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Abortions in Bremen: unintentionally pregnant women without help

In Bremen, the medical center will soon have to close again due to a shortage of doctors. 30 to 50 women do not receive an abortion every week.

In Bremen, this part of health care is precarious: abortion Foto: Colin LLoyd/Unsplash

BREMEN taz | The two women were desperate and angry, says Lea Pawlik, the managing director of the Bremen state association of “pro familia” on the phone on Thursday, she is audibly agitated. The day before, the two Ukrainians wanted to speak to a doctor who can perform an abortion. But that day there was only one doctor who was sterilizing men, says Pawlik, and the few appointments for abortions that they are currently able to offer at their medical center in Schwachhausen are booked out weeks in advance. “They yelled at us and broke into the house,” says Pawlik. In the end she had to call the police. Otherwise they would “only” be insulted on the phone. “We’ve had that every day for a few weeks.”

Pawlik has been leading the state association for a year and, like her predecessor, has been busy with almost nothing else since then than looking for doctors who will perform abortions up to the 14th week on a daily basis.

For years, the shortage of personnel has become more and more acute, and the offer has to be restricted. In August, the medical center even closed for two weeks, for another week only one-day abortions could be carried out. In October, Pawlik announces, the center will close again for a week or two.

30 to 50 women per week then remain in Bremen without care, as in August. This was made more difficult by the fact that the municipal clinics no longer carried out abortions due to a lack of staff. There are only a few resident gynecologists in Bremen who perform abortions, usually only on their own patients.

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“We gave the women addresses in Hamburg, Oldenburg and Verden,” says Pawlik, who then had to explain to the practices and clinics why so many called them. Because in big cities there are – at least in northern Germany – usually enough practices that offer at least one medical abortion, such as in Hamburg and Hanover.

150 kilometers to the next practice

It’s different in Bremen because there has been a medical center run by “pro familia” since 1979, a day clinic for outpatient surgeries. On average, 85 percent of all abortions in the state of Bremen take place here. About half of the women come from Lower Saxony, where there are districts in which there is no practice or clinic within a radius of 150 kilometers that can help pregnant women in these cases.

This is a problem that affects all of Germany. This has always been the case, especially in Catholic regions. In others, such as Bremen, doctors retire who have understood abortions as part of their profession, while their successors refuse this medical service. This is possible because Germany has the Pregnancy Conflicts Act, which stipulates that no one can be forced to have an abortion.

Many people also come to Bremen’s “pro familia” because the procedure is also performed here under local anesthesia and they are treated up to the 14th week of pregnancy. Many other practices and clinics only do this up to the ninth or tenth week.

An abortion is not prosecuted up to 14 weeks after the last menstruation. Provided there was a consultation beforehand and a three-day reflection period. After the deadline, doctors decide whether carrying the pregnancy to term is reasonable in their opinion. Women almost only have a chance of an abortion if a disability in the fetus is diagnosed. The law expressly states that it is about the physical or mental state of the woman, which should be decisive.

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In Bremen and Lower Saxony there will now be some whose pregnancy is too far advanced to be legally and safely terminated. Anyone who can afford it goes to Holland, where, according to taz research, every third to fourth pregnant woman residing in Germany has the pregnancy terminated in the second trimester. You must bear the costs yourself.

In Holland, the procedure is possible up to the 24th week of pregnancy in specialized day clinics. “More and more women from Germany are coming to us in the first trimester of pregnancy because nobody is helping them,” says Gabie Raven on the phone.

The doctor runs such a clinic with locations in Rotterdam and Roermond, which also advises on contraception and menopause. Roermond is close to the German border with Mönchengladbach. “Just yesterday I had two women here who couldn’t find anyone in Germany or whose appointments were postponed until they were over the 14-week period.”

Bremen relies more on medical abortions

A federal state like Bremen cannot solve the problem. “The law binds our hands,” says Diana Schlee, spokeswoman for the Bremen health senator Claudia Bernhard from the left. Paragraph 218 of the Criminal Code robs the state of any possibility of influence. A crime must not be promoted, it is not covered by health insurance, which is why clinics cannot be obliged to ensure care.

“The only thing we can do is talk to doctors to convince them to offer the service,” says Schlee. In cooperation with the Bremen Medical Association, there was a training course on medical abortion on Saturday, 19 doctors, including family doctors, had registered. In Bremen, this method, which is relatively easy to perform compared to surgical abortion, is only used in a fifth of the operations, the national average is a third, and in Berlin even half.

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However, medical abortion in Germany is only possible up to the 9th week of pregnancy. And most doctors would only do it like “pro familia” if the woman understands German sufficiently, says state manager Lea Pawlik. Because the woman must know what happens when the bleeding starts at home.

Pawlik is considering hanging a sign on the front door that explains the shortage of doctors on the one hand and that “pro familia” is a private organization on the other. “Many think we do it on behalf of the state or are even a state institution, but we are only closing a gap that the state created with paragraph 218.” This is not the way to make profits, on the contrary. “We only do this for women. But I can’t say for how long,” says Pawlik.

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