"Many survivors really worry about whether or not to have children because they are so afraid: What if it happens to my children too? What if I can't protect my children enough?," says Ava Anna Johannson, one of the survivors involved in the study commissioned by the Independent Inquiry into Child Sexual Abuse in Germany.

Johannson is herself a survivor of child abuse. She grew up close to Bremen in northern Germany and was sexually abused by her grandfather and other family members from the age of three. After a difficult youth with spells in psychiatric clinics, Johannson finished school, went to university, married and had children.

However, the experience of giving birth to her first child caused the trauma of the past abuse to come flooding back. "It totally shocked me," she explains. "I had a really strong feeling of being treated like an object, that it was absolutely not about me and my own needs, that I was being talked about and not to."

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Johannson draws a connection between her treatment by medical staff whilst giving birth to the abuse she experienced as a child, including the same feeling of powerlessness. A medical procedure to enlarge the birth canal, called an episiotomy, was particularly traumatic.

"I was cut open to force the baby out without even being warned," she told DW. "I think there's a strong parallel there with the abuse … you're supposed to just be........

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