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HEALTH

Do Germany’s planned changes to abortion laws go far enough?

A long-awaited change to Germany’s punitive abortion laws is underway, but some believe it stops far short of what's needed. Here’s what you need to know.

Do Germany's planned changes to abortion laws go far enough?
A woman receives a consultation at a catholic pregnancy advice centre in Baden-Württemburg. Photo: picture alliance/dpa | Marijan Murat

In January this year, Germany’s traffic light coalition – made up of the Social Democrats, Free Democrats and Green party – announced its intention to undertake “the biggest reform of family law in several decades”, introducing sweeping protections for same-sex couples and non-traditional families.

Centre-stage in these reforms was a drastic overhaul of Germany’s outdated reproductive laws – stripping away a controversial clause on advertising abortion that has remained unchanged since the 1930s.

Discussing the move, Justice Minister Marco Buschmann (FDP) said the current state of abortion law in Germany created an “unacceptable situation” where doctors faced criminal proceedings for trying to help people stay informed. “That doesn’t belong in our times,” he said.

On the face of it, it seems like the long decades of feminist campaigning has paid off. But a closer look at Germany’s current abortion laws suggests that the planned reforms may only scratch the surface. 

What’s are the current abortion laws – and how will they change? 

Once of the most controversial aspects of current abortion law in Germany is Paragraph 219a, a Nazi-era clause forbidding doctors from “advertising” the availability of abortion services or sharing information on the procedure with patients. 

The government has promised to dispense with this paragraph and, earlier this year, Buschmann announced that the cabinet had agreed on a draft bill to do just that. With this initial move to allow doctors to provide information to pregnant patients, the long road to reform has already begun.

READ ALSO: Why Germany is planning to overhaul abortion information laws

However, the much-publicised and in-the-works repeal of Paragraph 219a is only one piece of the many barriers to abortion in Germany. At present, the coalition has not announced a formalised intention to abolish Paragraph 218, which continues to fundamentally criminalise abortion, leaving pregnant women to manoeuvre within tightly-defined exceptions to the law.

A pro-choice protester in Berlin wears a mask with "away with §218" on it.

A pro-choice protester in Berlin wears a mask with “away with Paragraph 218” on it. Photo: picture alliance/dpa | Paul Zinken

The prospect of changing this status quo remains murky, couched in extremely careful language. The coalition contract does clearly state that access to cost-free abortions should be a part of reliable healthcare. But when it comes to fully decriminalising the act of abortion, the document only announces that a commission on reproductive self-determination and reproductive medicine will examine options for regulating abortion “outside of the framework of the criminal code”. No concrete promises there.

Katrin Helling-Plahr, FDP parliamentary group spokesperson for legal policy, was actively involved in negotiating this section of the coalition contract. Plahr has long advocated for more progressive laws on reproductive medicine, and greeted the demise of Paragraph 219a as long overdue

Responding to a request for comment on the coalition’s cautious language, she reiterated plans to appoint an exploratory commission, but made clear that her party did not necessarily regard a total decriminalisation of abortion as legally or ethically viable. 

We Free Democrats are of the opinion that Paragraph 218, as the result of a long societal discussion, represents a successful compromise with regards to protecting the life of the foetus and the right to self-determination of the pregnant person,” she wrote.

Abortion access remains fraught

Meanwhile, individuals seeking to terminate a pregnancy in Germany are often left with little choice but to travel abroad for care, to one of the many European nations with fewer barriers to abortion. 

As long as Paragraph 218 stands, those seeking legal abortions in Germany face mandatory and often aggressively pro-natalist counselling, a waiting period and strict time limitations, with abortions only available in the first 12 weeks of pregnancy. And even when eligible for a legal abortion, finding a provider to perform it is another matter entirely. 

A recent story from investigative news site CORRECTIV.Lokal showed the barriers faced by individuals seeking to terminate a pregnancy in Germany, including poor access to abortion providers, discriminatory treatment, patchy insurance coverage of the costs and extensive bureaucratic burdens. As the Green parliamentarian Ulle Schauws pointed out, despite more readily available information on performing doctors after the removal of 219a, the actual sparse landscape of abortion coverage won’t automatically become any more densely populated.

The difficulty of accessing contraception 

Abortion access isn’t the only thorn in the side of folks who would rather not be pregnant. 

