Little Woods' Aching Portrayal Of Abortion & Healthcare Is All Too Real

About halfway through Little Woods, Ollie (Tessa Thompson) offers a piece of advice to her sister Deb (Lily James). “Your choices are only as good as your options are,” Ollie says. It’s a line that echoes throughout the rest of the movie, which tells the story of two sisters who find themselves struggling with rural poverty in a North Dakota town where the fracking boom has made even basic necessities shockingly expensive. And it’s a line that neatly summarizes the plight of the real women of this region whose lives bear an uncomfortable resemblance to Ollie and Deb’s.

Within the world of Little Woods, the options are indeed slim. Ollie, a former oxycontin dealer just days from the end of her probation stint, finds herself a few thousand dollars short on her mortgage payments, with no good way to save her house from foreclosure. Deb, a single mom working as a waitress, learns that she’s pregnant — and with no health insurance, prenatal care alone will cost her $8,000, a sum that’s far too steep for her already-strapped budget. Over the course of the film, the sisters watch as their circumstances become increasingly untenable, ultimately forcing them to cross the border into Canada to seek the resources that will enable them to resolve their problems. In Ollie’s case, that’s a drug smuggling gig that’ll pay her the money she needs to save her house; for Deb, it’s an abortion that’s all but inaccessible back home.

For writer/director Nia DaCosta, Little Woods grew out of an urge to tell a story, with specificity, about women in rural America. “If you’re a woman experiencing poverty, this implicates so many things,” DaCosta says, citing childcare and reproductive health as two areas where poor women are uniquely burdened. Troublingly, these issues are more likely to be treated as political talking points than the daily realities of real people’s lives. “What’s forgotten is people who actually have to live and pursue healthcare,” DaCosta says.

In Little Woods, DaCosta creates characters enduring this particular plight, examining what pressures might lead someone to Canada in search of cheap prescription medications, or how an uninsured single mom might navigate her choices when a legal abortion feels just out of reach. And although DaCosta stresses that the movie is not about abortion, but rather a story in which an abortion takes place, it offers an insightful portrait of the reproductive healthcare landscape in much of America.

In the real world, women like Deb are in an unenviable position. When it comes to reproductive healthcare, women in North Dakota’s oil country face a “very real set of barriers,” Amy Jacobson, North Dakota State Director for Planned Parenthood of Minnesota, North Dakota, and South Dakota, explains. “Even accessing birth control locally can be a challenge… because the communities are so small, and everybody knows everybody, privacy is an issue.”

For people who find themselves in need of an abortion, things can feel even more dire. North Dakota is home to just one abortion provider, the Red River Women’s Clinic in Fargo, a five or six hour drive away from the town where Little Woods is set. And distance isn’t the only barrier to abortion access: North Dakota subjects abortion patients to a punishing set of restrictions, including state-directed pre-abortion counselling intended to discourage the procedure, a 24-hour waiting period before it can be performed, and limited insurance coverage. (Just over the border in South Dakota, the situation is even worse: Red River Women’s Clinic Director Tammi Kromenaker says that many South Dakotans head to Fargo for their abortions to evade their home state’s 72-hour waiting period.)

Because of its sparse population, North Dakota has never been an easy place to access abortion — there simply aren’t enough people in the state to sustain more than one abortion clinic. But over the past decade, access has gotten significantly more limited thanks to new legal prohibitions. Between 2011 and 2015, North Dakota adopted 15 new restrictions on abortion, banning later term abortions while adding in the waiting period requirement and blocking Medicaid from covering the procedure. For women like Deb, these restrictions have made an already difficult situation into one that’s nearly impossible to navigate.

In Little Woods, Deb ends up resolving her crisis with a trek through the woods across the border to Canada (and a forged Canada Health ID that she steals when the cost proves to be too high), but in real life, things rarely resolve so simply. Kromenaker says she’s never heard of someone from North Dakota heading to Canada in search of abortion. To the contrary, she tells Refinery29, “The opposite has been true — we’ve had women from Canada come to us,” particularly during the years when mifepristone, the pill that induces a medication abortion, was still unavailable to Canadians (although it was approved for use in the U.S. in 2000, Canadians had to wait until 2015 to get access).

The more likely end result for a pregnant woman in North Dakota who can’t get to Fargo is bleak. Kromenaker points to the findings of The Turnaway Study, which examines the outcomes for women who arrive at abortion clinics past the point in their pregnancy when the provider is able to safely (or, in some cases, legally) perform an abortion, and are “turned away.” “What researchers found was when the barriers were so great, women just continued a pregnancy that they did not feel prepared for,” Kromenaker says, a reality that will probably further exacerbate the problems of poverty that lead many to seek abortion in the first place.

And as our political climate becomes increasingly hostile to abortion, expect things to get worse: In the event that Roe v. Wade is overturned, North Dakota is already prepared to fully criminalize abortion, removing even the limited options currently available to pregnant North Dakotans. For many Americans, that discussion may seem abstract, or just one more political debate. But Little Woods illustrates, in high relief, just how catastrophic a lack of abortion access can have on the lives of women in rural America.