Germany′s medical system sidelines abortion | Germany| News and in-depth reporting from Berlin and beyond | DW | 11.05.2018
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Germany's medical system sidelines abortion

Abortion doctors can be hard to find in Germany. In some cities there are none, and their number appears to be declining, while medical schools often fail to teach the procedure so crucial to women. Papayas help a bit.

In papaya workshops, medical students learn to perform abortions

These Berlin medical students are learning the abortion ropes in a 'papaya workshop'

Around 101,200 abortions were performed in Germany in 2017, or 277 each day. It's not exactly a rare procedure. Which is why future doctor Alicia Baier was disturbed to find that abortion played virtually no role in her studies at Berlin's Charité university medical school.

"In six years of studies, in which we learn many details that we will not need later, we learn almost nothing about such an important intervention," she says.

Read more: Half of all abortions carried out in unsafe conditions

Indeed, abortion is important, but it's also against the law in Germany.

There are, however, exceptions: If it's a medical necessity; if the pregnancy was caused by rape; or if the woman is less than 12 weeks pregnant and has taken part in a counselling session. That doesn't mean that abortion is legal in those cases, only that neither the woman getting the abortion, nor the doctor performing it will be punished.

But it isn't necessarily easy to locate a doctor who will carry out the procedure. Part of the problem is that medical professionals are banned from "advertising" that they do abortions, which has been interpreted to mean even providing information on their websites about abortion.

Read more: German doctor fined for illegally 'advertising' abortions

States must ensure access  

Another problem is that there appear to be ever fewer practitioners, as ageing doctors retire. The actual number is elusive. The Federal Statistical Office (Destatis) says that abortions are carried out at around 1,200 facilities but can't say how many doctors provide abortions. A Destatis employee said the agency does not collect that information because it could be considered an aid. He did, however, refer DW to the website of an Austrian gynecologist, Dr. Christian Fiala, which he said gives a sense of the situation.

Dr. Christian Fiala

Women in Germany seeking an abortion are likely to come across Dr. Fiala's website

Dr. Fiala's website abtreibung.at — the German word for abortion — has become a well-known source for information in Germany. It includes a search function that allows women in numerous countries, but above all Germany, to locate the nearest abortion practitioner. It lists 1,141 doctors, clinics and hospitals here, with 111 in Berlin, all of four in Bonn – a university city of 320,000 – and none in Trier, where 110,000 people live. Trier women have to cross state lines and travel at least 45 kilometers (30 miles), to Saarland, to get an abortion.

Along with the Catholic and Protestant churches, pro familia, a German family planning NGO, offers the counselling sessions pregnant women must attend to be permitted to get an abortion without providing a reason for their choice. The apparent decline in practitioners hasn't escaped their notice, says Regine Wlassitschau, the group's press contact.

Read more: Germany's future doctors forced to seek training abroad

"Pro familia is worried about reports from numerous federal states that indicate deficits in the provision of abortion," they told DW in an e-mailed statement. "The states must fulfill their duty to ensure 'an adequate supply of ambulant and stationary facilities to conduct terminations of pregnancies' as demanded by [law]."

Women demonstrate for abortion rights in Berlin

Abortion is officially illegal in Germany

The states are also responsible individually for education, so medical school requirements differ, but when it comes to training new generations the situation is bad across the country, Wlassitschau said. If the trend continues, one day there simply won't be any more doctors who perform abortions.

Student prep

In Berlin, Alicia Baier says, abortion doesn't come up until nearly the end of one's studies, in the ninth of 12 semesters, and then only in a seminar on prenatal diagnostics.

Read more: Would you have an abortion if you knew your baby had Down syndrome?

"Terminating a pregnancy is spoken of within 10 minutes, if you're lucky," she says. "Fellow students have said it didn't come up at all, because time ran out." But the future doctors are expected to be able to discuss the legal and ethical aspects of abortion as well as be aware of the "psychological burden in the societal context." Although every woman does not feel burdened, she adds.

Three members of Medical Students for Choice pose in MSfC T-shirts

Alicia Baier (middle) and her fellow students believe abortion should be part of medical studies

In late 2015 Baier began considering starting a group to tackle the deficiency she saw in medical schools. "When I brought it up with fellow students, I often heard: 'I don't really know that much about the topic to be able to discuss it, but I don't have the impression it's a problem in Germany. Everything is surely well organized.'"

Those attitudes, which she considered dangerous, helped steel her resolve. "Those who become gynecologists will decide for themselves whether they perform terminations," she says, "and if they don't come into contact with it in their studies, don't have the feeling it is an issue, then they will possibly be more likely to say later: 'I won't offer abortions.'"

Papaya workshops

Baier and the other students who now make up Medical Students for Choice at the Charité want medical schools to teach prospective doctors to carry out abortions and for the taboo that surrounds choosing to end a pregnancy to be eliminated.

Papayas are one of their tools.

In hands-on workshops organized by MSfC, gynecologists help med students do abortions on the ersatz uteruses. They practice one of the two most common forms of terminating a pregnancy, vacuum aspiration, using suction to remove the fruits' seeds.

Two medical students practice conducting an abortion on a papaya

The workshops offer students information that doesn't come up in their seminars

"The workshop makes clear that it isn't an extreme operation, but rather a relatively small and uncomplicated 10-minute intervention," Baier says. But there's another, perhaps more important point to the exercise, she says: "It offers a platform for the students to talk with gynecologists who do abortions themselves."

Unfortunately though, it is mainly a platform for women at the moment. Few men have been involved with MSfC so far, Baier says. But that is something she would also like to see change. "Men are very welcome."

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