religion classes even teach Christian fundamentalist content that focuses exclusively on abortion from a moralizing perspective. Understanding one’s own body, sexuality and contraceptive methods is however essential, especially for young people.

But there are also too few possibilities outside of traditional schooling for adequate sex education. Reliable information on the various methods of contraception is difficult to find online on the German-language websites. In gynecological consultation hours, physicians often do not have enough time to discuss the various contraceptive methods with their advantages and disadvantages in detail and in an understandable way. The topic affects countless people on a daily basis – the “pill” is the most prescribed drug among young women in Germany.

Some people are sure that they do not want to have children (anymore). Some would therefore like to choose sterilisation as a definite contraceptive method. For those under 30, especially women, it is almost impossible to find a physician, as most doctors refuse to perform the operation for that age.

On top, contraceptives are only covered by health insurance up to the age of 22. Especially for people with low income, the cost of contraception is an essential barrier to access.

Our demand: 

From our daily practice we know that a large proportion of unwanted pregnancies occur despite the use of contraceptives. Nevertheless, investing in better sexual and contraceptive education could help reduce the number of unwanted pregnancies.

Comprehensive, ideologically neutral and gender-sensitive information on sex education and contraception must be guaranteed in school. The subject of abortion should not be excluded. Here, the health of those affected should always be emphasized, not religious and moral beliefs.

Contraceptives must be covered by the health insurance regardless of age. Sterilisation as the final contraceptive method should be available for all patients – regardless of gender – who are properly informed. 

The Problem: 

Even after the abolition of § 219a StGB (so-called “ban on advertising abortions”), there is still not sufficient, medically correct and neutral information on abortion. In contrast, there are still many websites that are run by the “Anti Choice” lobby which deliberately spread misinformation and abortion myths. Since these web pages try to keep a “neutral” first appearance, it can be very difficult for patients to differentiate, which web pages to trust.

Some counseling centers that are not recognized by the state also present themselves as neutral online, but then provide “counseling” with religious-fundamentalist motivation and do not even issue the mandatory counseling certificates. Some of these counseling centers even receive money from state funds.

The online search for abortion care providers is still difficult. Even after the abolition of §219a StGB, not all doctors publish on their website that they perform abortions, because they are afraid of the defamation by anti-choice activists. The list of the ‘Bundesärztekammer’ is not a sufficient alternative because it only lists some abortion care providers in Germany, contains incomplete information and is confusing. 

On top, those websites that can be recommended are often only available in German. The lack of information therefore notably affects refugees, migrants or whose native language is not German.

Our demand: 

In accordance with the World Health Organization (WHO) and the UN Women’s Rights Convention (CEDAW) we demand that factual information on abortion must be made available to those seeking help. An easily accessible, multilingual, free information service is essential.

Deliberately misleading and false information on abortion (e.g. by anti choice activists) should be banned following the French example.

Counseling centers that are not state-approved for pregnancy conflict counseling must make this very clear on their websites and counseling sessions. The should not receive funding as pregnancy conflict counseling centers.

The Problem: 

The costs for abortions are normally not covered by health insurance. In the case of low or no income, patients are able to apply for cost coverage. This must be submitted prior to the procedure. The application procedures vary greatly depending on the federal state and health insurance company.
Overall, these rules are confusing, lead to additional bureaucratic work for pregnant people and thus to the loss of valuable time for meeting deadlines. This problem became more apparent during the Corona pandemic, where pregnant people had difficulties in obtaining coverage due to state regulations like home office and contact avoidance. Especially for socially vulnerable people, refugees or those not fluent in German, access to abortion care is made more difficult by the lack of cost coverage.

Our demand: 

Abortion should become a public health service. The costs for abortion and contraception should be covered by public health insurance. Cost coverage must be standardized and simplified. Delays caused by the current application procedure must be avoided.

The problem: 

The tabooing of abortion care remains prevalent in medical education in Germany. Although it is one of the most common gynecological procedures, it is barely discussed during medical school. It is also not a compulsory part of gynecological training. The training regulations (“Muster-Weiterbildungsordnung”) do not even mention the vacuum aspiration – the method of choice for miscarriages and abortions. Similarly, the medical method of treating miscarriages and unwanted pregnancies up to the 9th week of pregnancy is not mentioned.

11.4% of the abortions carried out in Germany in 2021 were still carried out with curettage, a method classified as outdated and unsafe by the WHO. (source: German Federal Office of Statistics) We assume that a similar proportion of miscarriages are treated with said method. In many teaching hospitals, no abortions are performed at all. We know from numerous reports from our members that miscarriages are extremely rarely treated medically, and instead rather surgically, in the hospitals. This means that early medication abortions can only be trained if residents specifically spend part of their training in a medical practice where medical abortions are performed.

However, it is not only about studying the technique. They also need to learn how to deal with unwanted pregnant people in a non-judgmental and respectful manner before, during and after the procedure. Personal role models also play a role here. Physicians who do not learn about abortion as part of their own specialty during their residency and who have never come in contact with this topic will most likely not offer this procedure later when being self-employed.

