Never Rarely Sometimes Always, the latest film from writer-director Eliza Hittman (Beach Rats), merges the tension of a thriller, the sensitivity of a character study and the urgency of a documentary.

The story of a pregnant Pennsylvanian teenager seeking an abortion with assistance from her cousin delivers a sufficiently damning indictment of the frustrating inefficiencies and frightening biases found in American gynecological care for young women. It also throws a scathing rejoinder to the rancid rationale that maybe such lessons should be learned cruelly — such a gauntlet as a womanly rite of passage, completed with only lifetime scars shared with no one. But Never Rarely Sometimes Always is also a finely rendered portrait of grace and strength in friendship. All those elements are elevated by the verisimilitude of cinematographer Hélène Louvart’s 16-millimeter film stock, Chris Foster’s enveloping sound design, a stealthily heartbreaking performance from Talia Ryder (in her first feature-length role) and an exquisitely detailed lead turn from Sidney Flanigan (in her acting debut).

The film introduces Autumn Callahan (Flanigan) onstage at her high school’s talent show — where she is clearly a poignant outlier in a parade of pastiche. “He makes me do things that I don’t wanna do,” she sings, adapting a song by ’60s girl group The Exciters. “He’s got the power of love over me.” Her mother (singer-songwriter Sharon Van Etten), stepdad Ted (Ryan Eggold) and siblings watch with blank stares. The only response: Someone shouts “Slut!” in a silent moment. (The doo-woppy acts that precede Autumn onstage, and the Pink Ladies-esque jacket she wears, also let you know there won’t be any sort of oh-well easy-out solution a la Rizzo in Grease.)

Autumn suspects she is pregnant and, with no support system of note at home, surreptitiously visits a woman’s clinic for a test. She’s hoping to get some guidance and counsel beyond what a stick in a box would tell her. But the latter is all she gets, along some radically outdated trifold brochures and a pushy pro-life agenda from the practitioners. “This is the most magical sound you will ever hear,” says a sonogram technician of a fetal heartbeat that, to Autumn, might as well be a signal emitting from an unknowable alien planet.

Autumn’s cousin Skylar (Ryder) is the only one in whom she can confide. The two work as cashiers at a grocery store, where they are both physically and grossly leched upon by their male manager every night, and middle-aged men regularly ogle Skylar. When they learn Autumn cannot get an abortion in Pennsylvania without the consent of her parents — from whom she’d receive only shame — Skylar silently and instinctively instigates a plan. 

There’s no need for Skylar to speak it; we instantly recognize the resignation that feels like a last resort for young women shunted by a one-size-fits-all approach to pregnancy. It’s the first of several long, silent passages in which both Flanigan and Ryder convey so much simply through micro-expressions and body language. On a dime, Skyler snatches money from one night’s take at the grocery store. Soon they’re on a bus for Autumn to get the abortion in New York.

Complications arise — from both Autumn’s stubborn pride and bureaucratic circumstances — but never yank a yoke into the annihilative death spiral of the film’s closest counterpart, Cristian Mungiu’s 2007 Romanian film 4 Months, 3 Days and 2 Weeks. Skylar and Autumn certainly test their trust; there is the feeling, at least early on, that Skylar sees this as much as a cool story to someday tell about how she spirited off to New York as she does a way to help her cousin. But as the situation evolves, Hittman escalates the fear of the lengths to which Skylar will go in a desperate deployment of her wiles. Neither does the film give way to irrevocable anger; indeed, Hittman’s overall gaze on this story is more glowering than grim. By the end, Never Rarely Sometimes Always offers an emphatic plea to realize seeking help doesn’t make you weak but makes you human. Rarely has a visual motif of clasped hands, whether white-knuckle strong or barely touching fingertips, registered so strongly.

The film takes its title from a spectrum of available answers on a wellness questionnaire, issued Autumn by a social worker (Kelly Chapman, a real-life counselor with whom Hittman consulted on the film’s script). Autumn’s answers to the questions represent the story’s centerpiece — emotionally, thematically and performatively, with Hittman training the camera on Flanigan’s face for an appropriately agonizing single take.

Yes, there are four answers from which to choose. But what should be the selection of those who fall somewhere in between or, like Autumn, feel like life is a flood of every option all at once? Autumn also realizes that, in many people’s minds, “sometimes” and “rarely” are tantamount to “always.” For if something happened once, could it not just be happening all the time? It’s a masterful scene in which Flanigan lets us see how Autumn’s dizzying reaction to the inquiry finds her pointing an inward finger at all of her choices — for better or for worse, like a confessional without anonymity. (Almost entirely offscreen, Chapman also lets us hear how the flavorless cadence of the inquisitor represents its own defense mechanism.) 

Hittman and Flanigan effortlessly exhale similar grace notes throughout the film — notable also in a necessary visit to a 24-hour karaoke bar where Autumn sings a song she likes … but glances upward in disdain over a lyrical aside that has taken on new meaning. Whatever comes of this year in cinema at this point, Flanigan’s will be a performance to remember at its closing.

Never Rarely Sometimes Always isn’t perfect. Julia Holter’s score isn’t necessarily intrusive per se, but the thrum of diegetic sound offers enough necessary ebb and flow of anxiety and calm. Outside of perhaps a light swell at the very end, such manufactured imprints of emotion feel somehow inauthentic. (A closing-credits song from van Etten, though, feels fittingly metaphorical and sweetly penned like a song Autumn and Skylar could sing to one another.) And for all of the film’s believable moments where Autumn and Skylar cautiously, and silently, weigh a man’s intentions, some overt moments feel cartoonish (Ted calling the family dog “an easy slut” after a belly rub) or like an overindulgence of big-city panic (a suited man rubbing himself on the subway).

Minor quibbles, though, for a story that tackles a major subject with visual dexterity, tonal control and an equal measure of care and alarm. It is both an odyssey unafraid to challenge beliefs about the issue at hand and one of 2020’s best films so far.

Never Rarely Sometimes Always is now available as a 48-hour rental for $19.99 on most Video on Demand platforms.