Abortion in Germany

In Germany, there are three situations in which abortion is legal:

• If it is carried out no later than 12 weeks after the pregnancy started (the end of the 14^th week of pregnancy) in accordance with the counseling requirement (Beratungsregelung). This means that you must attend a special counseling appointment at a government-approved unplanned pregnancy counseling center (Schwangerschaftskonflikt-Beratungsstelle) at least three days before the abortion. You also need a document from the center to prove you’ve had the counseling. If you’re on a low income, you can apply to your health insurer to have the cost of the abortion covered. Otherwise, you have to pay for the abortion yourself. Medical examinations before and after the abortion are paid for by your health insurer.
• If there is a medical reason for the abortion: This is when the pregnancy would harm your physical or mental health and there is no other way to prevent that harm. One example could be the result of a test during pregnancy (prenatal test). The doctor then has to establish that your physical or mental health is at risk and advise you on what the abortion involves, the associated risks and possible effects. There are no time limits for these types of abortions. Public health insurers cover the costs.
• If the pregnancy was caused by a crime: If there is good reason to believe that the pregnancy is a result of rape or sexual abuse, it can be terminated within the first 12 weeks of becoming pregnant. A doctor must establish if this is the case and advise you on what the abortion involves, the associated risks and possible effects. Public health insurers cover the costs.

These rules are set out in sections 218 to 219 of Germany’s Criminal Code (StGB). The Act on Assistance to Avoid and Cope with Conflicts in Pregnancy (Schwangerschaftskonfliktgesetz) lays down the rules for the counseling and other aspects.

It is completely up to the woman whether she has an abortion or keeps the baby. Her partner has no legal right to a say in the matter. No woman may be forced to have an abortion.

The two main approaches used to terminate pregnancy are:

• Medication abortion ("abortion pill"): This involves using two medications with a gap of 24 to 48 hours between them. They trigger bleeding in the womb, which terminates the pregnancy. In Germany, these medications are approved for use up until the 7^th week (63^rd day) after the start of pregnancy – in other words, up until the 9^th week of pregnancy. Medication abortion fails to work in 10 out of 1,000 women. If this happens, the pills can be taken again or a surgical procedure can be carried out to end the pregnancy.
• Surgical abortion with suction (vacuum aspiration): Here the doctor inserts a plastic or metal tube into your womb. The tube is connected to a suction device, which is then used to remove the lining of the womb and the embryo. The procedure is usually done under a short-acting general anesthetic or, less often, using a local anesthetic. Surgical abortion fails to work in 2 out of 1,000 women. If this happens, it can be repeated.

Most medication abortions and surgical abortions don't lead to complications like an infection or heavy bleeding.

Some doctors perform a procedure that involves scraping out the lining of the womb with a scoop-like instrument called a curette. This approach is called “dilation and curettage” or “D&C.” German medical guidelines no longer recommend D&C because it is considered to be higher-risk than the suction method.

Most abortions are carried out in doctors’ practices or outpatient clinics. Not all hospitals perform abortions – and some only provide them if the abortion is for medical reasons or the pregnancy is the result of a crime.

There are some cities and regions where it’s difficult to find an abortion provider. Some areas don’t have (enough) doctors who carry out abortions. And not every provider offers the whole range of approaches.

If you would like to find out where abortions are possible and what approaches are offered there, you can contact a pregnancy counseling center or gynecology practice, for example.

You will find a list of doctors, clinics and hospitals that perform abortions on the websites of the Federal Centre for Health Education (BZgA) and the German Medical Association (Bundesärztekammer). But the list doesn’t include all providers because it’s based on information that is given voluntarily. Many doctors only perform abortions for their own patients or don’t openly provide any information on this service.

Women can expect some vaginal bleeding in the first few days after the abortion. Pain (similar to period pain) is also common, but painkillers help here. Both the bleeding and the pain stop after 1 to 2 weeks. Abortions don’t usually cause complications like an infection in the womb. Rest is recommended for the first few days. You can get a sick note from the doctor for a few days. But if you feel ok, you can do whatever you want.

It is possible to become pregnant again after just a few days. So it’s important to sort out contraception quickly.

You don’t usually need a check-up after a surgical abortion. After a medication abortion, you’ll need to make sure that the pregnancy actually has been terminated. You can do this by having an ultrasound scan at the doctor's practice or doing a special urine-based pregnancy test at home. If you have any problems, you can contact your abortion provider at any time. If you’re finding it hard to cope mentally, counseling centers can help.

If you would like more information or advice, you can go to your gynecologist, family doctor or a government-approved counseling center (Beratungsstelle). They provide advice for all women, especially those who aren't sure what to do. They will also help you to find other assistance if you need it. They can let you know where you can have an abortion, what time limits apply and what documents you will need too.

Approved counseling centers also provide the unplanned pregnancy counseling that is required by law. They will give you a document to prove you’ve talked to them (Beratungsschein). You will have to show this document to the doctor who does the abortion.

The German Society for Family Planning, Sexual Education and Sexual Counselling (pro familia) provides information about abortion on its website profamilia.de.

General information on pregnancy and fertility programs is also available from the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ).