The Provision of Care for Unwanted Pregnancies Must Be Decriminalized

In 2020, then-Federal Health Minister Jens Spahn (CDU) commissioned the so-called ELSA1 study on unwanted pregnancies. Its official purpose was to investigate the alleged long-term psychological consequences of abortions and scientifically prove the existence of "post-abortion syndrome" – to support the case against longstanding calls for decriminalisation.

The ELSA study has now finally been published. The result is the most comprehensive investigation to date of unwanted pregnancies in Germany – methodologically sound, representative, and bound to the standards of social science research. And its findings clearly contradict Spahn's political intentions – because the problems it identifies arise not from the procedure itself but from its illegality and the stigmatisation this creates.

What does the study actually say?

The authors of the study come to a clear conclusion: “post-abortion syndrome” is not empirically verifiable. Instead, it is simply an invention of anti-feminist abortion opponents. What began as an attempt to cement Section 218 of the German Criminal Code2 – commissioned by the CDU, financed by taxpayers' money, and carried out by a coalition of six universities – has, over a thousand pages, provided the best arguments for its abolition. 

This becomes particularly evident when looking at access to care. Whether – and how quickly – those affected find help very much depends on where they live. In Berlin, care is relatively good, but women in many areas in southern and western Germany are confronted with long journeys, extended waiting times, and high costs. Doctors report bureaucratic hurdles, a lack of training, and complicated medication regulations. The women affected describe feelings of shame and guilt and the fear of social condemnation. 

Poor levels of care are not an occupational hazard, but rather a direct consequence of the illegality of abortion.

Decriminalization requires political will 

The ELSA study brings to light something that tends to be obscured in the political debate: poor levels of care are not an occupational hazard, but rather a direct consequence of the illegality of abortion. As long as Section 218 defines the procedure as a criminal offence, improvements will remain piecemeal. Training more doctors and making it easier for the costs to be covered are important steps, but they will remain insufficient as long as abortion is not decriminalised.

The majority of the population has long been in favour of decriminalisation. Nevertheless, politicians continue to preach the mantra of supposed “social harmony” that must not be disturbed. But what sort of harmony involves women being made to search desperately for medical care and healthcare professionals being subjected to hostility and attacks?

Researchers recommend new regulations

If we really want to improve care, we need to abolish Section 218.

The authors of the ELSA study spell out what needs to be done: Section 218 should be removed from the Criminal Code, mandatory counselling should be abolished, and health insurance funds should ensure full coverage of the costs of abortion. Their proposals are in line with the recommendations of the 2023-4 Commission for Reproductive Self-Determination and Reproductive Medicine [Kommission zur reproduktiven Selbstbestimmung und Fortpflanzungsmedizin]. Both emphasise that only decriminalisation can enable comprehensive and non-discriminatory care in the long term.

A lesson in politics and science

The ELSA study highlights not only the current gaps in care and their causes, but also how political attempts to exert influence can fail. What was intended as an instrumentalisation of science has ended with a clear political mandate for action.

It is highly ironic that Jens Spahn, of all people, paved the way for these findings. The study he commissioned makes it unmistakably clear: if we really want to improve care, we need to abolish Section 218 and finally treat abortions as what they are – a question of self-determination and proper access to healthcare. 

Get Involved - Presidents' column

Get involved! There’s no other way to be real – thus the message of Heinrich Böll, and, to this day, his encouragement is inspiring us. With this column the Presidents of the Foundation involve themselves in current social and political debates. This column will appear each month, authored, in turn, by Jan Philipp Albrecht and Imme Scholz.

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