Covering the costs of abortions is apparently more complicated in Bremen than in many other federal states. Anyone who earns little and would like to have an abortion paid for by the state must submit an application to the health insurance company – and provide documents to prove that they are below the income limits and actually live in Bremen. Confirmation of registration, bank statements, confirmation of income: What is specifically required varies from fund to fund.
The government factions now want to change that – a motion initiated by the Die Linke faction will be presented to the citizens this Thursday. In the future, the application process should work on a trust basis, as it does elsewhere.
Abortions are time-sensitive: Normally, they are only possible without penalty for 14 weeks. Until then, you need confirmation of pregnancy conflict counseling, you need doctors who agree to carry out the abortion – and it takes between a good 200 and 500 euros: an abortion that is not medically indicated, is not covered by health insurance.
In many cases, the federal states actually cover the costs: The Pregnancy Conflict Act, a federal law, stipulates that a woman is entitled to reimbursement of costs if “she cannot reasonably be expected to raise the funds to terminate a pregnancy and she has her domicile or habitual abode within the scope of this law”. Specifically, all pregnant women who receive social benefits or earn less than 1,500 euros net are currently eligible; Each child increases the limit by 356 euros; rents over 440 euros are also eligible.
Onerous administrative arrangement
The Pregnancy Conflict Act is worded quite low-threshold: “The procedure will be carried out in writing at the woman’s request,” it says in paragraph 20. “Facts must be made credible.” In many places this is probably interpreted as meaning that an oral request is sufficient: anyone who declares a need will be believed. In most federal states, a simple self-declaration that the information provided is correct is sufficient, according to the Bremen Left.
In Bremen, however, there is an administrative agreement from 2002 between the state government and health insurance companies. It states that when examining applications, health insurance companies must generally require evidence of receipt of social benefits or income and assets. The coalition factions write in their application that this is only regulated in a similar way in North Rhine-Westphalia, Saarland and Saxony-Anhalt.
This is not banal: written evidence is not always available, especially for people in precarious life situations. Anyone who makes ends meet by working illegally does not receive a pay slip; Even everyone who lives with their partners on their income has no documentation. And if you suffer from depression, for example, you may have never filed any documents – obtaining new documents costs valuable time.
Things also get complicated for refugees, EU citizens or homeless people: as the Left writes in their application, they often have “their habitual residence in Bremen, but do not always have the required written evidence of this”. The Bremen administrative agreement of 2002 even explicitly excludes some people from the group of beneficiaries: “Foreign women who are (illegally) staying in Bremen without a residence permit, authorization or permit” are not entitled to reimbursement of the costs of an abortion, it says.
“This contradicts the law and must be changed,” the application states. After all, “habitual residence” does not result from a specific residence status, but rather, according to the legal definition, is simply the place where someone “does not just stay temporarily”.
There were around 1,580 abortions of Bremen residents in Bremen in 2024. How many of them submitted applications and how many applications were ultimately accepted can no longer be answered by the responsible social authority on Wednesday by the time of going to press. The health insurance companies requested do not differentiate between the numbers according to the applicants’ federal states. The AOK Bremen/Bremerhaven alone reports 950 to 1,050 applications per year.
Marina Mohr from the Pregnancy Conflict Counseling Center Cara estimates that only around 20 percent of the pregnant women she advises are clearly above the income limit and do not apply for cost coverage from the outset. However, the vast majority are eligible to apply – the income of partners or parents is not asked for in the applications. She very much welcomes a change in the law: “It’s always hardest for those who do it anyway “Already living on the edge of the subsistence level.”
The administrative agreement can also mean additional work for the health insurance company. “Compared to other federal states, covering the costs of abortions on behalf of the state of Bremen is too complicated,” says the head of the state representative of the Techniker Krankenkasse, Sabrina Jacob. Bremen should establish a leaner administrative procedure, Jacob continued – “in the interests of our insured persons”.