The most important communication in Never Rarely Sometimes Always happens without words. Instead, a camera lingers closely on the back of 17-year-old Autumn (Sidney Flanigan) as she changes out of her grocery store uniform in a backroom. Autumn’s best friend/cousin Skylar (Talia Ryder) notices, and when Autumn sprints away from her register one day, she instinctively finds her in the bathroom. We hear Autumn vomit; we don’t hear her tell Skylar she’s pregnant. Skylar just knows.

This unspoken gravity holds together Never Rarely Sometimes Always, an achingly observant if pathologically spare movie from the writer-director Eliza Hittman which dwells in the mundane, confusing and quietly devastating moments of teenage pregnancy and abortion access in Trump-era America. Defamed by male classmates and neglected by parents exhausted by making ends meet, Autumn’s only resource in her small Pennsylvania town is the local crisis pregnancy center, which purports to educate women about their choices but in effect counsels against “abortion-mindedness”. The specialist at the center speaks to Autumn with patronising concern, and as the only person besides Skylar in town who knows of her condition, takes an interest in her; she also shows her a VHS tape which violently equates abortion to murder.

The state requires women under 18 to receive parental permission, one of the many, many restrictions on abortion access enacted by state legislatures.

It’s hard to watch this movie outside its context, as states across America cracked down on access to abortion services. Never Rarely Sometimes Always smartly refuses to wade into didactic political messaging. Autumn’s journey out of state for an abortion is one an increasing number of American women will have to make – if they can make it at all.

The film’s most poignant scene, which attracted buzz at Sundance and gave the film its title, captures an ordinary intake session for Autumn’s second-trimester procedure at a Manhattan clinic. The counsellor quizzes Autumn on her medical history with escalating emotional severity – does she have any allergies? Has anyone molested her? – with four response options: never, rarely, sometimes, always. Each word carries a short lifetime of unspoken pain. No need to detail it. The ordinary questionnaire is enough.