abortion
and Martina Feichter, medical editor and biologist Updated onDr. rer. nat. Daniela Oesterle is a molecular biologist, human geneticist and trained medical editor. As a freelance journalist, she writes texts on health topics for experts and laypeople and edits specialist scientific articles by doctors in German and English. She is responsible for the publication of certified advanced training courses for medical professionals for a renowned publishing house.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
Abortion is the deliberate termination of a pregnancy in women who have become pregnant unintentionally. There are many things to consider before making an abortion decision: How does an abortion work? Until when can you have an abortion? How much does an abortion cost? You can read the answers to these and other questions about abortion here.
Unintentionally pregnant - the statistics
For many - sometimes very young - women, it is not a pleasant surprise when the pregnancy test turns out positive. Quite a few decide against carrying the child to term. According to the Federal Statistical Office, around 100,000 women who were unintentionally pregnant chose the option of abortion in 2020. This corresponds to a slight decrease (of approx. 0.9 percent) compared to the previous year.
About 81 percent of women had the abortion performed in a gynecologist's office. In the remaining cases, the termination took place in the hospital - mostly outpatient, rarely inpatient. Most often, the unwanted pregnancy was terminated surgically with suction (55 percent of cases).
Abortion - 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. Abortion is a hotly debated issue, both socially and politically, because here the woman's freedom of choice stands in opposition to the protection of the unborn child.
Depending on which aspect is given more weight, the legal situation with regard to an abortion is very different around the world: The spectrum ranges from very liberal to so-called deadline and remedial notification models to very strict regulations including an absolute ban on abortion. In a sense, Germany has opted for a middle ground.
Abortion in Germany: legal situation
According to Section 218 of the German Criminal Code (StGB), termination of pregnancy is fundamentally illegal and punishable, but remains unpunished on the basis of the so-called counseling regulation under certain conditions. An abortion on the basis of a medical or criminological indication is also possible - it is then not illegal.
In 2020, the vast majority of all abortions (96 percent) took place according to the counseling regulation.
Advisory regulation
The counseling regulation stipulates that an abortion remains unpunished if the following conditions are met:
- The pregnant woman herself must request the abortion (not the woman's father or the child's father).
- The woman must seek advice from a state-recognized counseling center at least three days before the operation (pregnancy conflict counseling).
- She must present a written certificate of advice (advice slip) to the doctor who will carry out the termination (medication or surgery).
- The consultation must not be carried out by the same doctor who then carries out the termination.
Process of pregnancy conflict counseling
Pregnancy conflict counseling can be carried out anonymously at the woman's request. The counselor must lead the conversation openly - so he must not influence the woman in her decision for or against the unborn child. In addition, there is a duty of confidentiality for him.
The advice slip that the counselor issues the woman at the end only states that the legally prescribed pregnancy conflict counseling was carried out - with the date and name of the woman. However, no content of the consultation is noted on the consultation slip, including the woman's decision for or against the abortion.
If at the end of the counseling appointment the counselor has the impression that the conversation with the woman concerned should be continued, he can recommend another appointment instead of issuing the counseling slip. He is only allowed to do this, however, if the woman still has enough time after the second appointment to have an abortion within the legally permitted period (12 weeks after conception) if she so wishes.
Medical or criminological indication
If there are certain medical or criminological reasons (indications), an abortion is not illegal:
Medical indication
An abortion is not unlawful if the pregnant woman is at risk of death or serious impairment of physical or mental health and this risk cannot be averted in any other way that is reasonable for the woman.
This can be the case, for example, if a doctor determines during a prenatal examination that serious damage to the child's health is to be expected and that this - if the pregnancy continues - would seriously endanger the woman physically and mentally. The doctor can then certify the woman's medical indication for an abortion in writing. Requirements for this:
- The doctor may not issue the medical indication immediately as soon as he has informed the woman of the diagnosis, but rather three full days afterwards at the earliest.
- Before the exhibition, the woman must be informed by the doctor about the medical aspects of abortion and about the possibility of psychosocial counseling. If the woman so wishes, the doctor must put him in touch with counseling centers.
- Upon receipt of the medical indication, the woman must confirm to the doctor in writing that she has received medical advice and has been informed of the possibility of advice from other agencies.
Criminological indication
An abortion is also not illegal if, according to a medical assessment, the pregnancy was the result of a sexual offense (rape, sexual abuse). A criminological indication always applies to all girls who become pregnant before the age of 14.
There is no obligation to provide advice for an abortion with a criminological indication. However, the woman / girl is entitled to advice if she / she wishes it.
Abortion: until when possible?
If a woman is unintentionally pregnant, the following time frames apply to an unpunished abortion in Germany:
- Abortion according to the counseling regulation: No more than twelve weeks must have passed since conception. This corresponds to the 14th week of pregnancy if counting from the first day of the last menstrual period. The abortion must not be carried out by the doctor whom the woman has been to for pregnancy conflict counseling.
