The Supreme Court has struck down a 2014 Louisiana law that requires doctors who perform abortions to gain admitting privileges at nearby hospitals. Louisiana has three licensed abortion clinics and five doctors who perform abortions. With this decision, the 8,000 Louisiana women who seek abortions each year will continue to have some access, although the most vulnerable may still face obstacles in obtaining the care they need.

The majority of the court rejected the argument made by Elizabeth B. Murrill, Louisiana’s solicitor general, that the restrictive law aimed to provide “better health care” for “women and girls.” In 2016, the U.S. Supreme Court struck down a similar law grounded on a similar argument in Texas. Chief Justice John G. Roberts Jr. sided with the court’s four most liberal justices on the grounds that, “The Louisiana law imposes a burden on access to abortion just as severe as that imposed by the Texas law, for the same reasons.”

Historically, opponents of abortion have been far more straightforward and open regarding their efforts to restrict abortion access and their motivations. The author of one 15th-century gynecological text, for example, refused to write about abortion or contraception to prevent “some wicked whore” from using the information to escape the consequences for breaking the rules governing women’s sexuality. While we may think about abortion as a politically fraught issue specific to our own time, the historical record shows that women have sought abortions for centuries, faced institutions seeking to limit their autonomy at every step and found different solutions — some successful — for getting around these restrictions.

Several legal cases from early 16th-century England illuminate the consequences of limited abortion access and show women finding different ways to deal with unplanned pregnancy. These cases come from Catholic church courts, which couldn’t impose criminal penalties such as hanging or imprisonment. Instead they issued punishments such as requiring people to perform public penance, demanding that they get married if they were caught having premarital sex or fining them. They remind us that, even 500 years ago, women dealing with unwanted pregnancies made both difficult and desperate choices about their futures.

“With this child, alas, what should I do? Shall I keep it, or kill it?” wondered a young unmarried woman impregnated and abandoned by a clergyman in a popular 15th-century song. Women underwent coercion by their male partners and endured dangerous medical treatments to answer this question.

Two unmarried pregnant women in 1530 obtained abortions by drinking potions, which typically contained herbal abortifacients and sedatives such as rue, pennyroyal, fennel and sage mixed with wine. One of them, Joan Schower, was already a single mother to two children born when she was unmarried. But she chose to terminate her pregnancy, perhaps because she was unable to support another child financially.

Another record shows that John Hunt impregnated his servant, Joan Willys. Hunt was charged with advising Willys to terminate the pregnancy and giving her “certayn drynkes to distroy the childe that she is with.” Hunt and Willys were ordered to do public penance — which functioned as a form of public shaming in their tightknit community — and to marry as soon as possible. The court further specified that the pair refrain from having any more sex until their marriage. The entire affair exposed a gendered power dynamic: As a servant, Willys had little ability to consent to sex with Hunt or to resist his wishes to terminate the pregnancy, showing how her sexual consent as well as her reproductive choices were limited by her lack of power in the situation.

The self-administered, unregulated herbal abortion potions consumed by Schower and Willys accomplished their purpose. However, these potions were often unreliable, and they could be dangerous or ineffective: In 1508, Joan Wynspere died after drinking a poisonous concoction meant to induce abortion.

Another 16th-century Scottish poem tells the story of a desperate pregnant “wench” who turned to the women in her community for “medicines” made from pennyroyal, nettle, long pepper and purple orchid to “be flat again,” illustrating how women worked together to help one another obtain abortions. However, the herbs were useless, and the poem closes with the young woman eventually giving birth to a son.

And yet, women continued to work together to find solutions. In 1530, Widow Colls got in trouble for welcoming unmarried pregnant women into her home and caring for them there. Her choice to turn her home into a refuge shielded the women from suffering negative social and economic consequences for their pregnancies. She used her status as a widow — which meant she could inherit her dead husband’s business enterprises and wealth, giving her an economic advantage as well as the freedom to use her home as she pleased — to help fellow women and provide for their needs in defiance of local church authorities.

Without support, however, some women took extreme measures. In 1517, an unmarried woman named Alice Ridyng confessed that a local clergyman had impregnated her at his employer’s house. She had told no one about her pregnancy and eventually gave birth alone at her parents’ home on a Sunday. But then she killed the infant by suffocating him, and buried him in a dung heap in her father’s orchard. Two days later, a group of local women seized her and inspected her belly and breasts to prove that she had recently given birth. At that point, she told them everything and showed them where she had buried the baby. The church court sentenced her to perform public penance in a cathedral, ensuring that the largest possible audience would witness her shame.

Ridyng’s case, along with numerous other cases of unmarried women who gave birth in secret and killed their infants out of desperation, illustrates the overwhelming terror felt by single women facing unplanned and unwanted pregnancy. It also, like the case of the servant impregnated by her master, shows how the women in these situations were disadvantaged in multiple ways by their more powerful counterparts: Ridyng’s partner was a clergyman with considerable power in the community, and the records do not mention him suffering any sort of punishment.

These legal cases and poems show what happens when abortion is not safe, legal and accessible: Some women, like Schower, may be able to successfully self-perform abortions, but many are not. With abortion illegal, unregulated and forced underground, there exists a greater potential for coercion and deadly solutions. For 500 years women have searched for medical solutions to have control over their reproductive choices, and they will continue to do so. Even with the Supreme Court’s recent, narrow decision in favor of abortion access, many women today remain unable to access the abortion care they need.