{"id":2435,"date":"2025-09-17T10:09:35","date_gmt":"2025-09-17T10:09:35","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjsrh\/?p=2435"},"modified":"2025-09-23T08:46:18","modified_gmt":"2025-09-23T08:46:18","slug":"abortion-germany","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjsrh\/2025\/09\/17\/abortion-germany\/","title":{"rendered":"Criminalised, Stigmatised, and Underprovided: Why Germany\u2019s Abortion Law Fails both Patients and Providers"},"content":{"rendered":"<p style=\"text-align: right\"><em><strong>By Amelie Kolandt, Susanne Michl &amp; Mirjam Faissner<\/strong><\/em><\/p>\n<p><span style=\"font-weight: 400\">In Germany, access to abortion remains legally restricted and structurally constrained. Our recent qualitative study \u201c<\/span><a href=\"https:\/\/srh.bmj.com\/content\/early\/2025\/08\/26\/bmjsrh-2025-202798.full\"><span style=\"font-weight: 400\">Understanding structural barriers to abortion care under the counselling regulation in Germany<\/span><\/a><span style=\"font-weight: 400\">\u201d, published in <\/span><i><span style=\"font-weight: 400\">BMJ Sexual and Reproductive Health<\/span><\/i><span style=\"font-weight: 400\">, highlights how criminalisation, stigma, and a lack of training undermine equitable, patient-centred abortion care in Germany \u2013 and why legal reform is urgently needed.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Abortions in Germany: a grey area\u00a0\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Abortion in Germany is <\/span><a href=\"https:\/\/www.gesetze-im-internet.de\/stgb\/__218.html\"><span style=\"font-weight: 400\">generally illegal under \u00a7218 of the Criminal Code<\/span><\/a><span style=\"font-weight: 400\">. The \u201ccounselling regulation\u201d outlines criteria under which abortion remains exempt from punishment up to the 14<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\"> week of gestation: the <\/span><a href=\"https:\/\/www.gesetze-im-internet.de\/stgb\/__218a.html\"><span style=\"font-weight: 400\">person requesting the abortion must seek mandatory counselling<\/span><\/a><span style=\"font-weight: 400\"> at a state-certified counselling centre at least three days before the abortion is carried out. If these conditions are met, performing an abortion is legal for the physician \u2013 but receiving the <\/span><a href=\"https:\/\/www.bundestag.de\/resource\/blob\/541290\/4654eee8823c4fd7efb68cc1d85b1954\/WD-7-161-17-pdf.pdf\"><span style=\"font-weight: 400\">abortion remains illegal for the patient<\/span><\/a><span style=\"font-weight: 400\">. The German State considers abortions on demand <\/span><a href=\"https:\/\/www.bundestag.de\/resource\/blob\/541290\/4654eee8823c4fd7efb68cc1d85b1954\/WD-7-161-17-pdf.pdf\"><span style=\"font-weight: 400\">\u201emorally reprehensible\u201c<\/span><\/a><span style=\"font-weight: 400\"> but refrains from prosecuting abortion seekers. This creates a unique and contradictory framework within German law.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Our study shows that even though abortion is in principle accessible, the criminalisation of abortion leads to profound structural barriers in practice.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>What providers told us<\/b><\/p>\n<p><span style=\"font-weight: 400\">We interviewed 42 abortion providers and counsellors across Germany. They reported a stark shortage of professionals willing to provide abortion services, especially in rural areas and in the Southern part of Germany. Legal uncertainty and stigmatisation deter new doctors from entering the field. \u201cWe <\/span><i><span style=\"font-weight: 400\">urgently<\/span><\/i><span style=\"font-weight: 400\"> need gynaecologists who perform abortions\u2014many of them\u2014and they need to be well-distributed\u201d, one counsellor told us.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Access is fragmented and inequitable<\/b><\/p>\n<p><span style=\"font-weight: 400\">Due to the provider shortage, patients often have to travel long distances and face long waiting times to access abortion care. This particularly affects people with limited resources, those who have care responsibilities or face language barriers. In border regions, some travel to the Netherlands or Austria, where the legal regulation of abortion is less restrictive \u2013 not out of preference, but necessity.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Medication abortion: blocked by law and training gaps<\/b><\/p>\n<p><span style=\"font-weight: 400\">Although medication abortion is internationally recognised as safe and effective, <\/span><a href=\"https:\/\/www.destatis.de\/DE\/Themen\/Gesellschaft-Umwelt\/Gesundheit\/Schwangerschaftsabbrueche\/_inhalt.html#235870\"><span style=\"font-weight: 400\">its use remains limited in Germany<\/span><\/a><span style=\"font-weight: 400\">. Legal constraints such as restrictions of the distribution of abortion medication regulated in <\/span><a href=\"https:\/\/www.gesetze-im-internet.de\/stgb\/__219b.html\"><span style=\"font-weight: 400\">\u00a7219b Criminal Code<\/span><\/a><span style=\"font-weight: 400\"> and inadequate training opportunities keep it out of reach for many patients. Only one of the 42 experts we interviewed reported routine access to home\u2013use or telemedical abortion options.