RESTORING, PROTECTING, AND EXPANDING ABORTION ACCESS IN THE US: SEEKING CONSENSUS THROUGH THE DELPHI METHOD

Objectives

The Dobbs v Jackson Women’s Health Organization decision exacerbated inequitable access to abortion in the US. Agreement is needed on which strategies should be prioritized to restore, protect, and expand abortion access.

Methods

We convened a multidisciplinary, geographically diverse Delphi panel of clinical, research, policy, legal, and advocacy experts to reach consensus (ie, agreement >67%) on recommended actions. Using feedback from three rounds of surveys, and input from a select expert advisory group (n=10), we iteratively refined the consensus points.

Results

The panel (n=85) developed 25 consensus statements and 32 recommendations for action in states with protected, mixed, or restricted access to abortion based on categorizations by the Guttmacher Institute. In states with protected access, key recommendations (ie, >70% agreement) were to incorporate abortion into primary care and expand clinical services to include all types of abortion. In states with mixed access, key recommendations were to establish pathways for patients seeking abortion, lobby for Medicaid coverage of abortion, expand clinical services to include all types of abortion, and build broad coalitions for abortion access. In states with restricted access to abortion, the key recommendations were to combat gerrymandering and voter suppression, train emergency room staff in abortion care, establish protections against criminalization, and flip state legislatures.

Conclusions

This Delphi study identified actionable priorities in addressing inequitable access to abortion in states with varied policy environments. It also highlights areas where more strategic discussions are needed (eg, the utility of boycotts in states with abortion bans).