The novel is a dystopian reimagining of Nathaniel Hawthorne's The Scarlet Letter, set in a future theocratic America where rather than being imprisoned and rehabilitated, criminals are punished by being "chromed" – having their skin color genetically altered to fit their crime – and released into the general population to survive as best they can.

Hannah lives in Texas after a great outbreak of a sexually transmitted infection caused the majority of women of the world to become sterile leading to widespread panic, the rise of Christianity, and the overturning of Roe v. Wade.

Hannah belonged to a mega-church and after her father was the victim of a terror attack which threatened to leave him partially blind her family was offered comfort by the reverend Aidan Dale.

Because she refused to name her abortion care provider or Aidan, Hannah was sentenced to 16 years as a chrome, which also meant that she would be unable to bear children during that time because of an implant.

They decide to leave Texas and go stay with Kayla's cousin, but on the road they are abducted by Simone and Paul, two people who turn out to have been saving them from Fist members intending to harm them.

However, on their first stop along the way to Canada the women are betrayed by their host, Stanton, whose mother was an abortion provider and who sells them to be used as prostitutes in order to pay for expensive renovations for his home.

On the way there she sees a news report that Aidan publicly confessed to adultery without naming the woman he had an affair with and then collapsed of a heart attack.