In 2015, Germany finally made the morning-after pill available over the counter, without a prescription. Though many people are able to obtain it without too much hassle, there’s evidence to suggest that different pharmacies handle the situation differently – with some taking a more invasive approach. 

When US citizen Courtney Harrison tried to get emergency contraception at a German pharmacy, she found the experience intensely personal and far removed from the ease of obtaining most other over-the-counter medications. Before being given the medication, she was brought back to a separate room and had to speak with multiple staff members. 

“They had to ask a bunch of questions and I had to fill out a form,” she said, questioning the necessity of sharing “intimate details” with two different people just to obtain an over-the-counter medication. 

A woman holds the morning-after pill at a pharmacy

A woman holds the morning-after pill at a pharmacy. Photo: picture alliance/dpa/dpa-tmn | Benjamin Nolte

“I hope people who need Plan B here in Germany don’t face judgement when they have to personal answer questions about their reproductive health and sex history. I felt embarrassed and overwhelmed,” she added.

While reforms to access to contraception aren’t specifically on the cards, the traffic light coalition has pledged to ease the financial burden of obtaining it.

In the coalition pact, the parties say they want to give health insurance companies the ability to cover the cost of regular contraception “as a statutory benefit”, as well as making free contraceptives available for those on low incomes. Emergency contraception is already covered by health insurance – but only after a visit to the GP. 

They also want to invest in research for contraceptives “for all genders” – presumably including the much-awaited pill for men. 

READ ALSO: What you need to know about the abortion law battle that divides Germany

Do the reforms go far enough?

Though the traffic-light coalitions have made pledges that go far beyond anything posited by the previous conservative-led government, some campaigners question whether the changes set out will be enough to make a meaningful difference. 

At present, potential expense, legal issues and a mountain of bureaucracy often limit women’s access to reproductive healthcare. That, and the ever-debated Paragraph 218, that continues to consider abortion a criminal offence. 

“In Germany my body belongs, de facto, to the state,” journalist and campaigner Mithu Sanyal said in an interview with Deutschland Funk. “You can see that in a law like Paragraph 218: the state can decide whether I get an abortion or not.”

Though the coalition has also pledged to make abortions free of charge and tackle the information and access issues, the legal issues remain a sticking point. 

Speaking to broadcaster RBB24, Sabrina Odebrecht, who works at a pregnancy advice centre in Berlin, said she thought it was right for women to be offered counselling before an abortion. But, she added, they should have the right to choose whether to accept it without fearing legal consequences. 

“I think it is wrong to criminalise the procedure in principle, to criminalise and frighten women and doctors,” Odebrecht said. “That is why Paragraph 218 should finally be dropped.”

So despite the incoming changes, the debates surrounding abortion law are far from over. 

Member comments

  1. I wonder are these pro choice people and ministers the same ones who want to force people into vaccination?
    Everyone should have a choice. But I dont think abortion should be touted as a cure all. Decriminalise it and allow the parties involved to openly discuss options. It just can not be made too easy it is a very serious thing. Not a quick fix.

  2. Florida just changed their law and I find it reasonable. It gives women an option, but not an open-ended one that takes into account fetal development.

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HEALTH

What to know about Germany’s plans to raise health insurance fees

Germany is struggling to fill huge gaps in its health funds following the pandemic and is planning to raise health insurance fees next year. Here's who it could affect and how much more people could have to pay.

What to know about Germany's plans to raise health insurance fees

What’s going on?

In the aftermath of the Covid pandemic, Germany is struggling to fill a large gap in its healthcare reserves.

According to Health Minister Karl Lauterbach (SPD), the statutory health insurance funds are facing a deficit of €17 billion next year, placing Germany’s healthcare finances under severe strain.

Lauterbach says this is largely due to the generous spending policies of the previous government both before and during the Covid crisis. As well as pouring billions of euros into free tests, the healthcare system was overwhelmed by patients during the most severe waves of the pandemic. 

To tackle this shortfall, the Health Ministry has drafted a set of proposals for raising additional funds. 

One of these proposals is to increase the level of health insurance contributions that people have to pay each month. The funds raised from this would account for around 10 percent of the total rescue package. 

READ ALSO: How to make the most of reward schemes on your German health insurance

How much more could people have to pay?

Lauterbach has pitched a 0.3 percent rise in monthly contributions. This would be added to the so-called additional contribution, which is currently set at a maximum of 1.3 percent, on top of the 14.6 percent general contribution that is paid as standard. 

