A controlling father imposed his warped definition of female nature on his daughters in Sophie Mackintosh’s first book, “The Water Cure,” longlisted for the Booker Prize in 2018, and constraints on women’s behavior continue to be a theme in her new novel, “Blue Ticket.” This time, the restrictions are society-wide, in an unspecified nation where girls who have reached puberty draw tickets in a lottery to determine their future. The details about what this means emerge slowly in Mackintosh’s elliptical text, after 14-year-old Calla pulls a blue ticket from the machine.

“You have been spared,” a doctor tells Calla and the other blue-ticket recipients as the single white-ticket girl is escorted into a separate room by an “emissary.” (We learn about the sinister duties of these state functionaries over time.) Another doctor inserts a birth-control device in Calla, who knows that the blue ticket means she will never have children. “I was glad,” she tells us. “Don’t underestimate the relief of a decision being taken away from you.”

She feels differently 18 years later. The world of “independence, of pleasure-seeking and fulfillment” her blue ticket promised has mostly involved a lot of drinking and sex, some of it violent. Her most meaningful relationship is with Doctor A, who monitors her physical and emotional condition and writes a lot of prescriptions. Doctors seem to have a great deal of control over the woman they supervise, but Mackintosh keeps the details deliberately vague, intensifying the mood of generalized dread.

That mood also colors Calla’s decision to remove her birth-control device. She’s propelled by “a new and dark feeling inside me. A strange, ravaging ghost.” Her urge to have a baby overpowers everything she’s been told her entire life, and it’s not surprising that when she does get pregnant, her primary emotion is fear; although she doesn’t know what the consequences will be, they clearly won’t be good. What Calla really wants, the author shows us, isn’t necessarily a baby; it’s an answer. “I was not motherly. It had been judged that it wasn’t for me,” she tells us when she gets the blue ticket. Years later, she wants to know, “What made a mother? What was the thing I was lacking?”

The answer to that question, near the end of Calla’s odyssey, provides the novel’s most brutal moment. And this is a brutal society; Calla has known that since she got her blue ticket, a bottle of water, a compass and a sandwich and was told to go “to the place of your choice.” When an emissary arrives at her door three days after her pregnancy has been discovered, she thinks, “At least they gave me a tent this time.” (In addition, he hands her a map, some dried foods, a knife and an antiquated pistol.) As Calla flees shadowy pursuers, we learn from her memories that the blue ticket entered girls in a struggle for survival; they had to reach their destination alive to claim the ticket’s alleged rewards, and not every girl made it. A brief conversation with the man who fathers Calla’s baby (and then wants nothing to do with her) suggests that boys were pitted against one another, too, though there’s also a disturbing hint that they preyed on blue-ticket girls.

Without delving into specifics, Mackintosh creates a hostile environment that deforms all relationships. Calla joins up with several other illegally pregnant women heading for “the border” (apparently there are alternatives to her ticketed nation), but they don’t entirely trust one another, and the novel’s grim denouement shows they had reason not to. The revelation that one of their band, Marisol, had been a doctor before she got pregnant makes it clear that this is not a simple tale of men oppressing women. And the addition to the group of a white-ticket woman who ended her pregnancy underscores a point Mackintosh has made clear all along: “Blue Ticket” is not about whether women should have babies but about what happens to human beings when their ability to choose is denied. When Calla is finally offered a choice, it’s a terrible one, and Mackintosh gives her only the smallest modicum of hope to lessen its bleakness.

Written in cool, clinical prose parceled out in short paragraphs separated by lots of white space, “Blue Ticket” does not aim to stir our emotions, even though it deals with emotionally fraught material. Mackintosh traffics in ambivalence and ambiguity, suitable tools for charting Calla’s hesitant progress toward, if not self-knowledge, at least knowledge of what she is looking for.

Wendy Smith is the author of “Real Life Drama: The Group Theatre and America, 1931-1940.”

Blue Ticket

By Sophie Mackinstosh

Doubleday. 304 pp. $26.95