15 April 2024

Over the past three and a half years, a multidisciplinary research network with over 30 scientists from six colleges and universities has analysed the life situations and needs of unintended pregnant women, their support and care requirements and the care structures in Germany. The project "Experiences and life situations of unintentionally pregnant women - counselling and care services (ELSA)" was funded by the Federal Ministry of Health on the basis of a decision by the German Bundestag. To date, there is no comparably comprehensive and well-founded study for Germany. The overall report, including recommendations for action, should be available in autumn. Due to its high relevance, the project is already making selected results available.

The ELSA study pursues a multi-perspective approach. The research network examines various facets of the topic of unwanted pregnancies and abortions. The perspective of women who terminate or carry unintended pregnancies to term, the perspective of doctors and the perspective of specialists and managers from advice centres are combined with analyses of the current status of psychosocial and medical support and care services in their regional diversity. The Fulda University of Applied Sciences, the Social Science Research Institute for Gender Issues Freiburg, the Merseburg University of Applied Sciences, the Free University of Berlin, the Nordhausen University of Applied Sciences and the Department of Psychiatry and Psychotherapy II of the Medical Faculty of the University of Ulm are involved in the ELSA study. In addition to medical experts, the project advisory board also includes professional associations and counselling organisations.

Focus on life situations and well-being

The main topics of the ELSA study are the living conditions and well-being of unintended pregnant women as well as the medical and psychosocial care situation, the utilisation of existing services and the barriers that make access difficult. To this end, women who had terminated or carried an unintended pregnancy to term were surveyed. Women with wanted pregnancies were also surveyed as a comparison group. Surveys of counselling centres and doctors form a further basis of the study. Methodologically, both quantitative and qualitative surveys and analyses were used. The researchers also analysed structural data on medical and psychosocial care. The central data basis of the study is a standardised online survey of over 5,000 women with unwanted or wanted pregnancies. This survey includes a representative survey of 4,429 women who have carried an unwanted or wanted pregnancy to term. For this purpose, women with children under the age of six were randomly selected from residents' registers. Secondly, a sample of 662 women who had terminated a pregnancy - not representative in a statistical sense - was surveyed, who were invited to take part in the survey via doctors' surgeries, advice centres and social media.

Stresses, resources, coping processes

In predominantly qualitative-empirical in-depth studies, the researchers investigated the burdens, resources and coping processes of women who are unintentionally pregnant and carry this pregnancy to term or terminate it, taking into account the support they receive and their experiences of care. Specific vulnerable groups were also included: Women in violent relationships, women with mental illness, with migration or refugee experience and women with traumatic experiences in childhood. In addition to data from a special evaluation of the abortion statistics of the Federal Statistical Office, the structural data analyses included specially researched georeferenced data from practices and clinics that perform abortions, as well as from counselling centres.

According to the current status of the analysis, the data shows that

- Women with unintended pregnancies are more likely than women with wanted pregnancies to find themselves in unsuitable or difficult circumstances for starting or extending a family.

- Access to medical care varies from region to region and ranges from comprehensive coverage to underserved regions.

- The staffing requirements for mental health care are being implemented nationwide.

- Women encounter barriers when having an abortion, for example when it comes to access to information, the costs of abortion or access to care.

- Vulnerable groups have specific requirements for psychosocial and medical care that are not currently met by the services on offer.

- 65 per cent of doctors who perform abortions have experienced stigmatisation in their private, professional or public environment as a result.

- Doctors who have learnt how to perform abortions during their specialist training are also more likely to perform abortions later on.

More customised support and care services

"The insights gained into the experience and processing of unwanted pregnancies, psychosocial counselling and support services and the medical care situation can be used at both federal and state level as well as by institutions and facilities to develop these support and care services to better meet the needs of women and, if necessary, to make the appropriate health and specialist policy decisions," explains Daphne Hahn, project manager and Professor of Health Sciences and Empirical Social Research at Fulda University of Applied Sciences. This could, for example, involve improving access to and quality of information for women and reducing experiences of stigmatisation, as well as expanding resources or structures for medical care, qualifying specialists and expanding cooperation and interfaces between advisory services and care services. "All of this always serves the goal of providing unintentionally pregnant women with the best possible support and safeguarding their reproductive health."

The ELSA project provides fact sheets with the selected results on request. These can be requested via the following e-mail address:

Scientific contact:

Project ELSA Daphne Hahn, Fulda University of Applied Sciences E-mail:

Tilmann Knittel, Social Science Research Institute for Gender Issues at FIVE e.V. Freiburg (SoFFI F.) E-Mail:

Science communication:

Dr Antje Mohr, Fulda University of Applied Sciences Tel.: 0661 9640 1050 E-Mail:

Scientific contact Nordhausen University of Applied Sciences:

Prof Dr Petra J. Brzank E-mail: