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Set in 1987, two years before the downfall of Communist dictator Nicolae Ceausescu, 4 Months moves from the shabby clutter of an overcrowded college dorm, through the dimly lit streets of a provincial city, to a rundown Stalinoid deco hotel, with a memorable detour to the cramped bourgeois apartment where a middle-aged woman celebrates her birthday. The dreariness is electric . . . with suspicion. The world teems with black-market hustles. Quotidian ID checks and ticket inspections punctuate the action, as bureaucratic snafus and quid pro quo deals enhance the jitters. This is a society where not much works and everything, even closing a car door, is a hassle.

Thin and nervous, pregnant Gabita (Laura Vasiliu) seems to have ignored her condition for as long as possible; she's helplessly distracted, leaving her more responsible roommate, the stolid, steady Otilia (Anamaria Marinca) to handle every detail. Anxiety begins when Otilia attempts to book a hotel room for the clandestine procedure. Like The Death of Mr. Lazarescu, the 2005 tour de force which put the new Romanian cinema on the map, 4 Months—filmed in handheld 35mm by Lazarescu's director of photography, Oleg Mutu—dramatizes a particular process. With virtually every scene shot in a single setup, the movie feels like it's unfolding in real time.

For all its long behavioral takes, 4 Months is remarkably unshowy. The movie is as drained of color as the girls' faces. Daily life is a hellish adventure. Where Lazarescu was an exceedingly dark comedy, 4 Months is a shockingly matter- of-fact horror film. For one thing, the procrastinating Gabita is openly terrified. She doesn't know much and, her squeak of a voice increasingly timid, lies about what she does know—a form of denial as pitiful as the homemade pastries she brings to her abortionist, the bizarrely named Mr. Bebe (Vlad Ivanov). He wears the leather jacket of a secret-police thug, and given the power he wields, could almost be one. To say that this depressed, volatile predator, who keeps a switchblade in his toolkit, is without bedside manner is to say the least—he works as much for "love" as money.

4 Months is discreetly—and then shockingly—graphic. Negotiations with Mr. Bebe take an appalling turn. The abortion is the ultimate violation of Gabita's body—and not just hers. The procedure is shown in an unflinching single take. How do these Romanian actors train? As in Lazarescu, the ensemble scenes are mind-boggling, and the principle performances get at an authenticity beyond naturalism. Marinca's alert, open face is the screen for a remarkably inward performance. Although at one point the freaked-out Otilia, pale with exhaustion and close to panic, berates her selfish friend, she is usually alone with her thoughts. 4 Months brings this home in the movie's most stressful scene, when Otilia leaves Gabita and travels halfway across town to arrive (late) at a birthday dinner with her (furious) boyfriend's parents, whom she is meeting for the first time.

Complete with an alarmingly unanswered ringing phone, the sequence is sensationally excruciating. Otilia is not only sandwiched between her elders and trapped in inane conversation but squeezed under the microscope of their continual surveillance. The class, gender, and generational alienation is palpable, exceeded only by the larger confinement in which Otilia finds herself—something for the viewer to ponder as she manages to flee the apartment for the dog-barking, bottle-smashing sinister murk of the Romanian evening.

Otilia's journey to the end of the night is best experienced without additional detail—although, having seen it twice, I'd say that one's identification with her situation is so strong that even knowing the upshot, the tension remains. By any standard, 4 Months is a white-knuckle deal. Is there an audience?

Among other things, 2007 was the year of the abortion—or perhaps we should say the abortion-not. 4 Months came out of nowhere at Cannes to win the Palm d'Or, beating No Country for Old Men and The Diving Bell and the Butterfly, and, on the basis of festival screenings and a week-long qualifying run in Los Angeles, finishing fourth in the Village Voice film critics' poll.

Tony Kaye's Lake of Fire, which opened at Film Forum in October, was one of last year's best-reviewed documentaries—although that hardly translated into box-office success. This provocatively gorgeous and unsparing account of the Manichean battle between the forces of choice and those of life barely lasted a week onscreen. The movies people really wanted to see were Knocked Up, Juno, and, to a lesser degree, Waitress, all of which portrayed an unwanted pregnancy as an essentially comic situation.

