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Introduction: Barriers to accessing abortion care can delay access to services, which can lead to delayed abortion and health risks. Barriers include geographical accessibility, confidentiality, waiting times, stigmatization, poor or inaccessible information and the cost of abortion. This article examines barriers to accessing abortion care in Germany. This includes barriers in the availability and accessibility of care services, access to information, costs associated with abortion and organisational barriers., Methods: The analyses are based on data from an online cross-sectional survey of 594 women in Germany who had an unwanted pregnancy terminated, which was conducted as part of the ELSA Study in 2021 and 2022., Results: The findings indicate that access to abortion care in Germany is associated with various barriers for many women. Of the respondents, 80.1% reported at least one barrier to accessing abortion, 65.5% reported more than two barriers and 40.5% reported three or more barriers. In particular, the non-disclosure of the procedure and the associated fear of stigmatisation represented hurdles for many participants., Discussion and Conclusion: The results of the study underline the need to improve access to safe abortions. Reducing access barriers therefore includes the decriminalisation of abortion, a comprehensive care structure, financial support services, improved information services and the reduction of stigmatisation and discrimination., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: D. Hahn, R. Torenz, I. Thonke, S. Eckardt, M. Schneider, A. Wyrobisch-Krüger, U. Busch, C. Helfferich, T. Knittel, M. Böhm, P. Brzank, C. Knaevelsrud, S. Krumm und S. Schumacher geben an, dass kein Interessenkonflikt besteht. Die Befragungen von ungewollt Schwangeren wurden mit Zustimmung der zuständigen Ethik-Kommission der Hochschule Fulda (positives Votum vom 27.04.2021, Az.: 3.1.9.2-kkm), im Einklang mit nationalen Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patient/-innen liegt eine Einverständniserklärung vor., (© 2024. The Author(s).)

Since 2003, the number of facilities reporting abortions to the Federal Statistical Office has decreased by 46% from 2050 to 1092 in 2021. In the last 5 years, the decrease slowed down. The media report that there is a shortage of physicians willing to perform abortions in some regions of Germany. Reduced availability and accessibility of providers are barriers to access that can negatively impact the health and well-being of abortion seekers. To date, there is no scientific evidence on regional differences in access to abortion in Germany. The article answers the following questions: What data are available in Germany regarding the availability and accessibility of abortion providers? How informative is this data? To what extent do the data show regional differences in availability and accessibility? We conclude that the available data are not sufficient to adequately describe regional variations in the provision of abortion care services. Nevertheless, they give clear indications of differences regarding provider density, provider workload and spatial accessibility, especially between the northern and eastern states on the one hand and the southern and western states on the other. We describe needs and policy recommendations for adequate data collection., (© 2023. The Author(s).)