Bavaria threatens to reduce abortion access

Bavarian women's access to termination of pregnancy will be reduced if a cabinet proposal becomes law. In a bill currently before its state parliament Bavaria proposes to restrict both the type of doctors allowed to terminate pregnancies and the amount of their income that may be earned from performing this procedure. This could force some clinics to close and make it harder for women to find doctors who will carry out terminations of pregnancy.

If passed, the bill will allow only holders of a full specialist qualification in obstetrics and gynaecology to carry out terminations of pregnancy. Until now “other appropriately qualified doctors” have also been explicitly included in the wording of national guidelines. The bill would also restrict the proportion of a doctor's income that may be derived from performing termination of pregnancy to 25%.

If the proposal became law it would threaten the right to practice of a small number of doctors in Bavaria who carry out a large proportion of terminations of pregnancy for social reasons. Dr Andreas Stapf, for example, who works in Munich, is not a specialist gynaecologist but with a colleague in Nuremberg carries out 50% of all socially indicated terminations of pregnancy in Bavaria. In Bavaria, only medically indicated terminations are available on state health insurance.

All of Dr Stapf's income comes from carrying out terminations. “If this becomes law,” said Dr Stapf, “I will have to close. This will not lead to a reduction in the number of terminations but to a dramatic worsening of the service provided to Bavaria's women.”

In a letter to colleagues and ministers Dr Stapf accuses Bavaria of an unwillingness to abide by federal law. This is, he claims, an unconstitutional attempt to pursue a conservative policy by the back door.

The liberal law of the former German Democratic Republic and the more conservative West German law were synthesised into a single code in August 1995 and came into effect on 1 January 1996. This followed detailed discussion in a government “select committee for the unborn,” at which Dr Stapf was an expert adviser.

The committee agreed to allow the practice of abortion by appropriately trained non-specialists, in contrast with the Bavarian proposal.

The Bavarian cabinet, however, argues that the national law is open to interpretation.—SANDRA GOLDBECK-WOOD, BMJ