Unintended Pregnancy While Fleeing and in War Zones
Many women in war zones and on the move are affected by sexualized violence. In
particular, sexual violence is often used as a weapon of war.
These women frequently lack access to contraception and abortion services. Unintended
pregnancies are taboo and stigmatized.
Access to abortion while fleeing is a matter of chance. Although counseling services exist,
not all women can reach them.
Women who are displaced or living in conflict areas have little access to medical care.
Many women are therefore forced to resort to alternative methods of terminating a
pregnancy. This often has fatal consequences that can even lead to death.
Unintended Pregnancy After Fleeing – Legal Situation and Services
Pregnancy Conflict Act / Section 218 et seq. of the German Criminal Code
An abortion is, in principle, illegal under the German Criminal Code, but it is not punishable
in certain cases, for example:
● if it takes place within twelve weeks of conception (calculated from the beginning of
the last menstrual period: up to the 14th week of pregnancy) and after mandatory
counseling (§ 218a StGB), or
● if medical or criminological indications exist (for example, danger to the life or health
of the pregnant woman, or pregnancy resulting from rape).
Coverage of Costs & Financial Need
For women who are financially in need, there are legal provisions under which the federal
state or the health insurance fund can cover the costs. Key points include:
● Income below certain thresholds and no readily available assets.
● Benefits under the Asylum Seekers’ Benefits Act (AsylbLG) are relevant: refugees
receiving these benefits may be eligible.
There is a procedure for applying for cost coverage. Preliminary examinations, follow-up
care, or complications are often treated separately—for these, a treatment voucher may be
required if the AsylbLG applies.
Specific Barriers for Refugee Women
Although the legal right exists, refugee women face various practical obstacles:
- Language Barriers & Cultural Differences
○ Information is often not available in their native language or in plain,
easy-to-understand German.
○ There is sometimes a lack of awareness about what is permitted in Germany
or how the procedures work.
○ Counseling centers and medical staff are not always prepared for
communication difficulties—studies specifically highlight this. - Bureaucracy and Proof Requirements
○ Proof of residency status or address, as well as documentation of benefits
received, income, and assets, is required—difficult when ID papers are
missing or status is uncertain.
Treatment Voucher
For services under the Asylum Seekers’ Benefits Act, a treatment voucher often has to be
requested for doctor visits or medical care. This can lead to delays. - Costs & Financing
○ Even when cost coverage is granted, preliminary examinations, travel, and
translation services can create additional expenses or effort.
○ There are income limits to qualify as “in need.” While refugee women often
meet these criteria, the application process can still be complex or unfamiliar.
- Time Limits
○ Mandatory counseling plus a waiting period (at least three days between
counseling and the procedure) are required.
○ This timeframe can be especially challenging for refugee women, for example
if they live in transit accommodations or have difficulty securing appointments.
In some regions or municipalities, doctors or clinics that provide abortions are difficult to
reach. ⇒ This can mean long travel distances, lengthy waiting times, or limited availability. - Stigmatization & Uncertainty
○ Social or religious norms from countries of origin play a role, often
accompanied by shame and fear of being discovered by family or community.
ncertainty about what is legal, or fear of legal consequences, especially for
those without a secure residency status.
○ Lack of confidentiality or fear of discrimination can lead women to avoid
openly expressing or seeking an abortion.
Conclusion
Overall:
● Legally and normatively, access exists: Refugee women are entitled under certain
conditions to abortion, counseling, and cost coverage.
● In practice, many obstacles remain: Access is hindered by factors such as place of
residence, residency status, language skills, financial resources, access to
information, and local infrastructure (e.g., availability of counseling centers or
doctors).
● Regional differences matter: Some federal states offer more support, interpreters,
and local services, while others provide significantly less.
Abortion Laws and Struggles Worldwide – Argentina
The fight for abortion rights in Argentina has a long history and tradition. It began in the
1970s, was interrupted by the military dictatorship from 1976 to 1983, and resumed in the
1980s. The law in force at the time had been passed in 1921 by an all-male congress.
Emerging from the National Campaign for the Right to Legal, Safe, and Free Abortion (La
Campaña Nacional por el Derecho al Aborto Legal, Seguro y Gratuito), which grew out of
the National Women’s Conference, Argentina’s feminist movement expanded over the years.
Activists fought for an abortion law both on social media and in the streets, recognizable by
their green scarves—a symbol of protest and solidarity. This “green wave” (marea verde)
swept through streets and public squares.