Comedy is the operative term. Had the protagonists been poor, black, illegal, or Jamie Lynn Spears, the movies necessarily would have been more serious and scarcely as much fun—but that's not even the point. Neither 4 Months nor Lake of Fire can be easily enlisted as pro-choice or pro-life. But both are realistic. They articulate the tragic aspects of an unwanted pregnancy while acknowledging that the burden of tragedy is borne by women and enforced by men. Abortion was made illegal in Romania in 1966; by the time Ceausescu was overthrown 23 years later, an estimated half-million women had died as a result of botched illegal abortions. The nation's overflowing orphanages were notorious for their subhuman conditions.

By contrast to 4 Months and Lake of Fire, Knocked Up, Waitress, and Juno are proudly fantastic and a priori pro-life; their female protagonists have no choice other than to bring their pregnancies to term. Obviously, these movies could not exist if their preg protags elected to have abortions. What's more crucial is the fact that the Knockee, the Waitress, and even the hyper-articulate 15-year-old hipster improbably named Juno are unable to express why they feel obliged to give birth to unplanned and unwanted babies. They have no choice and they have no say. It is simply their fate.

If Knocked Up's Alison were a devout (or even lapsed) Catholic in addition to being a glamorous newsreader, if Waitress's guilt-ridden Jenna imagined that a child would improve her disastrous marriage, if little Juno were planning a welfare scam to fund her alt-rock band or simply wanted to gross out the neighbors, these narratives would still function, but now with the added aspect of free will. (This is the paradox at the heart of Todd Solondz's authentically problematic Palindromes—the movie is pro-choice in that its 13-year-old protagonist chooses to get pregnant because she wants to have a baby.)

There can be no female agency in Knocked Up, Waitress, and Juno—not because they are comedies, but because, in each scenario, unwanted pregnancy is the joke played (by God?) on the female lead. As the most successful of the preg protags, she who is Knocked Up is necessarily the most smacked down—the glass ceiling turns out to be Alison's own uterus. Jenna and Juno are less formidable, but unexpected fertility mocks their dreams of autonomy. All three are taught their place by their own bodies—and what's more, they learn to like it.

That's the kicker: a baby. They might not have known it, but what these women really wanted was to have babies. Knocked Up, which is basically a revenge fantasy, is at least cathartic in its humorously blatant misogyny. Waitress, written and directed by Adrienne Shelly (herself a martyr to male brutality), is only pathetic. Unique in that she really, really, really doesn't want the child, Jenna is consequently thus the most oppressed—imprisoned by an ogre husband, betrayed by the wimpy doctor who loves her, "liberated" only by the grace of Andy Griffith's curmudgeonly fairy godfather. Juno, which was written by a woman and has become something of a fetish (albeit mainly among male film critics), is positively creepy.

Juno's knocked-up 15-year-old is at once provocatively precocious and primly pre-sexual. Her pregnancy is a miracle of bad luck—she simultaneously loses her virginity and conceives a baby. It's all but immaculate. Perhaps because, in this case, the preg protag is legally a child, Juno (unlike Knocked Up) is mature enough to employ the word "abortion." Still, disgusted by the yucky receptionist at her local women's clinic, Juno decides to have her baby. Not to worry: It won't be for keeps. She will donate the infant to a deserving careerwoman with a deadbeat husband and a stopped biological clock.

Even more than Juno's understanding father and benign stepmom, this act of charity is the movie's essential fantasy. It scarcely seems coincidental that Juno was released in time for Christmas. Pivot its scenario 90 degrees to the right and you have a more spiritual version of Knocked Up. People love clever little Juno because she isn't really a teenager, let alone a person. Juno is an angel.

The protagonists of 4 Months, by contrast, are recognizably human. Otilia and Gabita are not slangy wiseacres. They are messy, sometimes foolish, often naive, and increasingly desperate, but they are never unsympathetic—not even the whimpering Gabita. Their trouble is all too real, and there are moments—most powerfully when the true awfulness of the abortionist Mr. Bebe begins to dawn upon them—that they resemble wide-eyed children, at once vulnerable and resilient. And they have neither script, nor religion, nor a patriarchal order to help them.

4 Months is too specific to suggest a tract, let alone an allegory. As I said, it's a thriller. In the most visceral sense, this is a movie about living with terror—political and biological. Like Knocked Up and the others, it's set in a world where unwanted pregnancies occur, and legal abortion is not an option.