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The Book of the Unnamed Midwife is a post-apocalyptic novel, told in a combination of journal entries and short narratives. It follows the midwife from her origin as an ob-gyn nurse in San Francisco through her years struggling to survive as a virus-driven plague kills almost all the men on the planet, even more of the women and children, and every single fetus and newborn infant.

As in similar works, such as The Walking Dead, the story begins with our narrator waking in a hospital, surrounded by the dead. As a healthcare worker, however, the midwife worked at the San Francisco hospital in which she awakens, and has firsthand knowledge of the early stages of the plague.

The first man the midwife encounters after waking in the post-plague world tries to rape her. She kills him, almost by reflex. The second and third men she meets are a pair of gay lovers, and the group of men after that try to kill this earlier pair, again in order to rape the midwife.  It is shortly after these events that the midwife makes her decision to disguise herself as a man—to wear a binder, to dress as a man, to adopt the characteristics and language of a man. These events and the midwife’s subsequent decision are plot points, but they also matter thematically. Three of the issues examined in this book—as well as in its sequel, The Book of Etta—are, first, the status of women in the post-apocalyptic world; and second, the question of whether and to what extent women should use violence to defend themselves; and finally, the subject of gender and identity.

The first of these, the status of women in a post-apocalyptic world, may seem an obvious consideration by any writer of such a book; but when you’ve read as many post-apocalyptic books as I have, you’ll find it isn’t. Almost every post-apocalyptic novel and film just defaults to the presumption that, come the apocalypse, women will return to their “natural” status—which is to say, the status of rape victim, slave, and breeder of children. Further, nearly every one of these writers assumes that the “natural” place of women is the margins. Needless to say, in most of these texts, the main characters are straight, cisgendered men (and almost entirely white).

In James Howard Kunstler’s World Made by Hand (2008), for instance, what remains of civilization is governed by a town council, all white men. Kunstler informs us, “The egalitarian pretenses of the high-octane decades had dissolved and nobody even debated it anymore, including the women of our town” (p. 101). Indeed, throughout that book and its sequels, the major characters are men or male children. The few (minor) women characters exist as sexual objects, and this includes the female children.

Likewise, in Peter Heller’s highly acclaimed The Dog Stars (2012), the main characters are men. The one woman who arrives as actual character, late in the book, exists as an object of sexual gratification for the main character. Until she arrives, we only see dead women, or women as rape victims, or (very minor characters) women-as-mothers. In Cormac McCarthy’s The Road (2006), similarly, the only women characters are dead or victims. While Pat Frank’s Alas, Babylon (1959) has women as characters, including some black women characters (it is set in Florida after a limited nuclear exchange), white males run the surviving civilization—women are relegated to mending, cooking, and teaching.

And in Stephen King’s iconic The Stand, we find this rumination from Frannie—very nearly the only woman character of whom the author seems to mean us to approve:

Women's lib … was nothing more nor less than an outgrowth of the technological society. Women were at the mercy of their bodies. They were smaller. They tended to be weaker…. Before civilization, with its careful and merciful system of protections, women had been slaves. Let us not gild the lily; slaves was what we were, Fran thought. Then the evil days ended. And the Women's Credo, which should have been hung in the offices of Ms. Magazine, preferably in needlepoint, was just this: Thank you, Men, for the railroads. Thank you, Men, for inventing the automobile and killing the red Indians who thought it might be nice to hold on to America for a while longer, since they were here first. Thank you, Men, for the hospitals, the police, the schools. Now I'd like to vote, please, and have the right to set my own course and make my own destiny. Once I was chattel, but now that is obsolete. My days of slavery must be over; I need to be a slave no more …. Thank you, Men.

Now all that had changed, in a matter of weeks it had changed—how much only time would tell. But lying here in the night, she knew that she needed a man. Oh God, she badly needed a man. (pp. 515-516)

I could go on. While there are post-apocalyptic novels that break from these constraints, or at least work against them—Emily St. John Mandel’s Station Eleven (2014), for instance—they are not common. Given the pervasive and unexamined presence of this assumption in so much of the genre, it almost certainly represents a male fantasy of some sort—“Here is what the world would be like if we could get rid of these pesky laws and regulations,” sort of thing. However, none of these books follow this hypothesis through to its conclusion. Without law, their theory goes, women would be property of the most powerful men around, subject to rape, forced to bear children, their voices silenced. This is women’s “natural” state.

