In 1987, obese, illiterate, black 16-year-old Claireece Precious Jones lives in Harlem with her dysfunctional mother, Mary. She has been impregnated twice by her father, Carl, and suffers long term physical, mental and sexual abuse from her unemployed mother. The family resides in a Section 8 tenement and subsists on welfare. Her first child, known only as "Mongo", has Down syndrome and is being cared for by Precious's grandmother.

Following the discovery of Precious's second pregnancy, she is suspended from school. Her junior high school principal arranges to have her attend an alternative school, which she hopes can help Precious change her life's direction. Precious finds a way out of her traumatic daily existence through imagination and fantasy. While she is being raped by her father, she looks at the ceiling and imagines herself in a music video shoot in which she is the superstar and the focus of attention. While looking in photograph albums, she imagines the pictures talking to her. When she looks in the mirror, she sees a pretty, white, thin, blonde girl. In her mind there is another world where she is loved and appreciated.

Inspired by her new teacher Miss Blu Rain, Precious begins learning to read. Precious meets sporadically with a social worker named Miss Weiss, who learns about incest in the household when Precious unwittingly conveys it to her. Precious gives birth to her second child and names him Abdul. While at the hospital, she meets John McFadden a nurse who shows kindness to her. After Mary deliberately drops three-day-old Abdul and hits Precious, Precious fights back long enough to get her son and flees her home permanently. Shortly after leaving the house, Precious breaks into her school classroom to get out of the cold and is discovered the following morning by Miss Rain. The teacher finds assistance for Precious, who begins raising her son in a halfway house while she continues academically.

Feeling dejected, Precious meets Miss Weiss at her office and steals her case file. Precious recounts the details of the file to her fellow students and has a new lease on life. Her mother comes back into her life to inform Precious that her father has died of aids. Later, Precious learns that she is HIV positive, but Abdul is not. Mary and Precious see each other for the last time in Miss Weiss's office, where Weiss questions Mary about her abuse of Precious, and uncovers specific traumas Precious encountered. The film ends with Precious still resolved to improve her life for herself and her children. She severs ties with her mother and plans to complete a General Educational Development test.

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