The fragility of abortion access in Europe: a public health crisis in the making

Poland is rightly being criticised for suppressing abortion services.¹ Since January, 2021, abortion is only legal if the pregnancy is directly life-threatening or the result of rape or incest. However, countries with allegedly more progressive policies have reasons to be self-critical as well.

An example is Germany, considered a liberal country in terms of abortion law from an international perspective, since women can be granted an abortion on request for any reason, including socioeconomic reasons. Yet, abortion in Germany is technically a crime (albeit not punished up to 12 weeks from conception), and gynaecologists are losing court cases for stating on their websites that they provide abortion care in a supportive environment.² Attacks on abortion rights and services are nourished by vocal conservative and religious forces whose agendas find support in a non-negligible share of the population.

The number of doctors providing abortion services is declining,³ teaching of abortion techniques in medical schools is marginal,⁴ and a mandatory consultation before an abortion (in some regions done by religious organisations) and a so-called cooling-off period add barriers to access.⁵ As a result, some women from Germany (and other European countries) are seeking care in the Netherlands, as highlighted by the Europe Abortion Access Project.

Women on Web, a non-governmental organisation, has recently recorded an increased demand for abortion pills in Germany.⁶ The COVID-19 pandemic has created further access challenges, in the form of reduced opening hours of clinics, fewer social infrastructures, and rise in domestic violence. Contrary to some other countries (eg, the UK and France),⁷ demands from reproductive health activists to modify medical abortion delivery (eg, through telecare or drug mailing) have remained unheard in Germany.

Yet Germany is still seen as a safe haven for Polish women who are living in fear under one of the strictest abortion laws in Europe. Poland and Germany are only two examples of how fragile abortion access remains in Europe (in both constrained and more liberal societies) paving the way for a public health crisis. Denied or reduced access to abortion services has short-term and long-term health consequences, and disproportionately affects the most vulnerable groups in societies. Initiatives led by civil society (eg, Doctors for Choice, Women on Web) and crossborder care alone cannot compensate for the scarcity of governmental impetus, and cannot mitigate the threats to abortion rights coming from growing right-wing and anti-feminist movements in Europe. As a matter of health equity, abortion access needs to be sustainably guaranteed in practice, including beyond the allegedly permissive legislations.

CM reports funding from Bielefeld University, Germany, for a postdoctoral researcher position. OR declares no competing interests. The funders had no role in the writing of or decision to submit this Correspondence.