The plot closely follows the account found in Abby Johnson’s memoir, Unplanned. The film opens with a depiction of Johnson’s home life with her husband, Doug, and daughter, Grace. In voice-over, Abby Johnson says she was tricked into participating with Planned Parenthood and the scene shifts to a time in 2009 when she claims she was asked to assist in an ultrasound-guided suction aspiration abortion at thirteen weeks gestation. The scene ends with Abby leaving in tears. Johnson then describes, in voice over, that her story started her junior year at Texas A&M. The scene is depicted in flashback of a Planned Parenthood booth at a career fair. Johnson agrees to volunteer after the representative in the booth says to her that their ultimate goal was to reduce the number of abortions. As a clinic escort, she meets director Cheryl and witnesses anti-abortion protesters being verbally confrontational towards the women going in One protester, Marilisa, is depicted as being kinder to women than the other protestors and says that those from her organization, “Coalition for Life”, are “not here to hurt them or condemn them”.

A flashback within a flashback then happens to when Abby had her two abortions, the first as a college student and the second after she marries then divorces. During the second abortion, she is given mifepristone at the clinic and is told there will be “a little bleeding”, but the experience is depicted as being excruciatingly painful, over twelve hours and then followed up with “eight weeks of blood clots and excruciating cramps” causing her to fear for her life.

The film then cuts back to Abby’s continuing work at the clinic, and she recounts in voice-over that it became “my career, despite the disapproval of virtually everyone in my life”. The film flashes forward to her second marriage to Doug, a man who proclaims love while, like her parents, disapproving of her career on religious and moral grounds. Abby describes starting her life with Doug and attending a church with him that is decidedly opposed to abortion even while she continues to work at Planned Parenthood.

Abby becomes pregnant by Doug and decides to keep it. In the meantime, a scene is depicted of a botched abortion taking place at the clinic where Abby is told not to call an ambulance because of the way it would “look”. Abby gives birth to Grace and is promoted to director when Cheryl is transferred to Houston. Before Hurricane Ike strikes, Abby coordinates all of the abortions to happen beforehand, anticipating that it won’t be possible to perform the procedures for a while after the hurricane. Abby wins Employee of the Year while also being told by Cheryl that she should double the number of abortions. Cheryl explains that “Non-profit is a tax status, not a business model!”, and says the organization makes its money off of abortions the way that fast food restaurants make money off fries and soda. Abby is scolded for objecting to this, and then eventually reprimanded by Cheryl for insubordination after which the first few moments of the film are repeated just prior to Abby’s participation in the procedure.

Abby is then depicted going to the office of 40 Days for Life, run by Marilisa and her husband, Shawn, and tearfully telling them that she cannot stay in her job after what she has seen. They offer to help her find employment. Abby formally resigns from Planned Parenthood and begins to help with the 40 Days for Life campaign, to the point of being on the other side of the clinic fence encouraging women not to go through with their abortions. Planned Parenthood sues Abby for leaking confidential information about their operations, and Shawn convinces his laid-back lawyer friend Jeff to defend her.

In 2013, when the clinic Abby worked at has closed, she organizes a celebration at the abandoned building in which she expresses regret for performing abortions as well as having two. The closing captions say that Abby continues to work with the ministry “And Then There Were None”, helping other abortion clinic workers leave and find employment elsewhere.[