Eliza Hittman’s latest film is an austere character study of Autumn, a Pennsylvania teenager played by Sidney Flanigan, who travels to New York with her cousin Skylar, played by Talia Ryder, when she’s unable to secure an abortion in her small home town. Most of the film follows Sidney through her pregnancy and eventual abortion, although we never find out the father, or even the specific situation that led to her pregnancy in the first place. Instead, Hittman builds her minimal narrative from all the ways that the abortion procedure is extended and elongated, with a handheld realism that often reminded me of the Dardennes.

For the most part, the film could almost play as a docudrama, as Hittman keeps her camera very close to Autumn’s immediate bodily perceptions, and her haptic tics and routines, which effectively stand in for more conventional character development. With the camera rarely more than a foot away from Autumn’s face and body, the outside world feels totally closed off – barren, from the very outset, of any genuine support structure. Most of the film is thus set at the threshold of Autumn and Skylar’s proprioception – the outermost limits of their immediate personal space – making the sheer acting of watching them feel eerily intrusive.

Put slightly differently, the camera situates itself at the threshold beyond which bodily attention is unwelcome, as Hittman spends the first half of the screenplay outling a whole variety of characters who try to intrude on Autumn and Skylar’s personal space. This is always cloaked in a rhetoric of care, from the supermarket shopper who asks Skylar to come to a party while she’s serving him at the till; to the supermarket boss who insists that Autumn stay on her shift while she’s sick because it will make him feel happy; to the young man they meet on the bus to New York, who won’t stop hassling Skylar until she gives him her phone number so he can do her the “favour” of inviting her to a concert. These disingenuous expressions of care all crystallise around Autumn’s doctor, who sympathetically enquires if she is “abortion-minded,” before showing her a video on the moral dangers of terminating a teen pregnancy.

The sum total of all these characters is a profound scepticism about friendliness and charisma – both from Autumn and from the film itself. The closest we come to a conventionally charismatic mise-en-scene occurs during the opening credits, when Hittman depicts a school spectacle that rotates through one hokey mid-century display after another. The tone seems pretty warm here, so it’s a bit of a shock when Autumn makes her first appearance to perform an indie-styled song about abuse, and even more of a shock when a member of this wholesome crowd calls out “slut” as she’s doing so. The most shocking, thing, however, is how easily the crowd ignores this misogyny, including Autumn’s mother, who, in a brilliant turn is played by Sharon Van Etten. Despite her rich and charismatic musical pedigree, we only ever see Van Etten aligned with the townsfolk, furthering the film’s distrust of “personality” or “friendliness” as a state that is virtually always weaponised against Autumn.

As a result, Never Rarely Sometimes Always is somewhat numbed to personality, much as Autumn’s main trait is her pervasive “unfriendliness.” Since “care” is used as a pretext for people to paw over her body, she has to make small self-destructive gestures to insist on her body as her own. Abortion is simply the most dramatic of these gestures, which start with her elliptical response to her pregnancy – piercing her nose with a sewing needle – and move through a series of increasingly dangerous acts: drinking a whole bottle of mouthwash, punching herself repeatedly in the stomach, swallowing a whole container of pills. Much of the second act of the film takes place in this space between self-harm and abortion, leaving Autumn with nothing but a series of pre-abortive gestures to define her personal boundaries.

These gestures don’t just involve self-harm, but expand out to a series of broader defences of the outermost limits of her personal space. Autumn and Skylar can only afford to take the bus to New York because they steal cash from the supermarket where they work, but this is as much a physical as a criminal feat, since they have to twist their arm at a painful angle just out of sight of the security camera to retrieve the cash. Redrawing their personal space becomes a kind of affective capital, most beautifully when Autumn discovers Skylar kissing their bus companion for more money at the Port Authority. Hittman shoots this scene so that we only see a fragment of Skylar’s face, which is partly obscured by a pillar, meaning we can’t quite gauge the extent of her consent. Yet Autumn confirms that Skylar’s body has once again become a target for “well-meaning” intrusion, quietly locking her pinky with Skylar’s pinky, and so affirming to her that her outer bodily boundaries still exist despite being violated here.

This is one of many scenes that capture the duration of the abortion process, and the sheer lengths that Autumn has to go to in order to receive basic health advice. Since the procedure takes two days, and she goes to the wrong clinic to begin with, she and Skylar spend forty-eight hours drifting through New York, with nowhere to sleep after the abortion absorbs all their funds. In some ways this is the most evocative part of the film – a vision of New York from the perspective of the precariat, cloaked in drab, bleak, wintry textures, with most indoor sequences shot on location in the Port Authority. Here, Autumn and Skylar descend into a low-level fatigue that lasts for the remainder of the film – Autumn only falls asleep in the very last shot – and while this fatigue can be a bit draining to watch, it works perfectly to capture the exhaustion of anti-abortion rhetoric, and the way it drains the world while claiming to augment the world, leaving the film itself utterly drained by the final scene too.