Jasmin Schreiber isn’t a doctor. Yet, you’ll find more information about abortion on her website than that of just about any medical professional in Germany.
That isn’t because German doctors are particularly adverse to informing their patients about abortion, but rather because of Section 219a, a Nazi-era law that prohibits doctors from ‘advertising’ abortions. In practice, this means that doctors in Germany providing any information online about abortion beyond the fact that they offer them—including cost, available methods, and procedure—can face two years in prison or a fine. Meanwhile, anti-abortion websites that promote the widely disproven “silent scream” theory and falsely claim that medication abortions leave “the child to slowly starve in the womb” are allowed to stay online.
Last week, it was this law that was cited by a court in Frankfurt while upholding a conviction against gynecologist Kristina Hänel—a face of the pro-choice movement in Germany—for providing a PDF factsheet about abortion on her website. Citing the financial costs of potential fines, Hänel has since taken the factsheet down from her own site, but it can still be found here.
The move sparked outrage online, with some including Schreiber (herself a popular German writer) and information rights campaign group FragDenStaat posting the information to their own sites in solidarity with Hänel.
“I went into action that same evening [of Hänel’s conviction] and published the link the next day,” Schreiber wrote to Motherboard over email. “My first reaction was not shock or similar, since I have been following the case from the beginning. I would have been very surprised if anything else had come out of it, as bitter as that sounds.”
“The view that someone (cis women, but also trans men or non-binary people) would just ‘spontaneously’ or ‘just for the hell of it’ have an abortion if they were allowed access to this medical treatment and the associated information and therefore shielded from it ‘for safety's sake’ is deeply patriarchal and authoritarian,” she added.
Experts that Motherboard spoke to said that regressive laws such as Section 219a continue to keep abortion stigmatized and out of sight, hamstringing medical professionals’ ability to inform their patients and, in the process, creating an information asymmetry capitalized on by conservative anti-abortion groups. Because of this, Germany faces an ever increasing shortage of doctors offering the procedure, causing long waiting times and leaving rural areas of the country critically underserved.
They described the situation as a “catastrophe.”
It is exactly this information asymmetry that Merle (who asked that Motherboard not use her real name) ran into when she unexpectedly found out she was pregnant in 2011. A 23-year-old emigrant from Eastern Europe living in Hesse—a state in central Germany—at the time, the idea of having an abortion was still something shrouded in stigma and shame, but she began looking for factual information about the procedure online anyways.
What she found instead was pictures of bloody fetuses and other anti-abortion propaganda.
“All you read is that you are going to suffer horrible pains, a mental illness, you might even get cancer,” Merle wrote to Motherboard over instant messages. “This was stressful, because I still believed in the horrible pains and suffering so the anxiety was building up.”
“There was no transparency at all and you can’t make an informed decision,” she added.
Despite the lack of credible information on the web, after consulting her gynecologist in person Merle was able to make an informed choice about her pregnancy and easily terminated it without any medical complications. Her story, however, is indicative of how Section 219a continues to harm those who are often already in a vulnerable position.
Abortion is still technically illegal in Germany and is punishable with prison time up to three years or a fine. Authorities will not, however, prosecute any doctor or patient involved in an abortion if its because of sexual violence, or if the pregnancy is a threat to the patient’s life. Abortions for other reasons are permitted within the first trimester, but counseling from a state-approved organization and a three day waiting period are still mandatory.
This legal criminalization of the procedure has filtered into the wider medical system, says Alicia Baier, a physician at Family Planning Center BALANCE in Berlin and cofounder of Doctors for Choice, and even doctors themselves can lack proper knowledge about abortions. In the past, gynecologists have even had to organize separate “papaya workshops'' where interested medical students are taught the basics of vacuum aspiration (suction abortion) using papaya seeds.
“Abortion is [often] treated as an ethical topic for those studying medicine in German universities,” Baier told Motherboard over the phone. “[They often] only ever learn about the ethics of the procedure, but little to none of the actual medical aspects behind it.”
