Why German medicine is relearning abortions | World

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THE legal abortion has been available to women across Germany since the 1970s, but the number of doctors performing the procedure is decreasing. But there are students and young doctors who want to fill that gap.

The woman at the family planning clinic looked at Teresa Bauer and her friend sternly. “And what are you studying?” she asked her friend, who had just found out she was pregnant, and wanted to have an abortion.

“Cultural studies,” she replied.

“Ahhh, so you are living a colorful lifestyle?” Replied the woman.

Bauer was quiet, hiding his anger.

Stressed by the discovery of an accidental pregnancy, Bauer’s friend asked her to make the necessary appointments to organize an abortion.

It wasn’t just the case of calling her friend’s GP to make an appointment for the procedure.

First, she needed to make an appointment for counseling, which was designed to “protect unborn life”, as German law says, and discourage women from going on. Some of the clinics providing the service are run by churches – Bauer was careful to avoid them, fearing criticism.

‘I thought it would be easier’

Abortion classes use tropical fruits such as papaya – Photo: BBC

Next, she needed to find a doctor who would prescribe pills for an early medical abortion. Last year, the law allowed doctors to disclose that they work with abortions, but they cannot indicate the types of services they offer, so Bauer had to call the offices one by one.

“Berlin is a liberal city, so I thought it would be easier than it was,” she says.

“Even when we went to get the pill, the doctor’s assistant kept asking, ‘Are you sure?’ Seeing what my friend had to go through and how she was treated made me so angry that I decided to do something about it. ”

Bauer was a third-year medical student at the time, so a few days later she emailed Medical Students for Choice Berlin, run by students at her university, saying that I wanted to start volunteering.

She now works with them, campaigning to improve abortion training for medical students and raising awareness of the obstacles that people seeking abortion may face.

Although Germany is considered a liberal country, its reproductive laws are surprisingly restrictive. Abortion is not really legal – it is only decriminalized until the 12th week after conception, as long as the woman has undergone a counseling session, followed by a three-day waiting period.

For this reason, abortion techniques are not taught in medical schools and, therefore, there is a shortage of doctors performing the procedure.

In some parts of Germany, women need to travel long distances to reach an abortion clinic. In 2018, more than 1,000 of them traveled to the Netherlands, where the process is simpler and the right extends to 22 weeks of gestation.

Some doctors also travel from Belgium and the Netherlands to perform abortions in cities in northern Germany, such as Bremen and Münster.

German penal code

  • Section 218 declares abortion illegal:
  • 218a predicts “liability exception” for abortions performed in the first trimester of pregnancy, or later in cases of medical need – subject to advice and waiting three days
  • 219a prohibits advertising of abortion services, although since 2019 it is possible for doctors to disclose the fact that they have an abortion, as long as they don’t give more details

Medical Students for Choice Berlin is trying to resolve the difficulties faced by women seeking an abortion. They do this through papaya workshops – the procedure is tested on tropical fruits.

The size of the fruit is a useful substitute for the human uterus, and its seeds are aspirated to demonstrate how the fetus can be removed. The idea is to put students in contact with the topic and encourage them to seek specialized training after graduation.

The group was founded in 2015 by Alicia Baier, who claims to have only known of the difficulties faced by women who seek abortion by chance, at a congress during their fourth year of medicine.

“It is a taboo subject and nobody talks about it, so most people don’t know about access problems until they need an abortion themselves,” she says.

She then discovered that most of the doctors who perform abortions in Germany are 60 and 70 years old and are expected to retire soon. “They are the generation that has experienced previous struggles for women’s rights,” she says. “They became politicized. But the younger generations never learned how to do that.”

Baier contacted an American group called Medical Students for Choice, who explained that papaya can be used in demonstrations of the procedure. “They even posted the tools for us to use,” she adds. A speaker then put her in touch with some gynecologists who could host the workshops. “They said to me, ‘We have waited so long for students like you!'”