For those physicians wishing to become an abortion care provider, there is no official certified training opportunities. It is even made more difficult for physicians from other specialties (e.g. general medicine). They are often forced to travel to the Netherlands, for example, to get a certificate for this. 

Finally, there are no guidelines on abortion care that guarantee our patients’ consistent treatment according to modern standards.

Our demand: 

Medical aspects (including procedure, side effects and contraindications) of medical and surgical abortion must be taught on a theoretical level in med school. Something so vital has to be taught to every med student. There should also be sufficient room for emotional, socio-political, legal and ethical discussion in small groups during the course of study. 
Hormonal and non-hormonal contraceptive methods with their advantages and disadvantages should also be taught comprehensively in medical school. Future physicians will need this knowledge in their daily medical practice regardless of their future specialty.

Gynaecological residency training should provide practical knowledge and skills on contraception and abortion care. Vacuum aspiration and medical abortion should be explicitly listed in training regulations (“Muster-Weiterbildungsordnung”) for gynecology.
Financial incentives in hospitals could lead to more frequent use of vacuum aspiration as the surgical method of standard, for example by paying more for this method than for the curettage.
It is important that there is an in-house point of contact in each hospital who performs abortions and who is able to train residents. Medical practices and hospitals could be motivated to offer appropriate training rotations, e.g. through financial incentives.

Overall, it should be possible for physicians – regardless of their specialty – to become an abortion care provider. We therefore call for the development of training opportunities that enable physicians to perform abortions (e.g. through an additional qualification, based on the Dutch model). These should be open to all physicians, regardless of their specialty, and thus enable them to offer abortions. We have enough experience with this from other countries. Advanced training on medical abortion – especially for general practitioners – should be promoted and supported in all federal states.

The qualification of non-medical health professionals to perform abortions (task shift) is another measure recommended by the World Health Organization to counteract critical lacks of access to abortion care. In France, for example, midwives have been successfully carrying out medical abortions for years. In New Zealand, nurses and midwives are involved in care.

Evidence-based guidelines according to WHO standards on safe, professional and modern abortion methods must be established. The use of curettage should be strongly discouraged.

The problem: 

There is an acute lack of abortion care providers in many regions of Germany. The number of medical practices and clinics offering abortions has fallen by > 45% since 2003 – from 2000 to 1092 providers in the end of 2021. In many clinics, abortions are only carried out according to medical or criminological indications; however this affects only 4% of abortions. In some regions, unwanted pregnant people have to travel up to 200 km to their nearest abortion provider. Long journeys, and the additional organizational and financial costs associated with them, endanger the psychological and physical health of unwanted pregnant people. Medical procedures are unnecessarily delayed by these access barriers. Abortion is safer the earlier it is performed. 

Due to these care gaps, the pressure on the remaining abortion care providers is growing. Especially in regions where we are the only providers in a wide area, we are forced to postpone other medical treatments in favor of abortions, or to continue practicing despite retirement.

Our demand: 

For the health of our patients, a nationwide maintenance of abortion providers must be guaranteed. We need a reliable census of these current provision gaps and rapid political measures to counteract these. The implementation of the requirements mentioned under “German Criminal Code”, “Schwangerschaftskonfliktgesetz (Pregnancy Conflict Act)” and “Education” could be a first step: decriminalization of abortion, abolition of conscientious objection and an improved and broader medical training for abortion care – not only for gynecologists.

Abortion should be part of the range of health services offered by a gynecological hospital, regardless of denomination or hospital owner. At the same time, we would like to encourage our colleagues to take their responsibility seriously despite criminal intimidation. Because unwanted pregnant people depend on physicians who are willing to provide abortion care. This work should not rest on the shoulders of a few, but should be distributed more evenly among all colleagues. Midwives and nurses should be included in the care.

The possibility of telemedical abortion – an essential pillar of abortion care according to the WHO – should be promoted in Germany. Studies from other countries prove the safety and reliability of the method.

The problem: 

So-called “vigils” and demonstrations by anti-abortion activists in front of counselling centres, doctors’ practices and clinics impair the work of health care professionals. Patients seeking help feel harassed, intimidated or devalued by the demonstrators. 

Our demand: 

We demand nationwide protection zones around counseling centers, doctors’ practices and clinics so that healthcare professionals can fulfill their legal obligation to provide abortions undisturbed, and patients can seek help without harassment. Freedom of assembly and freedom of speech stop where health hazards and harassment of others begin. 

The problem: 

At the moment there is no significant medical research on abortion in Germany. This puts us far behind countries such as England, Sweden and France. As abortion is not an object of research, it is hardly discussed at specialist congresses or in training courses.

Our demand: 

Germany should no longer be at the bottom of the league concerning research in the field of reproductive health. Medical research on abortion should be increasingly promoted in Germany.