Yet almost none of these sorts of narrative note that in a world without law, most men would also be property, subject to rape, their children enslaved, their voices silenced, their labor stolen. This does not fit the fantasy, and thus it is ignored. In these first two novels of her planned trilogy, Meg Elison directly confronts this default presumption of the “natural” status of women (once the “unnatural” civilization we have created around us vanishes). One real value Elison’s books bring to the genre is their examination and subversion of the default assumption, first that subjugation and rape is the “natural” state of women; and second that what happens in the “natural” state is limited (somehow) to the status of women.

The second issue Elison examines in these books—how women should defend themselves—comes into play shortly after the midwife leaves San Francisco. Having stocked up with medical supplies and drugs, including heaps of birth control, the midwife travels north, and later east, crossing the mountains into first the Intermountain West and then the Midwestern plains. As she travels, she encounters roving bands of dangerous men, some of them traveling with enslaved women—some literally in chains. In her disguise as a man, the midwife is able to get birth control to some of these women. This is a necessity since the plague virus still lives in every survivor, and still kills almost every woman who becomes pregnant. The midwife also kills many men, both in self-defense and to free enslaved women.

As I mentioned above, the midwife kills the first man she encounters after waking—being “reborn” into the post-apocalyptic world. She kills this man swiftly, without thinking, by reflex. The next men she kills intentionally, and after much terrified deliberation (which we follow via her journals). She has always known how to shoot, having learned as a child. Now she begins the hard work of learning to defend herself.

This pays off when she gets involved in a gunfight, shooting six men to rescue two enslaved women. These women have been raped constantly by all six men, and have watched a third woman, impregnated by the men, die in childbirth, along with the infant. One of these women subsequently commits suicide. The other, Roxanne, travels for a time with the midwife. While they travel, the midwife tries to teach Roxanne the elements of self-defense. But Roxanne, like Frannie from The Stand, thinks the key to survival for women lies elsewhere. She thinks women should find men, and use sex to get those men to protect them.

Roxanne smoked and sighed. “I would have talked myself off that chain … I know what guys are like. Guys think they’re always in charge, but you can always manipulate the shit out of them. We hold all the cards….”

“If you say so.”

“What, you don’t believe me?”

“I believe I found you chained up and naked. I don’t think you held much then.” (pp. 72-73)

Later, they meet a young man on a motorcycle. Though by this time she has seen the midwife defend not just herself but also other women, Roxanne has been inculcated with the same default assumption as the writers of most apocalyptic fiction. She explains to the midwife that women can’t survive on their own, and leaves with the biker. Still later we learn that Roxanne and her biker have encountered a large group of men. To his credit, the biker tries to defend her—but he is easily overcome and killed. Roxanne attempts to use her sexuality to manipulate these men, to no avail. She ends up dying in sexual slavery. The message is clear: sexuality as a currency to purchase men’s protection is not the answer (despite what Stephen King’s Frannie tells us).

The third issue Elison examines in these two books—she begins to consider it in the first novel, and focuses on it more strongly in The Book of Etta—has to do with gender and identity. Through most of the first novel, the midwife assumes a male identity, even occasionally using male pronouns. She is poly, as are others in the book (the most common form of post-plague sexual bond, in fact, becomes one woman plus several men). However, in the first book, none of this is discussed, and the midwife spends no time thinking about her gender or sexual identity. We are given events, in other words—the midwife’s male pronouns, the midwife’s attraction to both men and women, the midwife’s desire for more than one partner at a time—but no commentary on these events.

Eventually, in Missouri, the midwife falls in with a group of survivors who have occupied a military base (now called Fort Nowhere) and have established a tiny civilization. However, unlike other survivors of the plague, the survivors at Fort Nowhere do not treat women as property. Neither rape nor the enslavement of women is an accepted fact of life. Rather, both are crimes, punishable by death. Here, women are part of the governing body, and have access to birth control and to abortion. It is this difference that makes this settlement succeed where the others have failed—at least in the first book.

Many women at Fort Nowhere choose to continue their pregnancies. Many die from the virus as a consequence. For years, many fetuses (most pregnancies end in miscarriages), and all full-term infants, die. Only after more than fifteen years post-plague does a child survive her birth. The novel ends with this faint optimism: humans are not doomed. The species will continue.

