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Women’s Health in Germany
However, it is important to note that ob/gyn care in Germany distinguishes clearly between gynecologists and obstetricians (Geburtshelfer). In case you are going to have a baby, you will have your pre-natal checkups at your usual gynecologist in Germany; but they will only be present during the birth if they happen to work as an obstetrician at your hospital of choice as well. All other exams and minor surgeries with regard to women’s health are the responsibilities of any normal gynecologist in Germany. They are the person to see for cancer screening, reproductive health, urinary tract infections, sexually transmitted diseases, etc.
For every woman over the age of 20, both state-funded and private health insurance in Germany covers an annual exam at her gynecologist to check for early symptoms of cervical cancer, ovary cancer, breast cancer, and similar cancers of the reproductive organs (Krebsvorsorge). Just tell your gynecologist in Germany that you are here for your yearly checkup, and they will know exactly what to do. Cancer screening at a German gynecologist includes the following:
- having your blood pressure taken
- questions about your medical history and cases of cancer among your relatives
- examination of vulva, vagina, cervix, uterus, and ovaries (pelvic exam and abdominal exam)
- Pap smear
- breast exam (usually for women over 30; however, your doctor may make an exception, for example, if you have an increased breast cancer risk)
- rectal exam (for women over 45)
As mentioned above, any German health insurance provider should pay for this yearly examination since it is part and parcel of basic medical care in Germany.
Your gynecologist can also advise you when you have any questions on contraception (Empfängnisverhütung) and reproduction or when you are unexpectedly dealing with an unplanned pregnancy and may be considering a termination of pregnancy (Schwangerschaftsabbruch).
All usual methods of contraception (Verhütungsmittel) are easily available in Germany. You can buy condoms at every drugstore or pharmacy. However, hormonal contraceptives (the birth control pill, implants, injections), IUDs (intra-uterine devices such as the spiral), and diaphragms are prescribed by a gynecologist.
Your doctor can also offer you counseling and advice on sexual issues and contraception, but your health insurance will not cover the costs for the contraceptives themselves. You have to pay for these from your own pocket. There are certain exceptions for birth control pills, but these are indeed the proverbial exception to the rule.
As in lots of other countries, abortion (Abtreibung) is a controversial topic in Germany. German law – or, to be more precise, § 218 of the German penal code – has come up with an odd compromise, which defines the status of abortion under certain circumstances as “illegal, but without threat of punishment”. In practice, this means that both the patient and her ob/gyn may decide upon an abortion together in one of the following three cases:
- An abortion on criminal grounds is permitted in cases of sexual assault (rape, abuse, incest) within 12 weeks after conception.
- An abortion on medical grounds is allowed within 22 weeks after conception if the mother’s life is in danger or if the pregnancy poses serious risks to the mother’s health or psychological wellbeing. If the child is likely to be born with a physical or mental disability, the doctor is legally obliged to give the pregnant woman detailed information on caring for children with disabilities before she may opt for an abortion.
- Abortions on criminal as well as medical grounds have to be recommended by an independent doctor (i.e. not the ob/gyn performing the abortion). They are usually covered by health insurance companies.
However, most abortions in Germany (97% in 2009) are abortions on demand. A woman may terminate her pregnancy within 12 weeks after conception. For this purpose, she first needs to have the pregnancy officially confirmed before obtaining a certificate (Beratungsschein) from a licensed counseling center, such as ProFamilia. After a waiting period of three days after the counseling session, a doctor is then allowed to perform an abortion. The patient has to pay for the procedure herself, but some low-income women may be eligible for financial support.
If you should find yourself in a difficult situation when you consider terminating a pregnancy, try to find out what your ob/gyn’s views on the topic are. For example, there have been (rather rare) cases when an anti-abortion gynecologist issued misleading information on abortion methods or when doctors tried to manipulate patients into aborting a fetus with a high risk of disabilities. Moreover, church-funded hospitals are often opposed to abortions. Catholic hospitals usually won’t administer the so-called abortion pill (not identical with the morning-after pill), although it is actually legal in Germany for the first 63 days of a pregnancy.
In any case, a good gynecologist will always try to tell you as much as possible about the legal and medical situation, the procedure itself and any potential complications, counseling clinics and support groups (especially if your fetus has been diagnosed with specific disabilities). They should help you make an informed and responsible decision.
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