Before an abortion

In Germany, women must have counseling before they have an abortion. This counseling takes place in a government-approved center known as a "Schwangerschaftskonflikt-Beratungsstelle." The law states that the counseling must be neutral regarding the outcome. The center will give you a document (called a “Beratungsschein”) to prove that you’ve had counseling. You have to show this to the doctor that carries out the abortion. This regulation is referred to as the "Beratungsregelung," or “counseling requirement.”

Some doctors offer this counseling too and you can get the document from them. But they’re not allowed to carry out an abortion on someone who went to them for the counseling.

The counseling appointment has to be at least three full days before the abortion takes place. If you’re on a low income, you can apply to have the costs of the abortion covered. It is important to make sure your health insurer receives and approves your application before you have the abortion. You will usually hear back from them very quickly.

Many women realize they’re pregnant pretty soon after they’ve missed a period (roughly in the 3^rd week after they become pregnant). If that happens, you still have a number of weeks if you’re thinking about ending the pregnancy. If you're not sure what you want to do, it's a good idea to contact a counseling provider as soon as possible. It might also take some time to find a doctor, clinic or hospital that will carry out the abortion. And there are fewer risks if the abortion is done early on.

You can do a store-bought pregnancy test at home. Women whose test result is positive often make an appointment with their gynecologist afterwards. The gynecologist usually does an ultrasound scan. They’ll be able to see the embryo if you’re more than 5 weeks pregnant.

To work out how many weeks pregnant you are, you will typically be asked when your last period started. In most cases, you will also have an ultrasound scan to measure the embryo – for example, if your periods are very irregular or you’re not sure when your last one started.

The goal of unplanned pregnancy counseling (Schwangerschaftskonflikt-Beratung) is to help you decide whether or not to continue the pregnancy. You can tell the counselor why you feel an abortion is or isn’t a good option for you, but you don’t have to.

If you wish, the counselor can give you advice on how to continue the pregnancy and how to prepare for life with a child. This includes information on financial support and childcare. You can discuss why you think it would be difficult for you to have the child, and talk to the counselor about possible solutions. Counseling centers can also provide information on the possibility of giving the child up for adoption or giving birth in secret (a "confidential birth").

If you like, you will be given information about where you can have an abortion and which approaches the different providers offer.

The law states that the counseling must be neutral regarding the outcome. It should encourage the woman to continue the pregnancy. But she mustn’t feel pressured into a certain decision or like she has to justify herself. Whether she keeps the baby or not is her decision alone. No matter what she decides after the appointment, she must be given the document (Beratungsschein) that proves the counseling took place.

Yes. You can also have more than one counseling session. Your partner can attend as well, if you want, or they can make their own appointment. You can bring a close friend or relative too, like your mother.

The counselors aren't allowed to tell anyone else about what you discuss. The counseling can be done anonymously if you wish. Then someone else from the counseling center will issue the document you have to show before you have the abortion.

The center keeps an anonymous record of certain details like age, ethnic background and reasons for the abortion. This information is only used for reporting to the local authorities.

No. Centers run by Caritas or the Sozialdienst katholischer Frauen (Catholic women’s welfare service), for instance, offer counseling but they don’t provide the required document. It is also important to be aware that only government-approved counseling providers are allowed to issue these documents.

The Federal Centre for Health Education (BZgA) has a list of government-approved counseling centers on its website. If you select the “Counselling certificate (Beratungsschein)" box, the list will only show centers that issue this document.

Many women who go to the counseling appointment are already sure they want to end the pregnancy. But some find it harder to decide – either because they’re unsure themselves or because, for example, their partner or family don’t want the same thing as they do.

The counselors are very experienced in dealing with situations like this. They can tell you about ways to help you make a decision that’s right for you. If necessary, they can arrange for you to get further help too.

Some useful things to remember:

• Don’t be pushed into a decision. Make use of the time you have to work through your thoughts and feelings.
• Talk to people close to you and to the professional counselors.
• Work out what potential solutions there are for different problems. These could be things like financial worries, lack of living space, or childcare.
• If you have any questions about how an abortion would be carried out, ask at the counseling center or your doctor's practice.

You don’t have to tell anyone else that you’re pregnant and thinking about having an abortion. But many women do turn to their family or good friends for support.

The first place people contact to find this out is often their gynecologist or, sometimes, their family doctor. If these doctors don’t carry out abortions themselves, they can tell you where to find someone who does. The counseling centers usually have lists of local doctors, clinics and hospitals that perform abortions.

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

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

You will find a list of doctors and clinics 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 given voluntarily. A lot of doctors only offer abortions for their own patients or don’t openly provide any information on this service.

There are two different approaches:

• Medication abortion ("Abortion pill"): This involves using two drugs with a gap of 24 to 48 hours between them. They trigger bleeding in the womb to end the pregnancy. In Germany, these drugs are approved for use up until the 7^th week (63^rd day) after the pregnancy starts – in other words, up until the 9th 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 you can have a surgical procedure 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, the procedure can be repeated.

Most medication abortions and surgical abortions don't lead to any complications.

Some doctors perform a procedure that involves scraping out the lining of the womb with a scoop-like instrument called a curette (curettage or "D&C"). But this is considered higher-risk than the suction approach, so it’s no longer recommended in the German medical guidelines.

Not every doctor or clinic offers both approaches, though. Sometimes you have to contact several providers to get the type of abortion you would prefer.

Yes, if the abortion falls under the counseling requirement – unless you earn less than 1,446 euros net per month (correct as at July 1, 2024) or claim welfare benefits. Then the federal state pays. If there are children living in your home or your monthly rent is more than 424 euros (correct as at July 1, 2024), the state will cover the costs at a higher income threshold. Your partner’s income isn’t taken into consideration. Information on the current income thresholds is available (in German) from the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth.

To have the costs of the abortion covered by your public (statutory) health insurer, you have to submit the application to the insurer and have it approved by them before the abortion is carried out. When you apply, you have to state how much you earn but the insurer isn’t allowed to ask for proof. Women who are insured privately or do not have health insurance can contact any local public health insurer. The abortion provider will first have to see the document confirming that the costs will be covered.

Abortions cost about 350 to 650 euros. The actual figure depends on things like whether you have it done as an inpatient or an outpatient and the region of Germany where it’s carried out. Medication abortions usually cost less than surgical abortions.

The health insurer or – in the case of people without health insurance – the social welfare office (“Sozialamt”) pays for the talk with the doctor before the abortion, examinations and additional medication before and after the abortion, and treatment for any complications.