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A federal appeals court issued a ruling on the abortion medication mifepristone yesterday.


The FDA approved mifepristone 23 years ago and today it's widely used. Medication abortions account for about half of all abortions in the U.S. And for now, mifepristone is still available anyplace abortion is legal. But Wednesday's ruling sets the stage for the Supreme Court to weigh in on that.

MARTIN: NPR's Selena Simmons-Duffin is covering this story and she's with us now to tell us more. Good morning.


MARTIN: So tell us what this ruling does broadly.

SIMMONS-DUFFIN: So a panel of judges at the Fifth Circuit Court of Appeals in New Orleans decided that mifepristone should still have FDA approval, but it should be much harder to access. So as a reminder, this case came out of Texas from several medical groups and doctors that oppose abortion. They challenged the Food and Drug Administration's approval of mifepristone and the changes it made later to how the medicine is prescribed. So on Wednesday, this appeals court agreed with those challengers in part and said the FDA should never have made it easier to prescribe mifepristone. Nothing changes yet, though, because the Supreme Court ruled in April that access to mifepristone must remain the same until it gets a chance to weigh in.

MARTIN: So when could that happen? And what could change at that point?

SIMMONS-DUFFIN: The Supreme Court could hear oral arguments in this case as soon as this fall. Its decision could be different than this appeals court ruling. But if it's the same, access to this drug would change dramatically. So under yesterday's ruling, access would essentially be rolled back to before 2016, when doctors needed to prescribe this medication in person and there were other restrictions. Here's how Greer Donley put it. She is a health law professor at the University of Pittsburgh.

GREER DONLEY: It would cause pretty significant changes to the status quo in terms of how pills are accessed in this country.

SIMMONS-DUFFIN: Changes like no more telehealth appointments for mifepristone and no access after those very first few weeks of pregnancy. And this would be nationwide. So the ruling would reach out into states that have been working to protect access to abortion and change things for patients and doctors in those states, too.

MARTIN: Was this ruling expected? Or is it a surprise?

SIMMONS-DUFFIN: It was definitely not a surprise. This was a panel of three judges. They were all appointed by Republican presidents. Two were appointed by former President Trump. In the hearing, they really hammered attorneys for the FDA and Danco, which is the pharmaceutical company behind mifepristone. The Alliance Defending Freedom, which is representing the plaintiffs in this case, was thrilled by the ruling and called it a significant victory. The Department of Justice released a statement saying it strongly disagrees with the decision and will be seeking Supreme Court review.

MARTIN: And, of course, this is the same court, the same Supreme Court, that overturned Roe v. Wade last year. What is our expectation about how they're going to respond to this ruling?

SIMMONS-DUFFIN: I mean, we will have to wait and see what happens. But many legal experts say this case has some weaknesses, especially when it comes to the plaintiffs' argument that they have standing to sue. So Mary Ziegler is a law professor at UC Davis who's written books about the history of abortion.

MARY ZIEGLER: My impression is that this is the Fifth Circuit trying to resurrect what had been a pretty flawed case in the hope that this Supreme Court is conservative enough that there's no case too weak or extreme, really, for this court on abortion.

MARTIN: I think many people will remember there was a separate federal case on mifepristone which was led by Democratic states. Where is that now?

SIMMONS-DUFFIN: Yeah, so a federal judge in Washington state agreed with the challengers who said that the FDA was being too restrictive when it came to mifepristone. And Ziegler says these conflicting lower court rulings makes it more likely the Supreme Court will take this up. So that's what will likely happen next.

MARTIN: That's NPR's Selena Simmons-Duffin. Selena, thank you.



MARTIN: Residents of West Maui are starting to head back to their homes - or what is left of them - as recovery from last week's wildfires continues.

FADEL: Disaster responders have loosened restrictions on parts of the island. But with the death toll still climbing and thousands of people now homeless, some residents are frustrated by what they perceive to be a slow recovery.

MARTIN: NPR's Gabriel Spitzer has been reporting from Lahaina, Hawaii. And he's with us now to tell us what he's seeing. Gabriel, thanks so much for joining us.

GABRIEL SPITZER, BYLINE: Sure thing, Michel.

MARTIN: Gabriel, just to start us off, what are you able to see?

SPITZER: Well, they fully opened the main road into West Maui for the first time since the fire struck more than a week ago. The actual burn area is still off limits. But we were able to visit an aid hub in a beachside park just a few miles north of Central Lahaina. And many people there still had really basic needs, things like pet food and underwear. And honestly, there's no real end in sight for now, as this is likely to be a really long recovery effort.

MARTIN: Well, just from what we've all been able to see, the destruction was just enormous in Lahaina. Why do you think people say that the recovery is moving slowly?

SPITZER: Well, there's a lot to be cautious about as they go through the burn area. For one thing, it's extraordinarily difficult to identify and even to find human remains. I talked with a forensic anthropologist, and she said it really takes a trained expert eye to spot, say, bone fragments in the rubble. And then there's a huge concern about toxics. This fire burned so many buildings and vehicles that it unleashed just a whole stew of hazardous chemicals. So search and rescue teams are moving extremely methodically.

MARTIN: We've been hearing from local residents who say they're filling in the gaps that they feel have been left by the federal response. Are you hearing that?