For people in employment, contributions are divided equally between the employer and the employee. That means the extra 0.3 percent would translate to 0.15 percent extra per month in reality. 

In concrete terms, that’s an extra €1.50 for someone with a gross income of €1,000 per month, or €4.50 extra for someone with a gross income of €3,000 per month. 

Self-employed people – who generally have to bear the full brunt of the health insurance costs themselves – will fare a little worse under the plans. They’ll be expected to shell out €3 extra per month for every €1,000 of gross profit. 

Would everyone have to pay this much? 

No. Firstly, the changes would only affect those who are registered with one of the statutory health insurance companies such as TK or AOK. People who are privately insured will continue to pay the contribution set by their insurer.  

Secondly, unlike the general contribution of 14.6 percent, statutory insurance funds have the option to decide how much of the additional contribution they want to charge. 

That means that, while 1.6 percent could become the new maximum, there’s no guarantee that companies will choose to charge this. Depending on their financial situation, they may decide to keep the additional fees lower to remain competitive, or alternatively hike the fees to the maximum in order to shore up their reserves or offer better services. 

In other words, people will still pay a minimum contribution of 14.6 percent of their income but could pay a maximum of 16.2 percent (assuming that their health insurance company chooses to charge the full additional contribution). Most will pay something in the middle. 

READ ALSO: Reader question: How can I change my German health insurance provider?

Health insurance cards from AOK.

Health insurance cards from AOK. Photo: picture alliance/dpa | Karl-Josef Hildenbrand

What other plans are on the table?

As we mentioned, raising health insurance contributions is likely to cover just a small fraction of the deficit. To cover the rest, Lauterbach is proposing a range of other measures, including:

More state funding

In 2023, the federal government will step in with increased funding for the health insurance funds. Instead of the usual spending of €14.5 billion per year, the traffic-light coalition will shell out €16.5 billion on topping up the healthcare funds next year and will also provide a further €1 billion in the form of an interest-free loan.

Money from healthcare reserves

Statutory health insurance companies will have to dig into their savings to the tune of €4 billion to help cover the deficit. At the same time, €2.4 billion will be taken out of a pool of money known as the ‘Health Fund’ (Gesundheitsfond), which is built up through a combination of health insurance contributions, taxpayer funding and other forms of insurance such as pensions insurance. 

Increased discounts on medicines

Under German law, pharmaceutical companies are required to provide statutory health insurance companies with a discount of at least seven percent on certain types of medicine. This will be hiked to 12 percent for one year. 

A pharmacist scans a prescription

A pharmacist scans a prescription. Photo: picture alliance/dpa | David Inderlied

Furthermore, pharmacies will be required to provide the insurance funds with a discount of €2 (rather than the previous €1.77) per packet of prescription drugs. This will last for at least two years. Meanwhile, a moratorium on raising the price of medicines will be extended to 2026. 

Restrictions on bonuses for doctors

Doctors’ surgeries will no longer be given financial incentives for taking on new patients. 

Is this all set in stone?

Not yet, although it is likely to be passed in a parliamentary vote. So far, the cabinet has already waved through the changes, and on Friday they were debated for the first time in the Bundestag. 

READ ALSO: Why large families are set to pay less for German care insurance

What are people saying?

In a seething speech in the Bundestag on Friday, Bavaria’s state health minister Klaus Holetschek (CSU) criticised Lauterbach’s plans to raise health insurance contributions, arguing that it would “send the wrong signal” to patients. 

He also laid into the proposals to cut doctors’ bonuses for taking on new patients, arguing that this would lead to a cut in services.

However, the FDP health expert Andrew Ullmann said Lauterbach’s plans could help to avoid a hike in contributions that could cost people hundreds of euros per months. “That would not be responsible in times of inflation and energy crisis,” he said.

Health Minister Karl Lauterbach (SPD)

Health Minister Karl Lauterbach (SPD) speaks at a debate in the Bundestag on the measures to bail out the health insurance funds. Photo: picture alliance/dpa | Annette Riedl

In his speech in the Bundestag, Lauterbach said the rise in health insurance contributions was ultimately fair since employers would be expected to pay half. He also defended his plans to dig into the health insurance funds’ reserves. At some of the health insurance funds, board members “earn significantly more than the Federal Chancellor”, he claimed. 

Pointing to his proposals to shift some of the financial burden onto pharmaceutical companies, the SPD politician said he would “stand up to lobby pressure” and refuse to change course. 

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