“You Can Run This Whole Gamut”: The Arduous Pathway to Abortion in Germany

Although access to abortion is a crucial reproductive right, in Germany, abortion is criminalised and subject to intensive regulation. It is only ‘free of punishment’ in the first trimester if the abortion-seeker follows a formalised process, which includes mandatory counselling and a mandatory waiting period. Our study critically examines the pathway to abortion necessitated by the current German regulations. We conducted 17 semi-structured interviews to capture views of abortion-related service providers on barriers and enablers to abortion in the federal states of Berlin and Brandenburg, applying a thematic analysis approach. Our findings point to multiple individual barriers along the pathway, but also that the complexity of the abortion pathway is itself a structural barrier. We identified 9 steps which most abortion-seekers must undergo to end an unwanted pregnancy, involving numerous different administrative and health service providers and the repeated need to communicate their pregnancy status and intention to have an abortion to these providers, exposing them to stigma, and limiting privacy. Even providers themselves were sometimes uncertain about how parts of the process worked and what they were or were not allowed to do. Our study illustrates that the pathway to abortion in Germany is in fact a state-induced barrier to a fundamental reproductive health service, and in this respect can be viewed as a form of structural violence. This underscores the need to analyse access to reproductive healthcare through sociological frameworks that expose structural injustice. It also reminds us that reproductive rights remain contested in wealthy western nations, despite their ostensibly progressive values. Our findings support existing recommendations to decriminalise abortion, which would align Germany´s regulation of abortion with its international human rights commitments and with international best practice.