Estimates indicated Argentina had one of the world’s highest numbers of clandestine and
unsafe abortions: about 750,000 births and 500,000 abortions each year, with 300–500
deaths annually. These deaths were largely due to unhygienic conditions of illegal abortions
performed by non-medical practitioners. Thousands of women have died from such
dangerous practices. Activist and physician Rosa Angela therefore calls for adequate
healthcare in rural regions: “Local healers induce abortions with obscure methods, and
maternal mortality is especially high there.”
Overall, the feminist movement introduced seven legislative initiatives before Argentina’s
parliament finally debated legalization for the first time in 2018, though that effort failed. One
major obstacle was the powerful influence of the Catholic Church, which enjoys significant
state funding and tax exemptions.
Only on December 29, 2020, was a law passed—drafted by the governing coalition rather
than directly by the feminist movement—that allowed women to have a legal abortion within
the first 14 weeks of pregnancy. Before that, abortion was only legal in cases of rape or
when the pregnant person’s life was at risk.
Since the law’s enactment, the Ministry of Health reported that by October 2023 a total of
245,015 people had used the public health system for a safe abortion. Abortion-related
deaths dropped by 53 percent between 2020 and 2022. In addition, a coalition of four
socialist organizations, the FIT-U, has used its seats in Congress to continue advocating for
feminist issues such as protecting abortion rights and expanding comprehensive sex
education in schools.
However, since the inauguration of right-libertarian president Javier Milei in December 2023,
social and feminist achievements—including the abortion law—have come under threat.
Parliamentary attempts to repeal the law have failed so far, but the Office for Sexual and
Reproductive Health reported shortages of essential supplies needed to perform abortions.
For example, a complete halt was placed on the procurement of the medications misoprostol
and mifepristone, which are commonly used for medical abortions in Argentina.
China
In 1979, China introduced a birth-control policy that initially allowed each family to have only
one child. To enforce it, the government used extremely brutal methods: if a woman became
pregnant without permission, she was forced to have an abortion—even in the seventh or
eighth month of pregnancy. Most affected women lived in rural areas and were too poor to
afford medical care. Many who were forced to undergo one or more abortions died from the
consequences; survivors often suffer lifelong pain.
Most of these women had little or no formal education and no access to contraception.
Instead of improving that access, the Chinese government compelled women to undergo
abortions or sterilization. At the same time, the one-child policy created widespread access
to abortion services.
The policy has since been gradually relaxed in response to an aging population and a
growing labor shortage: in 2015 the limit was raised to two children, and in 2021 to three.
The long-standing restriction also led to widespread sex-selective abortions, as male
children were culturally preferred. As a result, by 2023 there were about 30 million more men
than women in China. This gender imbalance has fueled marriage tourism, human
trafficking, the abduction of girls, and sexual violence against women and girls.
China has no single, specific abortion law. However, in 2018 some provinces restricted
abortions so that procedures after the 14th week of pregnancy are permitted only for medical
reasons. Policies may continue to shift as the government seeks to counter slowing
population growth; for example, national guidelines issued in 2021 already call for limiting
“non-medically necessary” abortions.
Poland
Poland has the most restrictive abortion laws in Europe. Until 1989 – until the fall of the
communist system – abortions were allowed in four cases: after rape, if the life or health of
the pregnant person was at risk, in cases of severe fetal impairment, or due to the woman’s
difficult socioeconomic situation. In 1989, a first draft law was introduced, aiming to remove
the last of these options. This led to many protests and the formation of new organizations,
such as FEDERA. Nevertheless, the conservative government achieved its goal in 1993,
and the fourth option for a legal abortion was eliminated.
From then on, the overall situation for legal abortions worsened, and tensions continued to
rise. This culminated in 2020 with another law that also prohibited abortions in cases of
severe fetal malformations. From that point on, legal abortions in hospitals were only
possible in cases of rape or when the pregnant person’s life or health was at risk. Even
providing assistance became punishable: since then, it has been illegal to give someone pills
for an abortion to carry it out at home.
These strict legal regulations have had such far-reaching consequences that pregnant
women in Polish hospitals die because they develop illnesses (e.g., sepsis) due to their
pregnancies and are still denied an abortion. For years, people have been protesting this
policy, and organizations and networks from activist circles have emerged to support people
with unwanted pregnancies. Abortion is the issue that mobilizes Polish society the most. In
October 2023, there was great hope surrounding the new elections, with 70 percent of
women voting. Yet despite many promises, little has truly changed to this day.
