Every third to fourth woman who terminates a pregnancy in the second trimester travels to the Netherlands.
Warning against aggressive abortion opponents at the entrance of the Vrelinghuis in Utrecht Photo: Robin van Lonkhuijsen/picture alliance
UTRECHT/HAMBURG/BREMEN taz | The last hope is hidden behind three numbers. "423" is written on a sign on the three-story building, two kilometers from the center of Utrecht. The house number is the only clearly visible indication that those seeking help here are in the right place. It is internationally known as the abortion clinic Vrelinghuis, named after the first letters of those who founded it in 1972.
In normal times, German pregnant women also come here every day. According to the clinic, there are 250 to 300 women a year. According to the Vrelinghuis, they are almost all beyond the first three months of pregnancy. Because after this period in Germany abortion is possible only in exceptional cases. The decision is not made by the women, but by doctors. In the Netherlands, on the other hand, abortions are legal until 24. Week of pregnancy allowed in principle.
To Holland despite Corona
The limit The border with the Netherlands is open, but there are sometimes controls. The director of the clinic in Roermond told the taz that women are asked for their reasons for entering the country, and that fewer Germans are coming at the moment.
The treatment The Vrelinghuis in Utrecht states that it will issue patients with a document stating the reason for their entry upon request. Until Thursday, the clinic in Heemstede had a notice on its homepage stating that women from Germany were not currently being admitted. (eib)
As research by the taz shows, this apparently leads to the fact that every third to fourth woman who terminates a pregnancy after the first twelve weeks after conception at a doctor’s office travels from Germany to the Netherlands for the procedure. And it’s not because she sought an abortion too late. But because the child she is expecting is probably healthy. If the unborn child had been diagnosed with a disability, another research finding, she would get an abortion in Germany.
There is no study that proves it, no information from the federal government that can confirm it. Because nobody has asked for it yet. A study funded by the European Research Council on abortion travel within the EU is still in its infancy. But there are empirical values from doctors in Germany and the Netherlands, which in combination with the available statistics speak a clear language.
"Abortion tourism" still exists
So first, the numbers: In Germany in 2018, according to the Federal Statistical Office, 2.163 women between the ages of 12. and 22. Week one abortion. According to the Dutch Ministry of Health, in the same year 1.237 women residing in Germany aborted a pregnancy in the Netherlands. In which weeks of pregnancy this happens is not recorded. Also, no clinic-specific listing exists. But the clinic Beahuis& Bloe-menhove in Heemstede near Haarlem, which, according to its own data, treated even more German patients than the Vrelinghuis, with 735 women in 2019, confirms: The vast majority would be between the 12. and 22. week. This is also what a clinic in Amsterdam says.
"The psychological distress of a woman who does not want to have a child with Down syndrome is accepted, while the distress of a woman in an extremely difficult psychosocial situation is not recognized because the child is healthy."
There are 14 clinics specializing in abortion in Holland, where 95 percent of all abortions take place; only in Heemstede and Utrecht are they up to 22 percent. week possible. Most Germans went to these two clinics, a spokeswoman for the Dutch Ministry of Health says. She does not give concrete figures.
In theory, German women could also travel to a country other than the Netherlands. But even the two European countries, England and Wales, where abortion is allowed for so long, show only 22 women in 2018, according to British government statistics.
Law that is not respected
There is a simple reason for this abortion tourism: those who are even a few days over the twelve-week limit need a medical indication in this country. This means that a doctor must certify that carrying the pregnancy to term would "endanger the life of the pregnant woman or seriously affect her physical or mental health". This is what it says in paragraph 218a of the penal code.
The legislature chose this wording in 1995 because it did not want to give the impression that fetuses were aborted because of malformations. But this is exactly what happens. The taz has talked to some gynecologists in private practice. All agree that it is no problem to get a medical indication in Germany if the child will be disabled. Sometimes, doctors say, they have to call all over the country to find a clinic that is willing to perform the abortion. 17 days on average between diagnosis and abortion. This was the result of an investigation by the Institute of Legal Medicine of the University Hospitals of Giessen and Marburg in 2017.
This Giessen study is almost the only data base on the subject. 160 abortions after the 12. Week at the University Hospital Giessen had evaluated the researchers*innen. Without exception, all of these abortions in Giessen happened due to malformations of the fetus. Not a single one because of the woman’s mental state – but according to the law, this should be the decisive criterion.
This is in line with the picture painted by experts. Only in individual cases, they say, do they find a psychiatrist or psychiatrist who certifies that the woman is in distress. And in individual cases this indication would be accepted by a clinic. But the majority have only two options: Carry the pregnancy to term or, if they have the money and the strength, go to Holland.
There, by the way, there are much fewer abortions after the 24. week, when the fetus is viable outside the uterus. In Holland, there were only 11 such late abortions in 2018 – in Germany 655. Germany has about five times as many inhabitants as Holland.
For Helga Seyler, this is an "intolerable double standard". "The psychological distress of a woman who does not want to have a child with Down syndrome is accepted, while the distress of a woman in an extremely difficult psychosocial situation is not recognized because, after all, the child is healthy." Seyler is a gynecologist and has worked since 1991 at the family planning center in Hamburg, which is supported, among others, by the association Pro Familia. Until 2005 she performed abortions herself, now she only does the pre- and post-abortions. While gynecologists in private practice say they see one or two women a year for whom Holland is a last resort, Seyler sees one a quarter. That’s because colleagues send many women to her when they discover a pregnancy that is too far along for an abortion under counseling regulations. "They sit here and are completely desperate," says Seyler on the phone.
