Jane Forrester has just earned herself a degree in social work and moved to Raleigh, North Carolina. She accepts a job, against everyone's advice, at the Department of Public Welfare. Her first case is fifteen-year-old Ivy Hart, but it turns out her entire family is part of Jane's area of concern. Living with her mentally challenged sister, Mary Ella, her toddler nephew, and her ill grandmother, Ivy is left with the brunt of her family's responsibilities.
A few years back, Ivy's father died in an accident on the farm where they live, owned by Davison Gardiner. As recompense, Gardiner allows the women to live there free of rent. They would have nowhere else to go if he didn't. When Mary Ella gave birth to William, she was involuntarily sterilized by the hospital staff. They determined, according to policy, that she was an unfit parent and hoped to resolve the issue then and there.
Jane is horrified to learn this. She had no idea this would become part of her job, but when Ivy reveals that she is also pregnant Jane becomes responsible for determining whether or not to sterilize Ivy as well. Considering Ivy's low IQ, history of epilepsy, and insufficient means of provision for a family, Jane is advised to recommend sterilization. Jane, however, knows Ivy on a personal level. She understands how physically and emotionally traumatic Mary Ella's sterilization was and cannot bear the thought of doing the same to Ivy against her will. At the same time, Jane will lose her job if she doesn't follow procedure. She's placed at the intersection of welfare gone wrong and genuine humanitarian concerns.
