Experiences with §219 pregnancy advice by phone or video. Client perspectives

The research project “BeSPa: Schwangerschaftsberatung und Sexuelle Bildung während der Covid-19-Pandemie aus Sicht von Fachkräften” (“BeSPa: Pregnancy Advice and Sexual Education During the Covid-19 Pandemic from the Perspective of Professionals”, duration: 7/2020 to 8/2023, see also www.sexualaufklaerung.de/forschungsergebnis/bespa/), was funded by the Federal Centre for Health Education (BZgA). Initially, it surveyed counsellors and sexuality educators from pregnancy advice centres using a quantitative questionnaire survey and qualitative interviews, primarily regarding their experiences with the digitalisation of their activities. This was followed by qualitative telephone interviews with clients who had experience with digital §219 pregnancy advice.² The guided interviews were conducted based on Witzel’s (1985) problem-centred interview, recorded with an audio device, then transcribed and analysed anonymously using qualitative content analysis according to Kuckartz (2016).

We recruited the 20 interviewees with the support of official pregnancy conflict advice centres, a post on Instagram and via the student mailing lists of various colleges and universities. Half of the clients had had a pregnancy advice session by telephone, the other half by video call. At the time of the interviews, the clients were between 17 and 41 years old and stemmed from throughout Germany. Only a small proportion of the interviewees had previously experienced §219 pregnancy advice. For most of those surveyed in the interview, this was their first encounter with this type of counselling.

Although this was not the focus of the survey, many participants also used the interviews to comment on the mandatory advice they had been confronted with. The respondents categorised the legal obligation to have a pregnancy advice interview as “stressful” or “burdensome”, as a “small hurdle” or as an “unnecessary stopover". Ms. Magenta³ is even more explicit in her criticism of the mandatory pregnancy advice: “It still sucked because I thought to myself the whole time: ’Why do I even have to do this? I know I don’t need counselling. I don’t need counselling right now – I need a doctor who can perform an abortion.’”

Various interview statements made clear that the interviewees found it difficult to assess the content and process of the compulsory pregnancy advice before the interview. For example, they stated that they went to the counselling session without any specific counselling concerns of their own but with the sole aim of “getting the certificate” (Ms. Aquamarine). Another frequently expressed concern was “whether you are somehow being influenced” (Ms. Black), or that “they try to persuade you to decide in favour of the child” (Ms. Violet). This is consistent with the results of the qualitative survey of clients in the “women’s lives 3” study (Helfferich et al., 2016), where a large proportion of respondents stated that they had feared or experienced attempts at persuasion during pregnancy advice (cf. ibid., p. 162).

In contrast to mandatory pregnancy advice, however, many interviewees considered a general right to counselling in the context of an unwanted or unplanned pregnancy important and helpful: “It’s good that it’s offered, but [...] not good that everyone has to have this conversation” (Ms. Schwarz).

Despite their predominantly critical assessment of the obligation to undergo pregnancy advice, in retrospect, most interviewees were satisfied with the actual counselling session. Some interviewees justified their satisfaction with the relief that their previous fears had not materialised. For example, Ms. Violet was “very afraid of the consultation [...] and had heard a lot of bad things beforehand [...]” and was then “very, very surprised, but also very happily surprised” by the interview, which she found pleasant. The gain in new information or the mere receipt of the counselling certificate required for the termination also led to a positive assessment: “I was satisfied because it did what was necessary to get the certificate” (Ms. Sepia).

In most of the interviews, however, satisfaction was related to the respective counsellor and their organisation of the counselling situation. On the one hand, this depends on how approachable the counsellor was and their ability to create a protected, value-neutral space for the counselling situation. A personal introduction and explanation of the counselling framework and the normalisation of the pregnancy termination decision contributed to this, so that the interviewees felt “very well looked after and also taken seriously” (Ms. Violet). On the other hand, the interviewees mentioned the methodological competence of the counsellors, demonstrated, among other things, by active listening, taking up the respondents’ comments and wishes, identifying and discussing resources, explaining different perspectives and reacting appropriately to unforeseen situations. The interviewees who received advice together with a partner also described the conversation in the couple setting and the inclusion of the partner as positive: “I also thought it was so great that she engaged with us both appropriately, even though we were at different points” (Ms. White). The adaptation of the conversation, the content and the scope of the counselling to the expressed needs of the interviewees was also positively emphasised, as experienced by Ms. Orange, for example: “She took me through it once [...] at my own pace.”

