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HEALTH

How German reproductive laws are pushing women to seek therapy abroad

High costs and restrictions around egg donation are driving international women in Germany to seek reproductive therapy abroad. But the traffic-light coalition has promised that change is on the way.

A woman takes a pregnancy test.
A woman takes a pregnancy test. Photo: dpa/CLARK

Berlin resident and freelance writer Laura Rosell is currently 37, and “always wanted kids,” but isn’t ready to have them yet.

As a compromise, this spring she bit the bullet and underwent egg extraction for the purpose of freezing eggs for the future. It wasn’t her first choice.

“I never thought I’d be pushing 40 while having to inject myself with a pricey cocktail of hormones to preserve any sliver of a chance of maybe being able to make babies one day with the love of my life,” she wrote in an essay on Medium

And she struggled with the decision: in a much-discussed post in International Women In Berlin, Rosell spoke frankly about her worries regarding the costs of the procedure, which isn’t covered by German health insurance.

“Financial struggle has been my entire adult life,” she said candidly. Freezing eggs meant losing what little financial cushion she had.

“I go back to being broke: unable to travel, unable to take time out to write my book, unable to socialise much (and meet men) — basically all the things I want to do before I’d feel ready to have kids in the first place,” she explained.

But other avenues to motherhood are difficult in Germany as well—with Rosell’s age, she foresaw potentially impassable obstacles to any attempt to adopt. Meanwhile egg donation remains illegal in Germany, both with regards to availing oneself of donor eggs, and to altruistically donating extra eggs from an expensive extraction-and-freezing procedure to other women.

“I asked about donating my eggs to someone else if I don’t use them, and the doctor told me this is one of the countries that prohibits donating eggs,” she recounted.

In the end, to preserve her chance of having children further down the road, Rosell accepted the costs. “Two weeks of prep, thousands of dollars… and I got just three eggs,” she wrote.

READ ALSO: OPINION: Germany, we need to talk about sexism

Labyrinthian procedure

The dilemma that Rosell was faced with is a familiar one for women in a country in which reproductive issues are tangled up in a labyrinth of laws and high costs.

In-vitro fertilisation (IVF), while legal, is comparatively expensive in Germany, a fact that drives many women to seek care elsewhere.

While IVF and egg freezing were often cheaper in countries like Poland, Bosnia and the Czech Republic, it isn’t merely a question of cost—the freedom to avail oneself of donor eggs, or in turn to donate away excess eggs from an extraction procedure for personal freezing, remains out of reach in Germany.

Expat women who responded to Rosell’s post on Facebook spoke of traveling to Denmark, for instance, to be able to have egg donation as an option.

Eggs are prepared at a fertility clinic in Berlin. Photo: dpa | Rainer Jensen

But Germany’s new centrist coalition plans to bring about changes. At least regarding the cost of basic IVF and which constellations of parental units are able to benefit, hope is on the horizon.

The coalition agreement promises improved financial support for IVF, with full coverage of the costs, independent of familial status and sexual orientation. Restrictions on age will also be up for critical review.

Yet the question of enabling egg donation remains a matter for a new special commission to explore, along with strictly altruistic surrogacy.

‘Swift implementation’

The Free Democrats (FDP) have introduced drafts of legislation in the past in support of legalising egg donation, but these failed to make it past the previous coalition of Union and SPD.

In public debates surrounding the issue, the German Medical Association (Bundesärztekammer) came down in favour of regulated legalisation, while assorted lobbying groups, including organisations with theological ties, argued against it.

“Other parties are still going through the process of consolidating their opinions on these topics,” Katrin Helling-Plahr, legal spokeswoman for the FDP told The Local.

She expressed confidence that the traffic-light coalition’s plan to appoint a commission on reproductive self-determination would “contribute to an open and broad debate” around the opportunities offered by reproductive medicine.

“Then we could also see further possibilities for reforms towards a modern law—with elements like the legalisation of egg donation or surrogacy for purely altruistic reasons,” she said.

“With the coalition contract, we have succeeded in reaching a new beginning in the legal framework for reproductive medicine,” said Helling-Plahr. She promised that her party would work for a “swift implementation” of these goals in the area of reproductive medicine, and would “continue to advocate for the legalisation of altruistic surrogacy and egg donation.”

The timeline for all these intended and potential changes, however, remains up in the air.

The aforementioned goals are under the aegis of the Federal Ministry of Health,” explained Helling-Plahr. “They are currently working to a timetable that at this point in time I haven’t seen.” 

READ MORE: Do Germany’s planned changes to abortion laws go far enough?

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HEALTH

How much more residents in Germany might have to pay for health insurance

People in Germany saw an increase in health insurance costs at the start of the year. It's now expected that they will be hiked up again next year.

How much more residents in Germany might have to pay for health insurance

Health insurance organisations are warning that costs will be hiked up again soon due to concerns over funding. 

Doris Pfeiffer, CEO of the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), told Germany’s Tagesschau that insurance funds are expecting a billion-euro deficit.

She said it was a tough year “because we don’t have particularly good prospects”.

For people paying statutory health insurance, things could become more expensive next year. Around 90 percent of people in Germany are covered by statutory health insurance.

The contribution rate is fixed by law and stands at 14.6 percent. The additional contribution that the health insurance funds set for their members was raised to 1.7 at the start of this year. 

The latest increase gave statutory insurance funds the ability to charge up to 1.7 percent on top of the standard 14.6 precent contrinution, though not all insurance funds chose to do so.

The costs are split between the employer and employee, so workers in Germany would pay half of any increase. 

READ ALSO: Reader question: How can I change my German health insurance provider?

How much could additional costs rise next year?

Due to the funding issues, health insurers expect an increase of up to 0.6 percentage points to the additional contribution threshold. What this would mean for the insured depends on a few variables such as their income and their insurer.

Someone earning €2,000 gross per month, for example, would have to pay €6 extra per month if their insurer opted to increase additional contributions by this amount. Meanwhile, a gross income of €4,000 would mean €12 extra per month. The employer’s share would be added to this. 

health insurance cards

Many health insurance cards in Germany double as a European Health Insurance Card (EHIC), meaning that they can be used across Europe. Photo: picture alliance/dpa | Jens Kalaene

“That may not sound like much at first glance,” said Pfeiffer. “But there are people who earn very little for whom this is a lot – supermarket cashiers, lorry drivers.”

It comes following a rise in fees at the start of the year. From the start of 2024, additional contributions for statutory health insurance rose by around 0.1 percent in Germany.

Why are costs increasing?

The German healthcare system is one of the most expensive in the world.

As German society ages more, costs continue to rise – and the Covid pandemic didn’t help matters. The National Association of Statutory Health Insurance Funds estimates that this year alone it will cost around €314 billion to provide care for everyone who is insured. 

The money is mainly spent on hospitalisation costs and medical treatment.

READ ALSO: Why long-term care insurance fees are likely to rise in Germany next year

Health Minister Karl Lauterbach (SPD) has so far not presented any concrete proposals on how he intends to relieve the burden on health insurance funds in future.

Instead, the system is likely to face further expenditure. Lauterbach’s hospital reform is expected to drive up costs, while proposals to pay GPs more in order to combat the shortage of doctors would also push up expenses. 

READ ALSO: German ministers greenlight plan to improve healthcare at GPs

Pfeiffer called for a plan to tackle the rising costs.

“We now finally need an approach that puts this healthcare system on a new footing,” she said.

In the coalition government’s initial agreement back in 2021, the parties vowed to support health insurance funds with more tax revenue.

But as difficult budget negotiations take place, it doesn’t look like this will happen. 

This is causing friction among the coalition made up of the Social Democrats (SPD), Greens and Free Democrats (FDP). 

Green budget politician Paula Piechotta, for instance, is unhappy about this.

The opposition CDU/CSU also taken the opportunity to swipe at the government.

“This is not acceptable,” said CDU health politician Sepp Müller. “The tense situation in the social security system cannot continue to be ignored.”

However, it should be noted that there was no plan to help provide more money to statutory health insurance under the previous Health Ministry headed by the CDU’s Jens Spahn. 

When the SPD’s Lauterbach took over in 2021, there was already a funding gap of billions of euros. 

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