The Book of Etta takes place a century later. While this book too is interested in examining the status of women and the use of violence in self-defense, it focuses much more directly and explicitly on the question of gender and identity. Eddy is the first person we encounter in the sequel. He is on his way out from Fort Nowhere, on a “raid,” which is a mission to scavenge goods from abandoned houses and buildings. Raiders also locate other settlements the Fort can trade with, and rescue girls and women from slavery.

A hundred years after the events of the first book—because of the high mortality of female fetuses, infants, and women in childbirth—men still outnumber women more than ten to one. Rape, murder, and theft of women and children are all common. When we first meet Eddy, an old man and an older woman are trying to sell him a girl child, Chloe, no more than five years old, whom the man has trained as a sex slave. Eddy kills the man; the old woman flees. Eddy takes the rescued child back to Fort Nowhere. Here, he becomes Etta.

In The Book of Etta, in the Fort Nowhere where Eddy lives, only heterosexuality is allowed. The most common sexual arrangement is polyandry—one woman with many men—and no form of same-sex relationship is admitted to exist. Further, no gender identity other than cisgender is recognized. All other sexualities and genders have been erased from public knowledge. In one eerie scene, we learn that the council which rules Fort Nowhere literally excises—cuts out—any word referring to anyone or anything queer from the pages of books that have survived from the pre-plague world. This is despite the fact that the people of the Fort very nearly worship the Unnamed Midwife and her journals, in which her queerness is made plain.

Because the Unnamed Midwife kept a journal, every midwife and every raider in the Fort is also encouraged to keep a journal. Eddy’s journal gives Elison’s second book its title—we watch as Eddy writes his journal, out on his raids. We watch him start each entry with The Book of Etta, naming himself by his female name even as he thinks of himself as Eddy, and uses his male pronouns.

His culture has erased queerness, and as a consequence, Eddy/Etta has no name for what they are. They spend much of the book making up stories, attempts at explanations. Etta (she is Etta when she is in the Fort) tells herself that she is like the Unnamed Midwife—that she dresses as a man for the same reason the midwife did, in order to survive in a world that enslaves and kills women. Outside the walls, on the road, Eddy tells himself he is Eddy because of a terrible trauma that occurred when he traveled all the way to Estiel (STL, St. Louis). Eddy was born in the chair, he thinks over and over throughout the book. We come to understand, long before Eddy does, that neither explanation is correct. It’s true that women are in danger outside the walls of the Fort; but so are men. Further, as the novel progresses we come to understand that Eddy was not “born in the chair.” Eddy/Etta has always existed; but they can’t exist in Fort Nowhere.

Etta/Eddy have no words for what they are, and can neither speak it nor write of it. Thus, for a long time, Eddy writes very little in his journal. The Book of Etta, he writes at the beginning of each entry, and often can write no further than that. The novel Elison is writing, The Book of Etta that we hold and read, likewise for most of its pages cannot tell us the truth about Eddy/Etta, because it is a truth they are not allowed to know.

However, shortly after Eddy rescues Chloe, he sets out on a second raid, and arrives at Jeff City, some distance from Estiel. Oddly, this town is filled with what seems to be an equal number of men and women, an impossibility in the post-plague world. Not only will no one in the town explain why their town is different, no one will even admit that their town is different.

Here, Eddy meets Flora. Flora is a “horsewoman,” which (as the reader understands much sooner than Eddy) means she is a trans woman. Just as Eddy finds it impossible to “see” the truth about his own gender, he cannot see the truth about Flora. Her existence, like his own, is an impossibility to him. Significantly, it is after Flora forces Eddy to understand the truth about who she is that Eddy first begins to write entries in his journal with the headings The Book of Eddy. It is only by seeing her, in other words, that Eddy/Etta begin to understand the truth about themselves.

But before this, Eddy sees an infant girl taken from the marketplace by the Lion’s Men (the Lion is a robber baron from Estiel). Eddy is told that every woman and girl child belongs to the Lion, which doesn’t mesh with all the women and girls walking about freely in Jeff City. Not stopping to understand the puzzle, he sets out to rescue the infant girl.