In contrast, the dissatisfactions expressed are similar to those known from the “frauen leben” survey (Helfferich et al., 2016): They relate, on the one hand, to an assessment of the pregnancy advice as inadequate and, on the other hand, to the feeling of being influenced: “I always had the feeling that she didn’t encourage me in my opinion or my decision – which I had already made – but rather always wanted to steer me in a different direction” (Ms. Fuchsia).

Bomert (2021) describes the potential for more self-determination through digital counselling formats from the perspective of professionals; this was also addressed in the interviews from the client’s perspective and was sometimes cited as one reason for their satisfaction with the counselling session. For example, the interviewees used the possibility of the digital setting to “set up the situation a little more the way you would like it to be” (Ms. Indigo). In combination with the option to end the conversation by simply hanging up or leaving the digital space, this provided the opportunity for more control and security in a – mostly – unfamiliar conversation situation: “Because you are acting from a safe environment. If you are somewhere else, then [there is] this uncertainty of the strange environment and the unknown person. Which might make it a little more difficult to open up at first” (Ms. Umbra). Because of the distance from the counsellor, the interviewees could also concentrate more on themselves and any partners present.

It was easy to integrate the advice session into everyday life because of the reduced time, cost and effort that would have been involved in travelling. This also lowered the organisational hurdles to participating in the counselling: “First, you have to get there – you have to have the time to get there. [...] I have to work, I have children, so I found it much easier for me” (Mrs. Malve). Other advantages mentioned were the greater anonymity, particularly in the telephone setting, and the lack of confrontation with pregnancy termination opponents. In the resulting (digital) protected atmosphere, these interviewees found it easier to discuss the sensitive decision-making processes regarding their pregnancy.

However, some interviewees missed the proximity to the counsellor, which caused them to feel the conversation was rather impersonal, and they felt left alone. They found it difficult to perceive and express their own emotions in the digital format, because, as Ms. Petrol said, “Communication is simply more than speaking and listening, and in online counselling, there is often a lack of gestures and facial expressions. Things just don’t come across so well.” Dissatisfaction with the digital format was also evident when it incurred additional work for the interviewee, as was the case for Ms. Green: “It was annoying that I had the video call and then had to go by and pick up the certificate [...]. I wouldn’t have had to do that if I had gone there in the first place and had the advice session directly.” Using digital formats also meant the interviewees depended on properly functioning hardware and software. Dissatisfaction was described here as well, for example, when unstable connections led to interruptions or setting up the technology led to delays.

The results of the partial evaluation of the interviews from the BeSPa study presented here with clients who used digital formats in counselling according to §219 StGB can be linked to the previously described hurdles that clients face in §219 pregnancy advice (cf., for example, Böhm, 2020; Helfferich et al., 2016; Matthiesen, 2009) as well as to the descriptions of digital fomats by Schmitz (2020) and Bomert (2021), who describe the expansion of formats as an opportunity for more self-determination for clients in §219 pregnancy advice. The interviews in the BeSPa study also show that adding digital counselling formats goes hand in hand with an increase of clients’ options for action and co-determination. At the same time – and this also became clear in the survey of the counselling professionals (Böhm & Wienholz, 2022) – digital formats are not only viewed positively: The assessments depend on the respective residential and life situation, personal openness towards digital media and the individual technical equipment. Telephone and video counselling should therefore not be seen as an alternative but as an extension of the existing face-to-face counselling services.

In line with Bomert’s (2021) descriptions that self-determination on the part of the recipient includes not only the choice of format but also “control over the content of the conversation and the goals” (ibid., p. 251), the results presented here also indicate that the counsellor’s actions are essential to the recipient’s orientation and clearly influence the client’s satisfaction with the counselling process. In addition to the establishment of a variety of formats in the portfolio of pregnancy advice centres, these findings reinforce the need to continuously reflect on and closely align one’s professional actions with the needs of clients in counselling sessions in accordance with §219 of the German Criminal Code (StGB).

We would like to thank all the participants in the interview study for their willingness and openness to share their experiences.

¹The BMG-funded joint project ELSA will soon be able to provide further empirical evidence (see www.elsa-studie.de).

²Due to the limited scope of this article, only selected results of the client survey are presented below.

³ All names were anonymised using colours.