In the United States, abortion laws have undergone many changes over the years. In the
early years of the country, abortion was not necessarily a controversial issue. However, in
the late 19th century, opposition to the procedure grew, and it gradually became taboo, until
it was declared illegal by the mid-20th century. At that time, abortions were only legal if the
pregnancy endangered the mother’s life or was the result of incest or rape.
This changed in 1973 with the landmark case known as Roe vs. Wade. In this lawsuit,
Norma McCorvey, under the pseudonym Jane Roe, along with her two attorneys, Linda
Coffee and Sarah Weddington, sued the state of Texas and the Dallas district attorney,
Henry Wade. McCorvey had become pregnant for the third time at age 26, struggled with
drug and alcohol problems, and wanted an abortion, which was illegal in Texas at the time.
The attorneys argued that Texas’ broad abortion ban violated the U.S. Constitution. After the
Texas district court declared the state’s abortion law unlawful, Roe and her attorneys
appealed to the Supreme Court.
The Court ruled that abortions were legal until the fetus was viable outside the mother’s
womb, generally between the 24th and 28th week of pregnancy. Before this point, states
could only restrict abortions under very limited conditions. With this decision, the Supreme
Court instantly declared the existing abortion laws of 46 states unconstitutional.
The effects of this ruling were significant: it is estimated that up to 130,000 illegal abortions
were performed annually in the U.S. before the 1973 ruling. Just two years later, this number
had dropped to 17,000, according to the U.S. health authorities. The number of women who
died as a result of illegal abortions fell from 39 in 1972 to three in 1975. By 1980, 1.6 million
legal abortions were performed in the U.S., and over time, abortions became safer, more
accessible, and more affordable.
This law, though interpreted differently by states through bureaucratic hurdles, remained in
effect for 50 years. However, in 2022, the landscape changed again when the
now-conservative Supreme Court overturned the nationwide right to abortion by a 5-to-4
vote. From that point on, the decision on abortion laws was left to individual states.
As a result, many conservative states tightened their abortion laws. Thirteen states, mainly in
the southern U.S., have largely banned abortions, allowing them only in extreme cases,
even in the first weeks after conception. Several other states shortened the abortion
deadlines or permitted abortions only if the pregnant person’s physical health was at risk.
Sixteen Democrat-led states codified a liberal right to abortion.
These changes triggered repeated protests and referendums on abortion rights. In response,
President Biden issued two executive orders to ensure access to abortion pills and to make
it easier for women to travel to other states for abortions. Shortly after taking office in 2025,
Donald Trump overturned both of these orders with his own decree. His administration also
blocked funding for international organizations that provide or support abortions; foreign
organizations no longer receive financial aid from the U.S. if they even mention abortion in
their counseling. Trump also pardoned 23 anti-abortion activists who had blocked the doors
of abortion clinics, causing delays in time-sensitive procedures, and who had attacked clinic
staff and threatened pregnant women. In June of the same year, Trump further restricted
access to abortions by nullifying another Biden-era guideline that required hospitals to
provide abortions in emergency situations.
El Salvador
El Salvador has one of the strictest abortion laws in the world, where abortions are
criminalized in all cases – including after rape. Women who see no other option often have
to rely on unlicensed practitioners, putting their health at serious risk. Dozens of women
have been imprisoned following miscarriages and sentenced to long prison terms under the
pretext of having had an abortion. Alongside the USA, Poland, and Nicaragua, El Salvador is
one of the four countries where abortion laws have become more restrictive in recent years.
Canada
In contrast to the USA, abortion in Canada is fully decriminalized. Since 1969, abortions
were permitted if the life or health of the pregnant person was at risk. However, the
procedure could only be performed in public hospitals, where a committee of three doctors
had to approve it. This resulted in significant practical differences between hospitals. Dr.
Henry Morgentaler opened a private abortion clinic in defiance of the law, for which he was
arrested and convicted. The case went to the Supreme Court, which in 1988 declared the
legal framework unconstitutional, as it violated the constitutionally protected rights to life,
liberty, and security of the person.
Since then, abortions have been recognized as a health service. While the implementation
varies regionally, they are universally considered medically necessary. Thanks to this
accessible system, 86.8 percent of abortions in Canada are performed before the 12th week
of pregnancy. Canada has the lowest maternal mortality rate and the fewest complications
from induced abortions worldwide.