In a pivotal scene in Eliza Hittman's abortion epic Never Rarely Sometimes Always the meaning behind the movie's title finally comes to light. Autumn (Sidney Flanigan) sits in a counselor's office being interviewed before having an abortion. The counselor asks her tough questions like, "Has your partner ever forced you to have sex?" She's given the choice to respond never, rarely, sometimes, or always — standard practice in real life. It's one keenly observed detail of many that Hittman uses to authentically capture the experience of so many young women seeking an abortion in the United States.
Never Rarely Sometimes Always tells the story of Autumn, a 17-year-old living in a rural Pennsylvania town who finds herself pregnant in a state that requires parental consent for an abortion for those under 18. Autumn and her cousin make an arduous journey to New York City for the medical care she needs, but not without multiple financial and logistical hurdles thrown in their way. The story highlights the barriers many women face to a safe and legal abortion, thanks to outdated restrictions on reproductive medicine and the shuttering of women's health clinics in isolated areas.
Hittman was inspired to write the film after hearing about the 2012 death of Savita Halappanavar, an Indian woman who was living in Ireland, where abortion was illegal at the time. (It was legalized in 2018). When Halappanavar began having a miscarriage, she was denied an abortion by the Catholic hospital, went into septic shock, and died.
Instead of focusing on Ireland, though, Hittman chose to base her story in a very American reality — one in which women and girls may find themselves traveling long distances to get the care they need. According to an Associated Press analysis of data collected from state reports and the U.S. Centers for Disease Control and Prevention, at least 276,000 women terminated their pregnancies outside their home state between 2012 and 2017.
"There was just something really compelling to me about the idea of that journey," Hittman tells Bustle. She began her research for the film by taking the same route that Autumn does in the movie. She stopped in isolated coal towns in Western Pennsylvania to get a feel for what life would be like for a woman seeking an abortion there.
"[I] just asked myself, if I was a girl in this town and I was pregnant, where would I go?" She visited controversial crisis pregnancy centers — which are known for pressuring women into going through with their pregnancy — but she wanted to form her own opinion. Pregnant at the time herself, Hittman took the store-bought pregnancy tests offered to her and sat through the counseling sessions. Much of what she was told and saw made its way into the film.
"They gave me pamphlets and showed me outdated videos, talked to me about my faith," Hittman says. "A lot of times they actually do the counseling before the [pregnancy] test has an answer, positive or negative. I was just kind of exploring the unethical aspects of what they do."
Hittman also took great care to make sure the scenes where Autumn finally reaches NYC and visits Planned Parenthood were entirely accurate. For confidentiality reasons, Hittman wasn't able to speak with any patients who had to cross state lines in order to get an abortion. So instead she consulted with counselors from Planned Parenthood Keystone, in New York, and with an independent clinic called Choices. "I just tried to play out scenarios. Like, how would you interact with a minor? What would your concerns be? And tried to get something more emotional about what their experience would be."
Despite being released in 2020 — a year in which abortion access is still being contested in the Supreme Court — Hittman insists she isn't trying to push an agenda. "I'm really interested, specifically with this film, in giving a face to the faceless and a voice to the voiceless, and taking the audience on this journey."