Unintentionally pregnant – the statistics
For many – sometimes very young – women it is not a pleasant surprise when the pregnancy test is positive. Quite a few decide against carrying the child to term. According to the Federal Statistical Office, around 100,000 pregnant women chose abortion in 2020. This represents a slight decrease (of about 0.9 percent) compared to the previous year.
Abortion – a difficult decision
The decision to have an abortion is not an easy one. In addition to medical aspects, personal, ethical and legal issues are also important. Abortions are the subject of sometimes heated social and political debate, because the woman’s freedom of choice is at odds with the protection of the unborn child.
Abortion in Germany: Legal situation
According to Section 218 of the German Criminal Code (StGB), an abortion is in principle illegal and punishable, but remains exempt from punishment under certain conditions on the basis of the so-called counseling regulation. It is also possible to terminate a pregnancy on the basis of a medical or criminological indication – it is then not illegal.
Counseling regulation
The counseling regulation provides that an abortion remains unpunished if the following conditions are met:
- The pregnant woman herself must request the abortion (not, for example, the woman’s father or the father of the child).
- The woman must seek counseling at a state-approved counseling center, at least three days before the procedure (pregnancy conflict counseling).
- The consultation must not be performed by the same physician who then performs the abortion.
Procedure of the pregnancy conflict counseling
If you wish to have an abortion (whether medically with the abortion pill or surgically by means of suction), you must first seek counseling at a state-recognized office, for example at “Pro Familia”. Contact information for recognized counseling centers in your area can be found here.
Pregnancy conflict counseling can be conducted anonymously at your request. The counselor must keep the discussion open-ended – in other words, he or she must not influence your decision for or against the unborn child. In addition, the counselor is bound by professional secrecy.
Sometimes, at the end of the consultation, the counselor recommends that a pregnant woman make another appointment before issuing her with a consultation certificate. However, he or she may only do this if there is still enough time afterwards to terminate the pregnancy within the legally permitted period (12 weeks after conception), if the woman wishes to do so.
Medical or criminological indication
Medical indication
An abortion is not unlawful if the pregnant woman’s life is in danger or there is a risk of serious impairment of her physical or mental health and this danger cannot be averted in any other way that is reasonable for the woman.
- The physician may not issue the medical indication immediately upon informing the woman of the diagnosis, but no earlier than three full days thereafter – unless the life of the pregnant woman is in immediate danger.
- Prior to issuance, the physician must inform the woman about the medical aspects of abortion and about the possibility of psychosocial counseling. The doctor must provide the woman with contacts to counseling centers at her request.
Criminological indication
An abortion is not illegal even if, according to a doctor’s assessment, the pregnancy resulted from a sexual offense (rape, sexual abuse). A criminological indication always applies to all girls who become pregnant before reaching the age of 14.
Abortion: Until when possible?
If a woman is unintentionally pregnant, the following time periods apply for a penalty-free abortion in Germany:
- Abortion according to the consultation regulation: No more than twelve weeks may have passed since conception. This corresponds to the 14th week of pregnancy if calculated from the first day of the last menstrual period. The abortion may not be performed by the same doctor with whom the woman has been for pregnancy counseling.
- Abortion for criminological indication: No more than twelve weeks may have passed since conception. The abortion may not be performed by the physician who certified the criminological indication.
Surgical or medication abortion
Medicinal abortion
In Germany, medication abortion with the active ingredient mifepristone (abortion pill) is permitted up to the 63rd day after the first day of the last menstrual period. It can be performed earlier than a surgical abortion.
Mifepristone inhibits the action of the hormone progesterone, which, among other things, ensures the maintenance of pregnancy. In addition, the active substance softens and opens the cervix.
In about 95 percent of the women treated, the medication abortion fulfills its purpose. However, if the pregnancy continues after medication, no miscarriage has occurred or heavy bleeding occurs, medication may need to be administered again or surgery (aspiration – see below: “Surgical termination of pregnancy”) may be necessary.
Surgical termination of pregnancy
In the past, surgical abortion was usually performed by means of curettage – that is, with a spoonlike instrument with which the doctor scraped out the uterine cavity. However, the risk of complications is higher than with suction. For this reason, scraping is no longer recommended today.
Possible complications of abortion
The latter can also happen in the case of a medication abortion – if the woman does not show up for the medical follow-up, which is scheduled about 14 to 21 days after the medication abortion. At this appointment, the doctor checks not only whether the pregnancy was terminated as planned, but also whether the body has completely eliminated the pregnancy tissue.
The following applies to both surgical and medication abortion: If the abortion proceeds without complications, it usually has no effect on the woman’s fertility and a possible subsequent pregnancy.
Psychological consequences after the abortion?
After the difficult decision often outweighs the relief
Exceptional situation of the soul
Despite everything, an abortion can be an exceptional situation of the soul. Under certain circumstances, psychological complaints can occur immediately after the abortion. In many cases, however, this is due more to other stressful life circumstances (poverty, experiences of violence, previous mental illness) than to the abortion itself.
The hormonal changes in the body can also have a short-term effect on the soul. Occasionally, there is talk of the so-called “post abortion syndrome” (PAS). The term stands for the psychological consequences of an abortion. However, studies have so far failed to provide clear evidence of PAS.
Abortion: Costs
Socially needy women may be entitled to have their costs covered: the federal state in which they live will pay for the abortion and any necessary medical follow-up treatment in certain cases. The application for this must be submitted in advance to the woman’s own health insurance company (including proof of income situation).
In case of an abortion according to medical or criminological indication, the statutory health insurances cover the entire costs. Private health insurances, on the other hand, usually only pay for an abortion according to medical indication. A possible reimbursement of costs for abortion according to criminological indication must be clarified in each individual case with the patient’s own private health insurance.
