Kei’Choura Cathey was in jail when she realized she was pregnant.

But when she asked the Maury County, Tennessee sheriff’s office to obtain an abortion, she claims in a new lawsuit they denied her on the grounds that her pregnancy was not life-threatening. When she finally left jail, it was too late for her to legally terminate the pregnancy.

Access to abortion, already limited for many Americans, can be even more complicated for incarcerated women. While inmates have a constitutional right to health care, inmates’ abortion rights are the subject of a murky set of policies that vary state by state, and even county by county. In her $1.5 million suit against Maury County and its sheriff, Cathey says her decision was left to the whims of county officials, who deemed the procedure unnecessary. She gave birth in April 2016.

Cathey, 29, realized she was pregnant two weeks after her arrest July 2016 arrest for aggravated robbery and conspiracy to commit murder. Facing a million-dollar bond, she couldn’t afford to bond out of jail for the procedure. Within a month of discovering the pregnancy, she contacted Maury County Sheriff Bucky Rowland, informing him of her wish to obtain an abortion. Without an official abortion policy at the jail, Cathey’s access to the procedure depended on the sheriff’s decision. But he allegedly refused to provide transportation to or funding for the procedure, calling her abortion unnecessary if Cathey’s life wasn’t at risk.

Rowland and his department didn’t return The Daily Beast’s request for comment, but he told local outlets that the county treated inmate abortions on a case-by-case basis.

"We did not have a specific policy," Maury County Sheriff Bucky Rowland told Columbia, Tennessee’s News Channel 5. “Tennessee Corrections does not have a specific policy. It's really a gray area.”

But in Cathey’s case, the “gray area” looked more like an anti-abortion platform, allowing the procedure only if Cathey had been raped or her life was at risk.

The sheriff’s department allegedly told Cathey’s legal counsel that it “would not provide funding or transportation for purposes of obtaining an abortion unless the abortion was deemed to be medically necessary to save the mother’s life or the pregnancy was the result of rape or incest,” her suit reads.

Rowland also characterized Cathey’s birth as her decision. "She decided to stay the course," he told Channel 5.

But Cathey lawsuit, which describes the ordeal as “cruel and unusual,” suggests she never had a choice.

Rowland denied that the jail refused to transport Cathey to a health clinic. But he described the procedure as “voluntary” if Cathey’s life was not at risk. "I brought in my command staff and medical team to research guidelines," he told Channel 5. "We felt this was a voluntary procedure, which we do have guidelines for."

Carolyn Sufin, an ob/gyn and researcher at Johns Hopkins School of Medicine said Rowland’s description of an abortion as “voluntary” created a “false dichotomy” of patients’ needs.

“When I think of an elective procedure, as a health care provider, I think of ones where, if you delayed it indefinitely there would be no significant impact on a patient’s health or life,” she said. “That is just not true when it comes to a patient’s pregnancy. The decision about whether to continue or terminate a pregnancy has tremendous and lifelong consequences.

A voluntary procedure would require Cathey to bond out of jail and pay for the procedure. But while Cathey’s lawyers negotiated her bond down, she was unable to pay even the reduced penalty. Rowland confirmed to Channel 5 that her final bond was set at $8,000, of which she was expected to pay $800 upfront. By the time of her January release, she had entered her third trimester, at which point it was illegal for her to terminate the pregnancy. She gave birth in April, and has required treatment for postpartum depression since the delivery, her suit alleges.

Sufin said inmates have a constitutional right to health care, but that lack of written policies on procedures like abortions can leave incarcerated people without the care they need.

“When it comes to health care for incarcerated people, there is tremendous variability,” she told The Daily Beast. “Although incarcerated people have a Constitutional right to health care and the correctional facilities are Constitutionally mandated to provide them with health care, there are no mandatory national standards for health care ... So when it comes abortion care, the best established recommendations come from the legal record.”

Tennessee has legal precedent for temporarily releasing an inmate so she could obtain an abortion. In 2005, a U.S. district court allowed a Knoxville woman temporary prison leave to terminate her pregnancy. But other pregnant Tennessee inmates have suffered in the corrections system, after allegedly being denied health care.

“Unfortunately things like this have happened before,” Allison Glass, a director for Healthy and Free TN, a group focuses on expanding reproductive rights in Tennessee told The Daily Beast. “There was a suit against the Corrections Corporation of America (which has its headquarters in Tennessee) in 2014 on behalf of a woman who was formerly incarcerated and gave birth while incarcerated. She did not receive the health care she needed and the baby died.”

Her lawyers described the county’s lack of an abortion policy as negligence at best, and open malice at worst.

“By their deliberate indifference to a serious medical need by knowingly, intentionally, negligently and/or maliciously failing to establish proper customs, policies, and practices regarding access to abortions by pregnant inmates,” Maury County violated Cathey’s constitutional protections against cruel and unusual punishment, her suit accuses.

Other inmates have made similar arguments when seeking abortions behind bars, to mixed results. Supreme Court rulings in 2005 and 2008 have allowed women in New Mexico and Arizona to leave detention to receive abortions, while in 2015, an unnamed Alabama woman was denied a medical release to terminate her pregnancy, and informed that she could only receive the procedure on a court order. The Alabama woman reportedly backed out of the case, deciding to give birth.