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HEALTH

Germany consigns Nazi-era abortion law to history

Germany's parliament on Friday agreed to remove a Nazi-era law that limits the information doctors and clinics can provide about abortion.

Pro-choice demonstrators hold a sign calling for Germany to get rid of paragraph 219a from the abortion law at a demo in Berlin in 2019.
Pro-choice demonstrators hold a sign calling for Germany to get rid of paragraph 219a from the abortion law at a demo in Berlin in 2019. Photo: picture alliance/dpa | Ralf Hirschberger

One of the most controversial sections of the penal code, Paragraph 219a, prohibits the “promotion” of abortion, a crime punishable by “up to two years of imprisonment or a fine”.

The decision to finally consign the law to history came almost eight decades after its adoption in 1933, shortly after Adolf Hitler had taken power.

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

“It is high time,” Justice Minister Marco Buschmann said in parliament.

It is “absurd” and “no longer in step with the times” that doctors are not allowed to provide complete information on abortion while “every troll and conspiracy theorists” are free to spout their ideas about terminating pregnancies.

The ruling coalition of Buschmann’s Free Democrats, as well as the Social Democrats and the Greens, had made a pledge to remove the law when they signed up to govern together.

The opposition Christian Democratic Union (CDU) and the far-right AfD voted against scrapping the law.

Elisabeth Winkelmeier-Becker of the CDU argued that while a woman may face difficulties because of an unwanted pregnancy, “we are also thinking of the child’s right to live”. She pointed this out as the “key difference” between the ruling coalition and her party.

German Health Minister Karl Lauterbach, of the Social Democrats, said the move was “overdue”.

“It cannot be (the case) that doctors are criminalised when they inform women factually about the medical possibilities of abortions,” he said.

Despite dating back to Germany’s darkest history, the law was applied until recently. Courts handed out penalties to doctors for offering information on the internet about pregnancy terminations.

In some cases, the sites offered a simple statement that the gynaecologist carried out abortions, with no further details.

Among the doctors prosecuted in recent years is Kristina Hänel, a general practitioner from Giessen in western Germany, who became the face of the campaign to ditch the law after being fined €6,000.

Her legal battle sparked a media storm and turned a spotlight on the law.

Welcoming the decision, Hänel wrote on Twitter that it was “a great feeling: 219a becomes history”.

“We can at last fully meet our professional obligation to inform thoroughly. Those affected can finally find factual and serious information on the internet.”

A pro-choice counter protester at the "March for Life" demo against abortion in Berlin in September 2020.

A pro-choice counter protester at the “March for Life” demo in Berlin in September 2020. Photo: picture alliance/dpa | Jörg Carstensen

Obstacles remain

In June 2019, two gynaecologists in Berlin, Bettina Gaber and Verena Weyer, were each handed two-thousand-euro fines for the same offence.

Anti-abortion militants, who organise themselves online, are behind most of the legal complaints made against medical professionals, while one activist was recently convicted for comparing abortion to the Holocaust.

Under pressure from such campaigners, many medical practitioners have removed all relevant information from their websites and have declined to be included in family planning lists shared with women looking to end their pregnancies.

With Paragraph 219a now out of the way, some campaigners are now turning their eye to another related law – Paragraph 218 – which outlaws abortions unless they are carried out within the first 12 weeks of pregnancy and only under certain circumstances.

READ ALSO: Reader question – is abortion illegal in Germany?

Abortion is ‘taboo’

Women wishing to have an abortion must have an obligatory consultation at an approved centre.

The aim of this discussion is to “encourage the woman to continue her pregnancy”, even if in the end the choice was up to her.

After the consultation patients must wait through a “reflection period” of three days.

Around 100,000 abortions are carried out in Germany every year although the number has gone down in recent years.

The subject is still taboo in Germany, according to a number of gynaecologists, and can be like an obstacle course for patients, particularly in traditionally Catholic Bavaria.

In some parts of the vast southern state, no hospitals offer the procedure, with many people opting to cross the border to Austria instead.

Heidi Reichinnek of the far-left Linke party said Paragraph 218 remained a “fundamental problem” and must be struck off the statute book.

For now, Buschmann said both pieces of law should be treated distinctly. But Minister for Women Lisa Paus said it was important to “talk about 218”.

READ ALSO: Do Germany’s planned changes on abortion go far enough?

By Hui Min Neo

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HEALTH

Who can get the monkeypox vaccine in Germany – and how?

The monkeypox virus continues to spread in Germany and the vaccines panel is recommending that three groups of people get a jab. Here's who can get one - and how.

Who can get the monkeypox vaccine in Germany - and how?

What’s the current monkeypox situation in Germany? 

The monkeypox virus is still spreading in Germany, with 2,982 confirmed cases of the disease recorded by the Robert Koch Institute (RKI) as of Tuesday.

The virus, which causes small lesions on the skin alongside flu-like symptoms, is primarily transmitted through close physical and sexual contact. The vast majority of cases have so far been found in gay men, though five women have also had the virus in Germany to date. 

On Tuesday, the RKI reported that a four-year old girl in Baden-Württemberg had contracted monkeypox from two adults in her household but was asymptomatic. Before that, two teenage boys aged 15 and 17 were also found to have picked up an infection. 

