CG heard from 4 co-authors of a study that suggests abortion medications could one day meet the criteria for FDA approval as over-the-counter products. Emma Hernández of We Testify even shares a personal story showing how OTC pills could improve access to reproductive care and autonomy amid storms.
A month before the ruling from the 5th U.S. Circuit Court of Appeals that temporarily blocked legal access to the provision of mifepristone via telemedicine, mail delivery, and pharmacy dispensing this spring, a new publication gestured toward a future when abortion pills might be accessible over the counter.
"[Over-the-counter] medication abortion has the potential to improve access to abortion care in the U.S., as well as in other countries where the medications are not currently available over the counter," Kari White, a co-author of the study and the Executive and Scientific Director at the Texas-based Resound Research for Reproductive Health, told CG via email.
The study, published in April in the journal JAMA Internal Medicine, indicated that medication abortion facilitated by mifepristone and misoprostol — two drugs that can be used to end a pregnancy — "likely meets the U.S. Food and Drug Administration criteria for over-the-counter sale."
Now, that's far from decreeing the medications officially approved for non-prescription sales at pharmacies, supermarkets, and convenience stores. But the co-authors of the study — led by Advancing New Standards in Reproductive Health, or ANSIRH — wrote that their results "broaden a small body of research demonstrating that people seeking clinician-supported abortion are largely accurate in self-reporting their [medication abortion] eligibility."
Of the 168 study participants seeking abortion, 88% were able to determine their eligibility for taking the medications after consulting prototype packaging for an over-the-counter, or OTC, version of the drugs — one requirement for FDA approval of an OTC product. According to the publication, most found the information provided on the packaging "straightforward, clear, organized, and easy to read."
The study was conducted amid ongoing and overlapping efforts in the U.S. to curb legal access to the medications used in abortion care and to abortion care more broadly.
Telehealth access to medication abortion — wherein abortion medications are prescribed during a virtual appointment and mailed to patients — has been widely regarded as a stopgap for preserving some legal access to abortion in states where the health care is now banned or heavily restricted following the overturn of Roe v. Wade in 2022.
Telemedicine for various health needs has also been understood as one way to make care more resilient to climate shocks that can interrupt access.
"In 2021, Texas experienced a severe ice storm and below-freezing temperatures (accompanied by blackouts) that lasted for days," White told CG. "Abortion was still legal [in the state] then, but it was nearly impossible for people to travel to facilities for care due to unsafe travel conditions, and there were fewer abortions that month as a result," she explained.
"In our work since the implementation of abortion bans, we have also heard from people who have had to travel to another state for care and who have needed to stay an additional night out of town due to severe weather."
OTC access to medication abortion, White said, might mitigate these impacts of extreme weather, with products "more easily accessed at stores closer to where people live."
Emma Hernández, a study co-author who holds a Master of Public Administration and is the Senior Communications Manager at the abortion storytelling organization We Testify, can speak to this from personal experience.
"I had my first abortion in Indiana during a winter storm that dropped up to half a foot of snow across most of the state, and on the day of my abortion, the peak temperature was just 10°F, with a low of -4°F," she wrote to CG in response to a query.
"I didn't have my own car since I was a college student living on campus, and I didn't want to tell anyone about my decision to have an abortion. … I decided to take the bus to the stop closest to the clinic, but that still meant a mile-long walk to my destination. I'd made this plan before I knew an extreme weather system was approaching, so when I woke up on the day of my appointment to shin-high snow and frigid cold, I didn't have much time to think of alternatives and still make it."
So "alongside a road that had no sidewalk," she journeyed that mile through the snow.
"I arrived at my appointment shivering in my soaked boots, grateful that it was too frigidly cold out for the protesters that usually surrounded the clinic to harass me."
That's when Hernández learned she wouldn't be receiving the abortion medication that day after all. In order to obtain the medication, she was legally required to undergo an ultrasound and hear mandatory counseling statements before returning days later for another appointment to receive the pills.
For Hernández, the hope for OTC access is that "one day, people will get the care they need without the hardship."
The potential for mifepristone and misoprostol to be approved as OTC products one day could help strengthen access as global temperatures rise and exacerbate extreme weather events.
"Migration due to severe weather and climate change will lead to more people migrating and potentially being forced into situations without adequate access to the contraception and abortion care they need," Kelly Blanchard, a study co-author and President of Ibis Reproductive Health, told CG via email.
Blanchard has plenty of experience to draw on. Her organization, which works in the U.S. and globally, powered the nearly 20-year-long effort that saw the U.S. FDA approve the first over-the-counter oral contraceptive Opill in 2023. Knowing that this work can take time, what does she think is needed to make OTC medication abortion a reality in the U.S.?
"We need a company to step forward to be willing to make an application to the FDA," Blanchard said, noting that researchers are "documenting answers" to inform such an application through more and larger studies.
"We are working on doing those studies in the next few years," Hernández said of her work with ANSIRH. "Hopefully, when we have all the data, the political context will be more conducive to considering the over-the-counter switch."
Some familiar with the state of reproductive rights in the U.S. in 2026 might consider OTC approval a long shot. (Nathalie Kapp, another co-author and the Chief Medical Advisor at International Planned Parenthood Federation, told CG that a key hurdle, besides securing a company to sponsor the product and engage with the FDA, was politics.) But examples like the approval of Opill show that work over decades can ensure an effort is ready if and when the political obstacles clear.
Asked what they would say to those who might otherwise support the approval of OTC medication abortion but who may be nervous about the safety of this method — including in scenarios wherein someone could be coerced into taking the medication — Hernández and Blanchard pointed to past research and existing laws.
"Reproductive coercion is a devastating form of both state-sanctioned and intimate partner violence, but studies show that pregnant people are more frequently coerced into continuing a pregnancy than ending one," Hernández said.
"Over-the-counter availability of medication abortion actually offers increased protection to those experiencing reproductive coercion. Bypassing the clinic entirely prevents an abusive partner from withholding transportation, creating a scene at an appointment, or otherwise derailing their care."
Blanchard underscored that self-managed medication abortion has already been documented by researchers as safe and effective and that laws already exist to hold people accountable for reproductive coercion. "It is especially important to address the most common forms of coercion, including being coerced to continue a pregnancy and violence during pregnancy," she said.
Because not everyone seeking an abortion will want or be able to use medication care, reproductive rights advocates will continue to aim to strengthen and protect access to multiple methods from legal threats, climate shocks, and more.
White pointed to one use of OTC products that could account for several such barriers.
"With OTC access, people could purchase the pills in advance and have them on hand when they need them if conditions make it unsafe for them to travel for care," she said.
Just last month, Planned Parenthood announced that affiliates in Washington state and Hawai'i would be offering the "advance provision" of abortion medication for future use. It's something that other telehealth organizations have done for years to enable potential users to keep the pills on hand "just in case," according to NPR.
Approving OTC access to abortion medication one day could streamline the process all the more.
An initiative by the Center for Biological Diversity in 2025 scored state-level emergency preparedness resources for their inclusion of sexual and reproductive health products in an effort to draw attention to the importance of having products like menstrual supplies and contraceptives on hand in case of a natural disaster. Down the line, OTC abortion medications could end up on those same — if improved, more inclusive, and robust — disaster prep checklists.
Kirsten Krueger contributed to the editing of this article.
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