- Abortion if medically indicated: Abortion is allowed even after the twelfth week after conception. However, it may not be carried out by the doctor who issued the medical indication.
- Abortion if indicated for criminological reasons: No more than twelve weeks must have passed since conception. The abortion may not be carried out by the doctor who issued the criminological indication.
Surgical or medical termination of pregnancy
Abortion methods are divided into medicinal and surgical. Which method is best suited in each individual case depends primarily on the age of the pregnant woman, the indication and any previous illnesses.
Drug termination of pregnancy
In Germany, medical abortion with the active ingredient mifepristone (abortion pill) is permitted up to the 63rd day after the first day of the last menstruation. It can happen sooner than an operative termination.
Mifepristone inhibits the action of the hormone progesterone, which, among other things, maintains pregnancy. The active ingredient also makes the cervix softer and opens it.
In addition, 36 to 48 hours after taking mifepristone, the woman receives so-called prostaglandins (as suppositories or tablets) under medical supervision. These hormones promote labor and trigger a miscarriage.
In about 95 percent of the women treated, the medical termination of pregnancy fulfills its purpose. However, if the pregnancy persists after the medication, no miscarriage has occurred or heavy bleeding occurs, another drug administration or surgery (suction - see below: "Surgical termination of pregnancy") may be necessary.
Surgical termination of pregnancy
The surgical abortion is performed under local anesthesia of the cervix or general anesthesia. The standard method is vacuum aspiration (suction curettage, suction): The doctor inserts a narrow tube through the vagina into the uterine cavity. The embryo and the uterine lining are then suctioned through this tube.
In the past, surgical termination of pregnancy was usually carried out by means of scraping (curettage) - that is, with a spoon-like instrument with which the doctor scraped the uterine cavity. The risk of complications is higher than with suction. Therefore, scraping is no longer recommended today.
Possible complications of abortion
Surgical termination of pregnancy is a very safe procedure that is rarely associated with complications - for example, injuries to the uterus, inflammation (e.g. of the fallopian tubes), high blood loss, incidents of anesthesia or remaining tissue in the uterus.
The latter can also happen in the event of an abortion using drugs - if the woman does not appear for the medical follow-up examination, which is scheduled around 14 to 21 days after the medical abortion. At this appointment, the doctor not only checks whether the pregnancy was terminated as planned, but also whether the body has completely excreted the pregnancy tissue.
In addition, abortion pain, nausea, vomiting and circulatory problems are possible side effects of a medicinal abortion. In rare cases, the bleeding that is expected to occur after taking the abortion pill may require medical attention.
The following applies to both surgical and medical abortion: If the abortion proceeds without complications, it normally has no effect on the woman's fertility and a possible subsequent pregnancy.
Psychological consequences after the termination?
Can a termination have emotional consequences? Abortion alone does not, at least, increase the risk of developing mental illness. Women who receive good medical and emotional care in this situation do not suffer from psychological problems more often than women who have an unwanted child. It is important to have the support of your partner or family - they can give support to the women concerned.
After the difficult decision, the relief often prevails
A few years ago, a survey by the University of California of around 700 women found that the majority of women who had decided to have an abortion rated the decision as positive in the long term. It is true that 53 percent of women stated that the decision to have an abortion was "difficult" to "very difficult" for them. Five years later, however, 95 percent said they did not regret their decision. Most found their decision a relief. Women found the stigmatization associated with abortion more stressful.
Exceptional situation of the soul
In spite of everything, an abortion can represent an exceptional mental situation. Mental health problems may occur immediately after the abortion. In many cases, however, this is more due to other stressful living conditions (poverty, experiences of violence, previous mental illnesses) than to the abortion itself.
A lack of social support from the environment, pressure from the partner and keeping the termination a secret can put a strain on mental health in this situation, even if the woman consciously decides to take this step.
The hormonal changes in the body can also have a short-term effect on the soul. Occasionally the so-called "post abortion syndrome" (PAS) is mentioned. The term stands for the psychological consequences of an abortion. So far, however, studies have not been able to provide clear evidence for the PAS.
Abortion: cost
A woman has to pay for an abortion according to the counseling regulation mostly out of her own pocket. You should expect costs of between 350 and 600 euros for an outpatient abortion - depending on the selected method (surgical or medicinal) and the type of anesthesia (a medical abortion does not require anesthesia and therefore costs less than the operative abortion). The statutory health insurances only pay for the medical advice before the procedure, the necessary preliminary and follow-up examinations and any follow-up treatment in the event of complications.
Socially needy women may be entitled to reimbursement of costs. Read more about it here.
In the event of an abortion for medical or criminological indications, the statutory health insurance companies will 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 in the event of an abortion according to criminological indication must be clarified in individual cases with your own private health insurance.
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