Flora travels with him. Along the way, she tells Eddy some of her story, including how she was “cut” as a child. Eddy thinks Flora is talking about female circumcision, a common practice in the post-plague world. As the book progresses, however, we readers slowly come to understand what Eddy does not: that many of the horsewomen in Jeff City are former child slaves, designated males at birth, who were “gelded” (as the slavers call it) when young. Jeff City, apparently, buys up these altered children and raises them as daughters in order to provide cover for their own (presumably cis) female children. Since the Lion is not interested in altered males, his men will not confiscate these children, or Jeff City cis-female children hidden among them.

The reason the Lion is not interested in confiscating altered male children, of course, is that Estiel, like most places in Elison’s post-apocalyptic world, has plenty of these children of its own to use as sexual slaves. In Elison’s books women (both cis and trans) are subject to rape and slavery, unless they can find or build a civilization that will recognize and protect their rights as human subjects.

This is not a surprise; almost all post-apocalyptic books do this. But unlike these other books, in The Book of Etta men outside of such a civilization are also treated as property, including sexual property. And even within a civilization, in Elison’s books both men and women surrender some of their individual rights in exchange for their value to the community.

We encounter three civilizations that protect the rights of women in The Book of Etta. The first is Fort Nowhere. The second is Jeff City, which refuses to engage in violence itself to defend women. Rather, it exports its violence, making weapons for others to use, and buying child slaves to use as shields. This practice, as Eddy correctly notes, creates a demand for more such slaves. Flora and others from Jeff City defend the practice to Eddy, saying that killing “makes things worse” (p. 68), that killing people is “barbaric,” and that dead men don’t “learn anything. Changed men change the world” (p. 51), the Council of Jeff City explains to Eddy.

Both of these civilizations are flawed, and both in the same sort of way. Though each protects the rights of its citizens overall, treating neither men nor women as property, each also fails to protect the rights of everyone. Jeff City buys its safety both through the suffering of child slaves, and by allowing the sacrifice of its infant girls—letting them be taken off into sexual slavery without protest. The Fort buys its safety by enforcing iron conformity to sexual and gender roles. Each city denies the needs and rights of a significant portion of its citizens, and it is this denial that will destroy these cities.

The third and final civilization both we and Etty/Eddy meet is Ommum, an LDS culture in a vast underground bunker. Though Ommun uses appropriate violence to protect not just its own citizens, but the people in the land around it, everyone in this culture is subsumed to the community. They seem very happy about being so subsumed—it is a community that works. But community members are as interchangeable as bees in a hive, and its gender roles are as rigid as those in the Fort.

By this point in the novel Eddy/Etta has been through their encounter with Flora, as well as further events that have clarified their understanding. Though they still have no words for their gender, they begin to understand that they are gender fluid. Through the last pages of the novel, both the name they call themselves (Eddy/Etta) and their pronouns begin to flow along the spectrum easily, so that Etta/Eddy moves from one name/one gender to the other and back again within the space of a few pages, or occasionally even a few paragraphs. By this point, also, Eddy/ Etta understands clearly that the world around them won’t accept their identity:

[Eddy] thought of Ina, telling Etta as a child that she could be a Mother or a Midwife, but the choice would not really be up to her.

Does anyone get to choose what they are?

Doesn’t seem like they choose here, either. Men are “Deks” and boys are “Aarons.” Everybody is “leaf.” This is all arranged for the many, and the few have to fall in line.

No different from Nowhere. Or Estiel. (p. 256)

At the end of the book, even though there is no room for queer and/or trans people there (the leader of the community, Alma, insists on calling Eddy “Sister Etta”), Etta/Eddy chooses Ommum as their community. This may be because Alma has convinced them it is their destiny; it may only be because they have few choices left at that point. In either case, this is a community that will require Eddy to (pretend to) be entirely Etta if he stays—to subsume their true nature to the culture—and Eddy/Etta has made it clear already that they will not do that. We as the readers are left to speculate: will Eddy/Etta change the culture? Or is this one more civilization that will be destroyed through its inability to change to fit the needs of its people?

The Book of the Unnamed Midwife won the Philip K. Dick Award in 2014; The Book of Etta has been nominated for the award in 2017. A third book is planned. I can hardly wait.

Kelly Jennings has published short fiction in Daily Science Fiction, The Sockdolager, and Strange Horizons; her first novel, Broken Slate, was released by Crossed Genres Press. Read more about her at her blog, delagar.
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