In almost 30 years, Helga Seyler has never experienced a woman who "just like that" came so late to have a pregnancy diagnosed and then wanted to have an abortion. "It’s always women in precarious living conditions," she says. Among them many victims of violence. Some of them had already decided to have the child, until they realized that they could hardly escape the violent father of the child. "Others have repressed pregnancy because they are unable to care for themselves." These women are mentally ill in one way or another, says Seyler. Psychiatrists could therefore certify that carrying the pregnancy to term would make their illness worse. But even in liberal Hamburg, it’s hard to find someone to do this, Seyler says. "Nobody wants to have anything to do with that."
Often it is migrants that the doctors talk about. In 2015 and 2016, when many refugees reached Germany, the cases of women raped on the run increased. Up to 12. week after conception is possible in Germany the criminological indication after rape. It means the woman doesn’t have to go to counseling or have a cooling-off period. But by the time a refugee arrives in Germany, months have usually passed.
No chance with psychological problems
Hamburg doctor Silke Koppermann remembers a woman from Eritrea who was in the 25. week when she came to her. She had been raped several times while on the run. There was a medical indication, but the clinic’s ethics committee rejected the abortion. "I told the clinic to please explain this to the woman herself," says Koppermann. Thereupon the committee would have agreed after all.
In a similar case in Wuppertal, a woman had to carry the pregnancy to term. Yet she was already in psychiatric care for treatment, says Eva Waldschutz, a doctor. "There was not even someone willing to make the indication."And a doctor from Baden-Wurttemberg, who wishes to remain anonymous, reports of a patient who had already had three children taken away from her because she was living in such desolate conditions that the Youth Welfare Office did not trust her to be able to take good care of her children. "I talked to her about Holland, but she is not allowed to leave the county because of her residence status."
At the same time, the two Dutch clinics, which together use about 1.The center, which treats more than 000 women from Germany, is prepared to treat patients from all over the world. The Vrelinghuis homepage has information in English, German, French, Italian and Polish. The cost has to be asked over the phone. The procedure costs 865 euros from the 13th week of pregnancy. week, before that 680 euros. For Dutch women, health insurance covers the costs. The doctors speak other languages, including Russian and Arabic, says Lev Querido, director of the Vrelinghuis. "Every one of us speaks five or six languages."
Attuned to foreign clients
Querido exceptionally agreed to be interviewed in order to support German colleagues like Giessen abortion doctor Kristina Hanel, as he says. One afternoon, he and his chief physician Frans Bocken receive the taz correspondent in a small meeting room on the first floor of the clinic. They are both specialists in abortion and have been doing their job for a long time. Bocken, in his mid-50s, for 23 years, Querido "a few years more," as he says. He still remembers times when women came from Germany en masse because, if they found a doctor at all, they were often treated under humiliating circumstances.
Querido speaks with a thoughtful detachment, like someone who has experienced great struggles and is sure he is on the right side. "If abortion is banned, it still takes place," he says. "Women who don’t want to carry a pregnancy to term find a way to do so." In the past under life-threatening conditions with soap suds and knitting needles – today with a trip to the Netherlands.
This is reflected in the statistics published by the Ministry of Health. In 2018, in the Netherlands, 31.002 pregnancies were terminated, almost 11 percent of the patients came from abroad, two thirds of them from Germany and France. The large number of foreign patients probably also explains why in the Netherlands almost 18 percent of all abortions take place after the 13th week of pregnancy. week take place.
Chief physician Frans Bocken explains what women can expect at his clinic. "We start with an intake interview by a health care professional to find out if she has made her decision with conviction. We have to exclude that she was forced to do so by someone else." If doubts remain about a free, well-considered decision, the doctors do not treat it. It happens every day, Bocken says.
If the woman does not tell them why she does not want the child, they do not ask at the Vrelinghuis. "It could be all kinds of reasons," says clinic director Querido, "she has come to the conclusion that it can’t be done any other way. It is not for us to evaluate their reasons."
Unlike in Germany, it is customary in Holland to scrape out the uterus after the third month of pregnancy. In Germany, only a few doctors do this, otherwise the birth is induced with labor pills. It’s the gentler method, they say in this country. In the Netherlands, surgical abortion is considered more tolerable. In fact, it is probably easier on the doctors’ psyches if the woman gives birth to the fetus and they don’t have to extract it.
Sometimes, as German gynecologists and Pro-Familia counselors tell us, the fear of an induced stillbirth is one reason why women go to Holland. There are other causes of abortion in Holland. Some women choose this route even in the first three months of pregnancy, perhaps because it is less inconvenient, perhaps because they know they will be in good hands there. This is what the director of the abortion clinic in Roer-mond suspects. The location is just over the border, 40 kilometers from Monchengladbach. About 30 percent of Germans give birth in the first trimester, she writes. Her colleague in Arnhem, near Kleve, says that one fifth of her patients are German women.
Number of abortions on the rise
Crossing the border for an abortion is on the rise. For nine years, the number has been slowly but steadily increasing. This may also be due to the fact that in Germany fewer and fewer doctors are willing to perform abortions, as the taz revealed three years ago.
It is therefore likely that the number of German patients in Dutch abortion clinics will continue to increase in the coming years and that Querido and -Bocken in Utrecht will have even more to do. Whether they don’t feel they have to do the dirty work for their German colleagues? "No," they say. On the one hand, it’s not a dirty job for them, they like to do it out of the conviction that they can help people. On the other hand, while they would like their European neighbors to make it easier for their female residents to get treatment. But as long as they don’t do it, they just do what they have to do.
As a farewell, Frans Bocken reminds us of a Dutch slogan from the 1970s: "baas in eigen buik," which means "boss in your own belly". For this he stands. "I think it’s nice to defend this." If it must be, also across national borders.