READ ALSO: Monkeypox in Germany: Two teens ‘among new infections’

With the number of cases rising globally, the World Health Organisation (WHO) has declared the situation an “emergency of international scope” – the highest alert level possible.

This is a sign for members of the WHO like Germany to implement containment and preparation measures, such as rolling out vaccination campaigns. For its part, the Robert Koch Institute (RKI) is tracking the cases and has put out an information sheet about the best practices for avoiding the measures and what to do in the case of an infection.

What should people do if they contract the virus?

If people think they have a monkeypox infection, the first thing they should do is seek the advice of a healthcare practitioner such as a GP or sexual health advice clinic. However, the RKI advises people to phone the clinic beforehand to let them know they believe they may have the virus.

In confirmed cases of monkeypox, people should self-isolate at home until the lesions on their skin scab over and peel over, but for a minimum of 21 days. They should avoid physical contact and sharing items like hand towels or bed sheets with others and should wear condoms during sex for at least eight weeks.

Healthy people with no pre-existing conditions are generally fine to remain at home with someone who has contracted monkeypox, but those with weakened immune systems, pregnant women, elderly people and children under the age of 12 should move out for the duration of the isolation. 

READ ALSO: EXPLAINED: How Germany wants to contain the monkeypox

What monkeypox vaccines are available? 

The smallpox vaccine Imvanex, which has been available in the EU since 2013, was approved for use against the monkeypox virus on July 22nd, 2022. 

People are generally protected against monkeypox for at least two years after their first dose of Imvanex, but doctors recommend a second dose after a four-week interval in order to make this protection permanent. 

The vaccine is generally seen as a preventative measure but can also be used up as a so-called post-exposure measure to lower the risk of getting ill after contracting the virus. In this case, the vaccination is most effective up to four days after exposure. 

Who are monkeypox vaccinations recommended for? 

So far, the Standing Vaccines Commission (STIKO) has recommended that two primary groups of people get a monkeypox jab: men who have multiple male sexual partners and people who work in infectious disease laboratories. 

As mentioned, the vaccine can also be used to ward off illness or prevent a severe course shortly after someone has been exposed to the virus. 

READ ALSO: German vaccine panel recommends monkeypox jab for risk groups

Nurse laboratory monkeypox PCR

A nurse sorts monkeypox test samples in a lab. Photo: picture alliance/dpa/EUROPA PRESS | Carlos Luján

Is there enough vaccine to go around?

Not currently.

In May, the German Health Ministry preemptively ordered 240,000 doses of the vaccine – but so far just 40,000 of these have been delivered. 

This is far too little to cater for the estimated 130,000 people who fall into one of the target groups for a jab.

The remaining doses are due to be delivered in August and September, though some pressure groups are already calling for more to be ordered. 

On Friday, the German Aids Federation (DAH) called on the government to secure at least one million doses of the monkeypox vaccine in order to help stamp out the virus in Germany. 

“The goal must be to reduce the number of infections as quickly as possible and to get the epidemic permanently under control,” explained Ulf Kristal of the DAH board.

This can only be done if as many people in risk groups as possible are vaccinated, he added. 

How can people book a jab?  

At the moment, this varies quite a bit from state to state, with some issuing the jabs via the local health authorities and others supplying the doses to specialist HIV clinics and hospitals.

In Saxony-Anhalt, Bremen and Hesse, vaccinations are primarily organised through the local health authorities, so this should be your first point of contact to enquire about a jab if you live in these states. In Frankfurt am Main, however, a handful of specialised HIV clinics are also carrying out vaccinations, according the FAZ newspaper. 

In Saarland, too, appointments should be booked through the health authorities, though they are carried out at Saarbrücken University Clinic. In Hamburg, jabs are being administered solely at infectious disease clinics.

UKE university clinic Hamburg

The main entrance to the University Clinic in Hamburg, where monkeypox patients have been treated for the disease. Photo: picture alliance/dpa | Axel Heimken

Berlin offers the most diverse range of vaccinations and, with 8,000, has the largest number of vaccine doses available. Vaccinations are given in HIV specialist practices, counselling centres for sexual health as well as in several hospitals. A list of vaccination centres has been compiled by the German Association of Outpatient Doctors for HIV Treatment. Neighbouring Brandenburg organises vaccinations through the local health authorities as well as through GP’s practices.

In three federal states, only hospitals are responsible for monkeypox vaccinations. In Saxony, hospitals in Chemnitz, Leipzig and Dresden have been vaccinating since the end of June. In northern Schleswig-Holstein, outpatient clinics in Kiel and Lübeck are responsible. Neighbouring Mecklenburg-Western Pomerania is administering its doses exclusively through the University Medical Centre Rostock.

Several federal states have opted to roll out monkeypox vaccinations through both HIV clinics and hospitals. These include Bavaria, which has more than 3,500 vaccination doses available, as well as Rhineland-Palatinate, Lower Saxony and North Rhine-Westphalia, for which a list of all vaccination centres was recently published.

What else should people know? 

The monkeypox vaccine is perfectly safe, but people can experience a few side effects for a day or two afterwards, including soreness on the vaccination arm, fever and headaches. 

People with HIV should talk to a specialist before getting the vaccine, because the effectiveness may vary depending on your Helper T cell count. 

For more information on the clinics offering jabs, the German Aids Federation has published a helpful Q&A along with a list of clinics in each of the federal states, which can be found here (in German).

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