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Stigmatisation as a recurrent theme<\/b><\/p>\n<p><span style=\"font-weight: 400\">The stigmatisation of abortion emerged as a highly relevant issue in most interviews. Patients fear judgement \u2013 not only from their social environment, but also from healthcare professionals. Some providers were reported to stigmatise abortion by refusing to provide treatment altogether. Meanwhile, doctors who offer abortion care face harassment, social ostracisation, or even death threats. Stigma, our interviewees emphasised, is built into the legal framework and reinforced by public discourse.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Undermining quality and patient-centred care<\/b><\/p>\n<p><span style=\"font-weight: 400\">The criminalised status of abortion affects not only access but also the quality of training and care. Abortion methods are rarely taught in medical school and are no obligatory part of obstetric training. Our interviewees stressed that surgical abortions remain the norm in Germany, despite evidence supporting the efficacy and safety of medication abortion. Moreover, Dilatation &amp; Curettage still is commonly used despite international guidelines recommending vacuum aspiration. Limited provider availability also means patients may not be able to choose their provider\u2019s gender \u2013 a critical issue for those with histories of trauma.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>What needs to change?<\/b><\/p>\n<p><span style=\"font-weight: 400\">Our findings strongly support the <\/span><a href=\"https:\/\/www.bmfsfj.de\/bmfsfj\/aktuelles\/presse\/pressemitteilungen\/kommission-zur-reproduktiven-selbstbestimmung-und-fortpflanzungsmedizin-legt-abschlussbericht-vor-238414\"><span style=\"font-weight: 400\">recommendation by the German government\u2019s expert commission<\/span><\/a><span style=\"font-weight: 400\">: abortion can and should be regulated outside of the Criminal Code. Only this would remove one of the structural foundations of abortion stigma and allow for a patient-centred, human rights-oriented approach to abortion care. Legal reform must be accompanied by improved training, better access to medication abortion, and the provision of funding for structures that ensure equitable and inclusive abortion care.<\/span><\/p>\n<p><span style=\"font-weight: 400\"><br \/>\n<\/span><b>Conclusion<\/b><\/p>\n<p><span style=\"font-weight: 400\">Abortion is an essential healthcare service. In Germany, however, it is still criminalised which supports to ongoing stigmatisation of both patients and providers. Structural change is possible, but it will require the political will to finally treat abortion care as what it is: a fundamental part of reproductive health and rights.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>About the authors<\/b><\/p>\n<p><span style=\"font-weight: 400\">Amelie Kolandt is a researcher at the Institute of the History of Medicine and Ethics in Medicine, Charit\u00e9 \u2013 University Medicine Berlin. Her research focuses on abortion care and stigma.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Prof. Dr. Susanne Michl is a professor of ethics in medicine at the Institute of the History of Medicine and Ethics in Medicine, Charit\u00e9 \u2013 University Medicine Berlin, with expertise in health justice and bioethics.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Dr. Mirjam Faissner is a senior researcher in ethics at the Institute of the History of Medicine and Ethics in Medicine, Charit\u00e9 \u2013 University Medicine Berlin, focusing on structural discrimination in healthcare systems.<\/span><\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Amelie Kolandt, Susanne Michl &amp; Mirjam Faissner In Germany, access to abortion remains legally restricted and structurally constrained. Our recent qualitative study \u201cUnderstanding structural barriers to abortion care under the counselling regulation in Germany\u201d, published in BMJ Sexual and Reproductive Health, highlights how criminalisation, stigma, and a lack of training undermine equitable, patient-centred abortion [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2025\/09\/17\/abortion-germany\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":472,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[599],"tags":[],"class_list":["post-2435","post","type-post","status-publish","format-standard","hentry","category-screening"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Criminalised, Stigmatised, and Underprovided: Why Germany\u2019s Abortion Law Fails both Patients and Providers - BMJ Sexual &amp; Reproductive Health blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2025\/09\/17\/abortion-germany\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Criminalised, Stigmatised, and Underprovided: Why Germany\u2019s Abortion Law Fails both Patients and Providers - BMJ Sexual &amp; Reproductive Health blog\" \/>\n<meta property=\"og:description\" content=\"By Amelie Kolandt, Susanne Michl &amp; Mirjam Faissner In Germany, access to abortion remains legally restricted and structurally constrained. 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