By Margot Barkey, Medical Institute of profamilia Bremen
I would like to thank you for the invitation to speak at this demonstration on safe abortion day. After all, this is our task at the Medical Center in Bremen and far beyond to make safe and hygienically impeccable abortions possible.
But between all the debates, court decisions, prejudices and statements, one voice remains silent. These are the voices of women who have claimed this right to decide for themselves in recent years and will continue to do so in the future.
In order to give a voice to exactly this silence of those affected I would like to report something from the everyday life of abortion practice. For women who are unintentionally pregnant rarely express themselves publicly in this supposedly so liberal and open society. But it is exactly this “not speaking”, “not demanding”, “not knowing” that is an expression of the current social and political climate. Where this in turn leads, we are currently observing in Poland and America. And the debates about retaining Nazi paragraph 219a § including minor modifications which have achieved absolutely nothing. It is quite the opposite. Further it continues to hail charges quite up-to-date also again against the profamilia.
We, from the medical institute accompany women in their final steps: explain the procedure, assist the doctors, calm them down and hold their hand during the abortion. We take care of them in the post-operative phase, both medically/nursing and psychologically we assist these women. Our tasks are not only limited to health control and pain medication but also to the final discussion about the behavior in the next days. If necessary, we always have an open ear for the feelings and the stories behind these decisions and sometimes it is just a matter of a handkerchief. This appreciative and unprejudiced environment of our institute allows us a unique closeness to the women concerned. I cannot imagine a more meaningful activity. But the relief that falls from these women is not surprising.
We are unfortunately a part of the unbearable system and work at the end of a chain of demands that lies behind every abortion. A legal abortion in Germany in 2020 is a marathon of doctor’s visits, declarations and self-agreements at every point, mandatory consultations with certificate, health insurance contacts and laboratory findings in written form, in three copies and the appropriate date. In addition, these women must organize an accompanying person, usually over 18. If she needs an translator*, this is her private problem. There is no fund for translators for abortion, unlike for counselling. Furthermore, additional costs, travel etc. etc…
But if we assume that the woman meets all these requirements, then the problems just start. If a woman in Germany thinks she has the freedom to choose the method or the doctor or the place she wants to go, she is quickly informed by someone else.
“11 weeks?…in our country only in three weeks” “Medicinal abortion?”… Only with my private patients”. “Termination by a female doctor”… unfortunately we can’t take that into consideration! “You have no health insurance card, no insurance number?…..then it will be expensive.
” You have called us 20 times and have not reached anybody”? … That is not unusual!
If the women have reached us by telephone it becomes very fast clear that the address lists are incomplete and can be glad at all within the legal period to get an appointment. If that woman is lucky and has recognized her pregnancy early enough, she usually has enough time for the organization. Otherwise she has to take the method and the appointment that is left over. If she has made it and can be treated in the medical center, she will hopefully have everything she needs with her, otherwise she will not be treated. And all this in a physical and psychological stressful situation.
This is at least one of the second most frequent sentences we should hear and show. Anyone can hit it. Really every woman of childbearing age.
“I didn’t think it would be so difficult” ” And I didn’t know how many women are here”, or ” Oh, abortion is forbidden? ” And abortion is not covered by the health insurance”? No, the abortion is not covered by the health insurance.
Let’s talk about money. 95 % of the women get a cost coverage approved by the health insurance company and financed by the federal states. Sounds not bad at first, but it shows how poor most women in Bremen are. The net income must not be more than 1300€. This means for all involved medical institutions to be dependent on the annually negotiated point values. The National Associations of Statutory Health Insurance Physicians and the GKV umbrella organizations ensure that the remuneration for abortion has stagnated for years. However, this is happening with rising costs, increasing requirements, hygiene concepts that have had to be implemented not only since Corona, documentation, maintenance, validation, security protection, telematics infrastructure, digitalization, data protection…
On the contrary, it was not until April that top officials attempted to remove the initial medical examination from the benefits catalog without substitution and without political attention. Due to the numerous protests by doctors, profamilia and other institutions, the decision was retroactively revoked. However, despite rising costs, the follow-up examination after a discontinuation has been reimbursed at a lower rate since April 1….. How can this be?
These examples show that not only the women but also all those involved in the abortion, the financial water is dug out. This endangers not only the financing but also the continuity of the entire medical care of women in Germany. It endangers the safe termination of pregnancy and the health of the women. Because it is simply not economical for doctors to perform an abortion. And what comes next? Will the women from Bremen have to go to Holland again in ten years?
Who decides in the annual committees about the financing? What political sentiments are expressed in this underfunding?
These unacceptable conditions are shameful. It is outrageous and embarrassing to stand here in 2020 and have to report about such conditions. In which country of top health care, with one of the best health care systems in the world can free people be exposed to such a situation?
Thank you for your attention!