“I’ve conducted a number of interviews with medical students regarding this subject,” she continued. “What I’ve often heard in them is that the first thing many medical students associate with abortion is religion class. One student I spoke to who was specializing in gynecology said that the only time he had come into contact with the topic in an institution was religion class in high school, where they were simply shown big images of fetuses. I’ll always remember that.”
While access to factual information is a long-standing issue in Germany, increasingly access to doctors who will even perform abortions is becoming one as well. Out of the 19,000 practicing gynecologists in Germany, public broadcaster Tagesschau reported, only 327 are officially registered as performing abortions. (The number is estimated to be higher, but some doctors intentionally don’t register for fear of harassment). In the conservative state of Bavaria there are only eight officially registered practices offering abortion services—five of which are in its capital, Munich.
The result of this? A disaster, said Kersten Artus, a pro-abortion activist, journalist, and member of Pro-Choice.
“There is an acute emergency,” Artus wrote in an email to Motherboard. “Fewer and fewer doctors offer abortions, and entire cities and regions are without resident doctors to carry them out. And, because many hospitals now belong to the churches, it is even more difficult to have an abortion carried out. The consequences are long journeys and waiting times, which, given the legal situation—legal terminations are only possible up to the 12th week of pregnancy—is a catastrophe.”
While laws such as Section 219a show that social conservatism is nothing new in Germany, the growing reach of the far-right into German politics has only further empowered fundementalist groups and conservative politicians to stifle change on both the federal and local levels. In some cities, local governments have even prohibited municipal clinics from performing abortions.
With the number of doctors offering abortions having decreased by a factor of 40 percent between 2003 and 2018, even the removal of regressive regulations like Section 219a—although necessary—probably won’t be enough on its own.
That’s why feminist groups like Stimmrecht Gegen Unrecht (Right To Vote Against Injustice) continue to emphasize that the issue needs to be looked at through an intersectional lens.
Since abortion is not covered by insurance in Germany, partially because it is illegal, cost can also be a barrier, Stimmrecht Gegen Unrecht said. While one can apply for the state to cover the procedure if they earn below a certain amount, this process often requires complex paperwork that can be difficult for non-native German speakers.
They also point out that transgender or non-binary people seeking an abortion can face extra hurdles and institutionalized transphobia within the medical system.
Then there’s the social stigma surrounding the procedure. One woman who had an abortion in Southern Germany told Motherboard that the first gynecologist she visited vehemently tried to convince her not to terminate her pregnancy.
“He tried to talk me out of it,” she wrote in an email to Motherboard. “It was not his place and I wish I would have had the power to stand up for myself and told [sic] him to shut up. I actually remember exactly how he warned me that women who abort suffer from mental health problems later on and regret their decision (which is false).”
“One of the friends I told tried to influence me as well and our relationship suffered greatly from it,” she added.
It’s this same stigma, said Leoni Vollmar, a member of Stimmrecht Gegen Unrecht, that causes misinformation to be normalized.
“The stigma around abortion in Germany goes hand-in-hand with more misinformation,” she told Motherboard over Zoom. “Restrictive regulations like 219a create an information imbalance. But, one thing we are seeing is that in pop culture abortion is starting to be associated with a positive connotation and an empowering connotation. This cultural sphere is incredibly important as well and a necessary movement if we want to get over this imbalance of misinformation.”
For now, the combination between social stigma, lack of factual information, and dwindling doctors willing to perform the operation continue to make an often difficult decision even more difficult. But the people Motherboard spoke to who had gone ahead with the procedure had a message for those who might be struggling: trust yourself.
“They know better than anyone what’s good for them,” Merle wrote, “and whatever decision they make, it’s the right one.”
For those looking for factual information regarding terminating a pregnancy in Germany, Doctors for Choice has posted information about the procedure here, FragDenStaat here, and Pro Familia (pro-choice despite the name) here. A list of practitioners and clinics offering the procedure, as well as advice centers, can be found here.