In Lower Bavaria, a region with a population of 1.2 million on the border with Austria and the Czech Republic, the last gynecologist who had abortions gave up retirement five years ago, as no other doctor in the 80% Catholic region agreed to replace it. But Michael Spandau, 72, stopped working again in March because his age put him at risk during the covid-19 outbreak.

“Women have to travel to Munich or Regensburg, 130 km away,” said Thoralf Fricke, of the local branch of the family planning charity Pro Familia, located in the center of Passau. “If you don’t have a car, you need to travel by train. This is expensive. If you live in the countryside, it takes three hours for each trip. And it’s a risk to your health. This operation is not like taking a tooth. You can have complications like blood pressure problems, “explains Fricke.

Difficulty in rural areas

There is also a large population of refugee women in the region, who often stay in rural areas while waiting for their asylum applications to be approved. In general, they do not have support networks that can help them find overnight accommodation when traveling to have an abortion.

Rose, who is from Nigeria and lives 40 minutes by bus from Passau, needed an abortion in December last year. “My daughter is six months old and I said to my boyfriend, ‘I can’t take another child anytime soon,'” she says.

After the procedure, she managed to spend the night at the home of a pro-choice activist, Lea. “I was feeling really dizzy afterwards,” she recalls. “I was very lucky to be with Lea because she supported me while I walked. If I had to take the bus, I might have passed out.”

The German Association of Gynecologists told the BBC: “In Germany, it is the responsibility of the federal states to provide sufficient advice and assistance to pregnant women in crisis situations. The law states that no one is required to participate in an abortion. The only exception is when mother’s life is threatened. ”

“Gynecologists and medical staff are free to decide, following their religion and ethics, whether they want to perform or deny abortion. No one should be forced. In regions where Catholicism is prevalent, there are fewer doctors and nurses. So, women must take the longest distances into account. ”

The Passau hospital said the city government decided in 2007 that abortions would only be performed at the hospital in an emergency.

The right to abortion has a long and complex history in Germany. In the Nazi era, having an abortion on a white German woman was a capital crime, unless the fetus was deformed. In contrast, women from other ethnic groups were encouraged to have an abortion. Years later, communist East Germany had more liberal laws, but the West’s more conservative stance became standard after reunification in 1990.

The law banning service advertising, 219a, was created in the Nazi era. It was recently used by anti-abortion activists to file lawsuits against doctors across the country.

Thoralf Fricke says there has been an increase in the occurrence of hatred in the past two years, with activists sending death threats and fetus dolls to him. Before the pandemic, protesters stayed outside the Pro Família clinic, where women seek counseling before abortion.

But the pro-choice movement is also getting stronger. As a result of the Medical Students for Choice campaign, the Charité university hospital in Berlin last year included abortion in its curriculum for the first time, as did the University of Münster. If quarantine permits, the group plans to hold a training weekend with medical students from across the country in Berlin in the coming months.

Alicia Baier has now completed her studies and is training at a doctor’s office that offers abortions. Here, she sees firsthand how the lack of access affects women. “A doctor made a woman wait unnecessarily an extra week, which pushed her over the limit for an abortion with pills,” she explains. After nine weeks, the only option is surgical abortion using the vacuum technique.

Baier also contacted a 19-year-old girl who suffered serious consequences. She had tried to have an abortion at home for lack of information on where to get a safe procedure. Her uterus had to be removed.

While more medical students are learning the procedure, says Baier, their age means that there will still be a gap in services in the near future.

“It will be several years before we are able to execute our own practices,” she says. “And before that, with the retirement of current doctors, we will have major problems.”

“Some women did not attend the consultations,” he says. “We think they were bullied.”

For a few weeks each month, Lucie seemed to become a different person – someone who suffered from countless mental and physical problems – and she couldn’t understand why. She spent years looking for a doctor who could give her an answer, and it took a hysterectomy at age 28 to cure her.

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