Lawmakers in Germany have approved a bill that prohibits therapies that attempt to alter the sexual orientation or gender identity of lesbian, gay, bisexual, and transgender youth.

Chancellor Angela Merkel has backed the legislation introduced by Health Minister Jens Spahn, who is gay.

Such therapies go by names such as “conversion therapy,” “reparative therapy,” “sexual orientation change efforts” or “ex-gay therapy.”

Germany is only the fifth nation with such a ban after Malta, Ecuador, Brazil, and Taiwan.

German LGBT advocate LSVD welcomed the ban in a statement posted on its website but expressed concern that it doesn't go far enough.

The group said that the ban should include people up to age 26 and that legal guardians should be held accountable if they participated in such therapies.

Jessica Stern, executive director of OutRight Action International, said in a statement that the ban sent “a powerful message that LGBTIQ people are not in need of change or cure.”

“At the same time,” Stern continued, “demand for 'conversion therapy' will only decrease if acceptance of LGBTIQ people grows. I urge authorities in Germany to bolster the legal ban on 'conversion therapy' with measures designed to promote understanding and inclusion of LGBTIQ people, thus tackling the root causes of these harmful, inhuman practices.”

In the United States, 20 states plus the District of Columbia have similar bans.