SPITZER: Yeah, very much so. And this aid hub that we visited actually is a really good example. It's almost completely run by locals. And talking to folks there, you get a sense of the tension between these grassroots aid efforts and the government response. Geoff Gracia lives just across the street from the aid station, and he's been volunteering every day at the info tent.

GEOFF GRACIA: It makes me kind of frustrated that - like, police telling us to start to move people towards the federally organized shelters just because we're more grassroots and not centralized, which is what they want, which is a valid concern. But also, it's difficult because these are our people we're trying to take care of.

MARTIN: You know, speaking of that, I'm just trying to think about how this is all going to take place when so many people in the community are also victims themselves.

SPITZER: Exactly. I mean, I talked to so many people who went through hell themselves and then just put their heads down to go help their neighbors. I met a guy named Adam Perry, who's a former wildland firefighter himself and who lives in Lahaina. He wound up sheltering with a few dozen other people in a concrete parking structure as the fire passed. His own house was leveled, but Adam says his firefighting training just kicked in.

ADAM PERRY: I left the parking garage to go look for survivors and the fire almost ate me up a couple of times. I had to dive underneath the fire, went right over my back. Felt like more we were at war than at a fire. Concrete was exploding. Things were blowing up right in front of you. And I've never seen anything like it in my career.

SPITZER: You really get the sense, Michel, that people are still getting their heads around this unprecedented fire. One young man who lost his younger brother told me that it looked like paradise in hell.

MARTIN: Wow. Well, Gabriel, before we let you go, as we are speaking now, just a small fraction of the victims have been identified. And an even smaller percentage of them have been named so far. Do you have any sense or do people there have any sense of what people are going to expect to learn in the coming days?

SPITZER: People have been told again and again that those numbers are going to rise. The search and rescue teams have only come through about 40% of the burn area so far. And so this is all still what officials call Phase 0, which is the recovery of human remains. And the cleanup and eventually rebuilding seem a long way off still.

MARTIN: That's NPR's Gabriel Spitzer from Lahaina in Maui. Gabriel, thank you so much.

SPITZER: You're welcome.


MARTIN: Now we're going to look ahead at the presidential election set for this weekend in Guatemala.

FADEL: The first round in June was met with apathy. But it produced a surprise candidate and a real choice about where the country is headed. To step back a second, Guatemala had been a place of hope a few years ago. A brave movement backed by the U.S. and U.N. was fighting corruption and impunity. But the establishment fought back, closing corruption probes, sidelining judges, prosecutors and even presidential hopefuls.

MARTIN: NPR's Eyder Peralta is with us now from Mexico City to talk about how this vote could determine which way Guatemala goes next. Eyder, welcome. Thanks for joining us.


MARTIN: So the country is down to a runoff vote between two candidates for president. As briefly as you can, tell us about who they are and who's backing them.

PERALTA: So the establishment is backing Sandra Torres. From 2008 to 2012, she was the first lady of Guatemala. And she led her husband's social programs, which made her very popular. But in 2019, when Guatemala was on this voracious anti-corruption campaign, she was jailed. She was charged with misusing campaign funds. But once this anti-corruption task force was disbanded, the charges against her were dropped and she launched a presidential campaign.

The surprise candidate is Bernardo Arevalo. And he also has a political bloodline. His father was the first democratically elected president in Guatemala in the mid-'40s. And he's been an ambassador and deputy foreign minister. He ran an anti-corruption campaign, but his party didn't have much money. He was the one candidate you didn't see on billboards, so no one thought he could actually make it to a second round. But here he is, and his campaign has reinvigorated this whole election process.

MARTIN: You know, Guatemala was once a focus of the U.S. and the U.N., trying to address crime there. What happened to that effort?

PERALTA: It's dead. There was a U.N.-backed task force that conducted hundreds of investigations, but they were kicked out of the country. Many judges and prosecutors have fled or they've been bought off. And we've seen some of the effects of that during the presidential campaign. The candidate who was leading in the polls during the first round was an outsider. He presented himself as an anti-corruption crusader, but he was disqualified five weeks before the first round of this election.

It was a move that was condemned as anti-democratic by the international community. And he said it was the corrupt of Guatemala trying to stop any effort to bring them to justice. But this campaign did change during the second round. Suddenly, corruption is the talk on the campaign. Even Sandra Torres, who had kind of sidestepped the issue, is now clear. Jail the corrupt, she says.

MARTIN: So you've been telling us about lots of problems with these elections. Given all that, what are the chances that this vote, however it turns out, will be disputed?

PERALTA: Well, there's already a lot of uncertainty. The offices of Bernardo Arevalo, the surprise candidate, have been raided. And a court actually ruled that he should be disqualified from the race. Electoral authorities said that they didn't know if that decision was legal, so the elections and the campaigns have continued. But also, polls show that Guatemalans have little confidence in their electoral authority. So the table is set for either side to contest the results. And the table is set for a legal battle.

MARTIN: And the elections are this Sunday. And when are we going to have preliminary results?

PERALTA: Overnight, we should get them.

MARTIN: All right. That's NPR's Eyder Peralta in Mexico. Eyder, thank you.

PERALTA: Thank you, Michel. Transcript provided by NPR, Copyright NPR.

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