Barriers to abortion care for recently arrived migrants in Germany

In Germany, abortion is criminalised but permitted without punishment through a specific mandatory counselling process. Navigating this highly regulated pathway may be particularly challenging for recently arrived migrants such as asylum-seekers, who often face specific vulnerabilities. The study analyses the barriers to access to abortion for recent migrants in Germany, to identify barriers for recent migrants with unwanted pregnancies by analysing qualitative data from 17 interviews with counsellors providing mandatory counselling, client advocates, and healthcare providers in the federal states of Berlin and Brandenburg. We employed a thematic analysis approach using MaxQDA. We identified two kinds of barriers for migrant access to abortion care in Germany. The first includes barriers that arise from the current legal frameworks for abortion and for migration, specifically related to mandatory counselling for abortion-seekers in Germany, and housing in collective large-scale accommodation facilities for asylum-seekers. The second relates to health system capacity and includes barriers that directly result from the limited and unequal availability of information and services in the languages spoken by clients. Interviews revealed a clear difference between Brandenburg, where abortion services are limited and predominantly provided by white German-speakers, and Berlin, where there is a more diverse network of healthcare providers, client advocates and support persons, relatively better access to care for migrants and language needs are more systemically addressed. Our findings of the disproportionate barriers experienced by migrants and asylum-seekers under the current abortion pathway further underscore the importance of the recommendation for decriminalisation of abortion in the first trimester, and of the diversification of healthcare providers. This would ensure better access to abortion care for migrants and asylum-seekers, themselves often a vulnerable group at higher risk for an unwanted pregnancy.