Never Rarely Sometimes Always, writer-director Eliza Hittman’s reticent, watchful film on two 17-year-old girls’ journey across state lines for an abortion, is about as opposite in tone to the incendiary, patronising anti-abortion movement in the US as one can get: understated, devastatingly spare, resonantly attuned to the unsaid, be it pain or the friendship tested by a healthcare system that leaves so many seeking reproductive care on their own.

There are numerous ways to go about depicting the obstacle course that is abortion access in the US – HBO Max’s Unpregnant, released this year, routes the same premise into a mostly charming roadtrip buddy comedy – but this is one of the most quietly powerful films of the year in its utter lack of pretension. The Sundance breakout allows the girls’ navigation of the hurdles – legal, financial, logistical, emotional – to compound into a searing portrait of reproductive healthcare in the US that lingers like a yellowing bruise.

So much goes unspoken – you don’t hear Autumn (an impressively inward Sidney Flanigan) tell her cousin and best friend Skylar (Talia Ryder) that she is pregnant. Their decision to secretly schlep to New York from their small Pennsylvania town, where state law prohibits abortion for minors without parental permission, is swift, mostly tacit. Nor is there a word on the volatile political environment and legislative assault on abortion access that presaged the film’s release: 12 states enacted a form of abortion ban in 2019, some barring the procedure from as early as six weeks, before many, including Autumn, know they’re pregnant; Alabama attempted to ban abortion outright.

Hittman observes this thicket through the eyes of one lost in it: the dismaying search for answers through Google, the condescension and confusion sowed by the town’s “crisis pregnancy centre”, an increasingly common facility that purports to counsel women on reproductive healthcare but in practice advises against “abortion-mindedness”. In New York, the obstacles become more diffuse and surprising – the girls navigate Port Authority, lug suitcases through a subway turnstile, hit up a skeevy yet approachable stranger from the bus for money. Hittman’s vigilant, passive style turns the city into an amorphous, shadowy challenge; midtown is far from unknown to movie-goers, but, under her direction, it becomes unfamiliar and suspect, the girls’ safety a bristling open question.

Never Sometimes Rarely Always, which takes its title from the answers on a patient intake form read aloud to Autumn by a Planned Parenthood receptionist in a scene that drew raves at Sundance, is almost too spare in its observance of the girls’ bond and journey. But it’s ambitiously unsettling – I realised in the final scene that I’d kept my jaw clenched the entire movie. Since its release, the reproductive healthcare environment in the US has grown only more hostile with the appointment of Amy Coney Barrett, a longtime favourite of the anti-abortion movement, to the supreme court. The court’s strengthened conservative majority will be a generational fight; this film carves out an aching, vivid space in its long shadow, by paying sustained attention to a journey more American women will likely have to take, if they’re able.