Before Roe v. Wade, the image of a coat hanger was one of the most compelling arguments for legalizing abortion nationwide. Now, a shocking case in Tennessee has put it in the center of the national discourse on abortion once again.

Anna Yocca, 31, of Murfreesboro, Tennessee, was arrested last Wednesday after a grand jury indicted her on a charge of first-degree attempted murder for a failed coat hanger abortion that took place 24 weeks into her pregnancy.

As the Murfreesboro Post reports, police say that Yocca attempted to abort the fetus at home in a bathtub but went to the hospital with her boyfriend after she began bleeding excessively. Her 1½-pound child was delivered, with significant damage to his eyes, lungs, and heart. Tragically, he will require oxygen for the rest of his life.

Yocca, meanwhile, is in prison on $200,000 bond, awaiting a Dec.. 21 court appearance. Her reason for ending the pregnancy is unknown but according police said that doctors and nurses heard her make “disturbing statements” about inducing an abortion.

The police were also quick to paint Yocca as entirely selfishly motivated, sharing no information about any extenuating circumstances that may have led her to this desperate course of action.

“The whole time she was concerned for her health, her safety, and never gave any attention to the health and safety to the unborn child,” Sgt. Kyle Evans told a local CBS affiliate.

As the unknowns swirl around Yocca’s particular case, the fact that abortion has become more difficult to access in Tennessee is not up for debate. As of July 2015, women in the state are required to receive in-person counseling 48 hours in advance of an abortion procedure, necessitating two separate trips to a provider. The year before, voters passed Amendment 1, which gave state lawmakers greater latitude in passing abortion restrictions.

Tennessee was once "a destination" for women seeking abortion in the American South. With restrictions like these on the rise, it is quickly losing that status.

If Yocca has been contemplating abortion in the few weeks leading up to her coat hanger attempt, her in-state options would have been limited.

At an abortion provider 27 miles from Murfreesboro on the outskirts of Nashville, surgical abortions are performed up to 16 weeks from the start of the last menstrual period. The cut-off at the Planned Parenthood in downtown Nashville is 15 weeks. Tennessee state law requires women seeking an abortion to undergo the procedure in a hospital after the first trimester of pregnancy but before a fetus is considered viable. Definitions of fetal viability vary but generally fall around 24 weeks—the gestational age at which Yocca allegedly attempted to self-induce.

Tennessee is not from the only state where abortion access has been restricted in the last five years. Since the 2010 midterm elections, abortion restrictions have passed through state legislatures at an unprecedented rate. The Guttmacher Institute reports that 282 restrictions have been enacted since 2010, with 51 in the first half of 2015 alone.

As these measures multiply, abortion-rights advocates have warned that an age of unsafe, self-induced abortions could return. Even beyond the anecdotal case of Yocca’s coat hanger abortion, there are some early indications that this moment may already be on its way.

In November, the Texas Policy Evaluation Project (TxPEP) at the University of Texas estimated that between 100,000 and 240,000 Texas women ages 18 to 49 had attempted a self-induced abortion, most commonly through the use of misoprostol, an abortion medication that is more readily obtainable in Mexico.

According to TxPEP, the number of licensed abortion facilities in Texas has more than halved since 2013—from 41 to 18—after the Texas Legislature passed House Bill 2 (HB2), an admitting-privileges requirement for abortion providers that the U.S. Supreme Court will review in its next term. For women in their study, the closure of a local clinic was one of the primary contributing factors to the decision to self-induce.

“Poverty, limited resources, and local facility closures limited women’s ability to obtain abortion care in a clinic setting and were key factors in deciding to attempt abortion self-induction,” the authors concluded. “This is consistent with other research indicating that barriers to accessing clinic-based care are an important reason why women decide to attempt to self-induce their abortion.”

Of the representative sample of 779 women that TxPEP surveyed, only 14 percent said that self-induced abortion should be against the law. Tellingly, 34 percent of women said that they were personally against abortion but could understand why a woman might attempt to self-induce.

But 38 states, including Texas and Tennessee, have “fetal homicide” laws which can send women who self-induce an abortion to jail. In Texas, it is against the law to harm “an unborn child at every stage of gestation from fertilization until birth” and in Tennessee—as of 2012—homicide laws define “another person” as including “a human embryo or fetus at any stage of gestation in utero.” Prior to 2012, it was only a crime to cause harm to a fetus after viability.

In other words, Yocca could have been charged with attempted first-degree murder if she was four weeks pregnant or twenty-four weeks pregnant. From a legal standpoint, it didn’t even matter how far along she was when she tried to self-induce—it only mattered that she did.

Between a new wave of abortion restrictions and fetal homicide laws, women who have trouble accessing reproductive health care can find themselves caught between a rock and a hard place.

According to a study in Contraception, women with less education or who have experienced more disruptive events in the last year (e.g. unemployment, divorce, missing rent or mortgage payments, etc.) are more likely to seek an abortion during the second trimester, when time is already running out in many states to receive the procedure legally. Second-trimester abortions also become more expensive by the week. With mandatory waiting periods becoming longer and 20-week bans becoming more commonplace, receiving an abortion can be a race against the clock—or a bank account balance—for women who are already in difficult positions.

But anti-abortion critics are already trying to use this latest coat hanger abortion to try to undermine one of the foundational public health arguments for abortion access—namely, that eliminating obstacles to reproductive health care will make abortion safer.

“The infamous U.S. Supreme Court decision Roe v. Wade did nothing to stop these tragedies, which were infrequent prior to 1973,” Micaiah Bilger writes of Yucca’s case for LifeNews.

In fact, studies from that period estimate that hundreds of thousands of illegal abortions took place every year in the 1950s and 1960s.

“[A]fter more than four decades of legalized abortion on demand through all nine months of pregnancy…women still attempt to kill their unborn babies themselves,” Bilger continues.

The trouble is, four decades after Roe v. Wade, we still don’t know what it looks like for women to have unrestricted access to abortion prior to fetal viability. And the data we do have suggests that if reproductive health care were more accessible, the coat hanger and its grisly consequences would finally stay in the past where they belong.