Review: â€˜Never Rarely Sometimes Always’ is a searingly confrontational drama about abortion rights

There’s an early moment in “Never Rarely Sometimes Always,� Eliza Hittman’s exquisite, quietly overwhelming new film, when 17-year-old Autumn (Sidney Flanigan) gives herself a nose piercing. You might cringe, groan and turn away from the screen (I did, anyway), but Autumn remains calm and unflinching as she deftly sterilizes and inserts the needle. It’s a tense scene that ends on a strangely reassuring note, and it tells you something important about Autumn: This is someone who, for reasons that will become slowly and heartbreakingly clear, has learned to look out for herself.

Sensitively and meticulously, with spare dialogue and quotidian details, Hittman fleshes out Autumn’s lonely world. Life in her small Pennsylvania town is humdrum at best, alienating at worst. Autumn may look like a conventionally moody teenager, but that resting frown is less grouchy than guarded. Her closest and perhaps only friend is her cousin Skylar (Talia Ryder), with whom she works at a grocery store after school. She has a kind but distracted mom (Sharon Van Etten) and a surly stepdad (Ryan Eggold) who occasionally hurls a troubling leer in her direction. He’s like an ostensibly grown-up version of the boys at school who crudely taunt her at every opportunity.

The lack of overt exposition suits Autumn’s natural reticence. But it also reflects a reality in which most people, being people rather than movie characters, are in no hurry to announce their identities or blurt out their secrets. Autumn’s secrets, and the glimmers of a plot, do eventually surface at a local women’s clinic, where a worker confirms her suspicions — she’s pregnant — and quickly hands her a pamphlet on the joys of adoption. But Autumn has other ideas, as we see in another series of wordless activities: a vitamin-C binge, some self-inflicted belly punches and a Google search on Pennsylvania state laws. Being a minor, she finds out, she can’t procure an abortion without parental consent — and as she has no intention of telling her parents, she sets her eyes on New York City.

In a notable rarity for an American fiction film, Autumn’s decision isn’t belabored, judged or rationalized; nor is it preceded by any protracted hand wringing. It’s borne of her difficult, desperate circumstances and her natural self-reliance. Most of all, the film makes clear, her choice is well and truly hers; if she owes anyone an explanation, it certainly isn’t us. When Autumn does confide in her cousin, Hittman tellingly doesn’t dwell on the conversation, instead cutting to Skylar’s swift, wordless response: She stuffs cash into her pockets, texts her family an excuse and follows Autumn onto the next bus bound for Manhattan. They’re in for one hell of a journey.

“Never Rarely Sometimes Always� is the third and most accomplished feature written and directed by Hittman, after her striking summer-of-love dramas “It Felt Like Love� (2013) and “Beach Rats� (2017). The explosive, sun-drenched sensuality she brought to those earlier pictures has been subsumed by a gray, wintry chill, a sobering premise and, once the characters arrive in Manhattan, a clock that starts ticking away in the background. The twist here is that time doesn’t threaten to run out so much as drag out.

With barely enough money for food, let alone a place to stay, Autumn and Skylar spend much of their time waiting in between consultations and procedures. The Port Authority Bus Terminal becomes a kind of purgatory, marked by the recurring, almost comically Sisyphean image of them dragging their hugely impractical suitcase up and down stairs and through turnstiles. For two teenagers who haven’t traveled much outside their hometown, the city of New York, with its teeming trains and bustling throngs, is both exciting and daunting, a labyrinth that proves indifferent to their existence even as it threatens to swallow them up.

The American health-care system, in particular the perpetually embattled zone devoted to women’s health, is a labyrinth of another kind. The heart of “Never Rarely Sometimes Always� — and the meaning of its initially awkward, perfectly gut-wrenching title — emerges in the scenes at Planned Parenthood, which are methodically researched and rigorously naturalistic. Here, Autumn is greeted by receptionists and social workers who, despite their unfailingly professional tact and sensitivity, don’t necessarily make her ordeal any easier.

At the recent Sundance Film Festival, a jury awarded “Never Rarely Sometimes Always� a special prize for “neorealism� — a somewhat amusing designation that nonetheless captures something of the movie’s discernible European art-house influences. (It also won the runner-up prize at last month’s Berlin International Film Festival.) Shot on grainy 16-millimeter film by French cinematographer Hélène Louvart, whose camera likes to linger on everyday waiting rooms, passing crowds and pensive faces, the movie owes a clear stylistic debt to neorealist standard bearers like Jean-Pierre and Luc Dardenne — who, like Hittman, have a particular gift for mapping the outer and inner lives of young people.

Another important touchstone here is “4 Months, 3 Weeks and 2 Days� (2007), Cristian Mungiu’s masterful thriller about a teenager helping her best friend procure an abortion in communist Romania. Hittman’s film isn’t quite that harrowing, insofar as Autumn’s procedure is legal and performed by trustworthy hands. But it says something about the present political climate in the U.S. — especially with a major abortion case before a conservative-dominated Supreme Court — that the movie generates some of the same roiling tension, the same haunting awareness of the physical and emotional vulnerability of its young characters, and by extension the thousands of teenagers who have found themselves in similar straits.

The movie’s sympathies, much like its political convictions, couldn’t be clearer. But paradoxically, what makes “Never Rarely Sometimes Always� so forceful — and certainly the most searingly confrontational American drama about abortion rights in recent memory — is its quality of understatement, its determination to build its argument not didactically but cinematically. Hittman can be bruisingly blunt when it serves her, as when she draws our attention to the casual misogyny Autumn and Skylar endure in the course of their journey, whether it’s their touchy-feely boss or the creep on the subway. Even the most benign version of this, an older kid (an excellent Théodore Pellerin) who chats them up and helps them out, makes clear just how ruthlessly transactional life can be.

But if the picture Hittman paints is stirringly bleak, it is not without its passages of tentative hope, even grace. Through it all, Autumn remains coolly, resiliently Autumn, even once her weary façade crumbles and her deeply buried anguish peeks through. Flanigan, in a remarkable screen debut, gives a lesson in the revelatory power of restraint: I’ve rarely seen an actor wring so much meaning and feeling from so many mumbled one-word responses. She and Ryder beautifully capture the bond between two young women who have evolved, by necessity, their own near-subliminal form of wordless communication. The most resonant image in “Never Rarely Sometimes Always� is of two hands clasping in silence, a gesture of solidarity that becomes its own profound act of survival.