Dissertations and Theses
Date of Degree
6-4-2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (Ph.D.)
Department
Community Health and Social Sciences
Advisor(s)
Diana Romero
Committee Members
Meredith Manze
Jeffrey Lazarus
Subject Categories
Public Health
Keywords
Abortion; reproductive health; reproductive justice; Dobbs decision; Delphi study
Abstract
Background: The Dobbs v. Jackson Women’s Health Organization Supreme Court 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 (i.e., 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 statements and recommendations.
Results: The panel (N=85) developed 25 consensus statements and 32 recommendations for action by advocates, funders, policymakers, and clinical experts in states with protected, mixed, or restricted access to abortion. States were categorized based on policy assessments by the Guttmacher institute. In states with protected access, key recommendations were to incorporate abortion into primary care, to amend state constitutions to explicitly and fully protect and expand abortion access, for clinics to offer all types of abortion (i.e., medication, procedural) via different modalities (i.e., in person, telehealth), and for medical schools and clinical training programs to expand and require curricula and training for all students in abortion provision. In states with mixed access, key recommendations included establishing referral chains for patients seeking abortion, advocating for Medicaid coverage of abortion, expanding clinical services to include all types of abortion via different modalities, building broad coalitions for abortion access, developing statewide ballot initiatives to protect abortion without restrictions, and focusing on community-based reproductive health services (e.g., midwives and doulas from marginalized communities) to help address abortion and other reproductive health disparities. In states with restricted access to abortion, the key recommendations were to combat gerrymandering and voter suppression, train emergency room clinicians in abortion care, establish protections against criminalization, flip state legislatures to representatives who support abortion, and develop statewide ballot initiatives to protect abortion without restrictions.
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 (e.g., the utility of boycotts in states with abortion bans).
Recommended Citation
Pickering, Sarah, "Restoring, Protecting, and Expanding Abortion Access in the United States: Seeking Consensus through the Delphi Method" (2024). CUNY Academic Works.
https://academicworks.cuny.edu/sph_etds/104