Brakes and accelerators to abortion access in a post-Dobbs landscape: Which factors are most amenable to intervention?

ABSTRACT It is critical to conduct research with people who consider abortion but never connect with a clinic, whose stories may help identify the largest impediments to abortion access. The need for this evidence is urgent in post- Dobbs restrictive states, including Wisconsin. We 1) located abortion considerers through innovative recruitment mechanisms, 2) examined their experiences within a dynamic state-based context, and 3) adapted a brakes-and-accelerators model to document the factors that most impede abortion-seeking trajectories, including those most amenable to intervention. Using three recruitment arms, we enrolled pregnant Wisconsinites who had considered abortion between June 2022 and February 2025: 1) callers to abortion clinics, 2) prenatal patients, and 3) people seeking abortion information online. Participants completed in-depth interviews about abortion consideration. We analyzed interview data using a qualitative descriptive approach. Forty-two interviewees ( n =8 clinics callers, 30 prenatal patients, 4 online information seekers) described over 20 brakes and accelerators to abortion, from legal (e.g., Wisconsin’s telehealth ban) to logistical (lack of transportation), personal (pregnancy ambivalence) to relational (interpersonal violence), cultural (stigma) to structural (housing insecurity). Three intervenable factors emerged as critical to abortion access (or lack thereof): 1) finances and insurance coverage, 2) state abortion restrictions, and 3) patient navigation services and resources. Our study would have underestimated these factors’ impact had we only recruited from abortion clinics. The brakes-and-accelerators model enables a clearer vision of how factors work in tandem to propel, or impede, individuals toward different pregnancy outcomes.