The Lord spoke to Moses, saying: Speak to the people of Israel, saying: If a woman conceives and bears a male child, she shall be ceremonially unclean seven days; as at the time of her menstruation, she shall be unclean. On the eighth day the flesh of his foreskin shall be circumcised. Her time of blood purification shall be thirty-three days; she shall not touch any holy thing, or come into the sanctuary, until the days of her purification are completed. If she bears a female child, she shall be unclean two weeks, as in her menstruation; her time of blood purification shall be sixty-six days. (Leviticus 12: 1–5)
According to the latest Ethiopian Demographic and Health Survey, only 10 per cent of labouring mothers in Ethiopia opt for deliveries in clinics or hospitals (CSA 2012: 126).Footnote 1 All others give birth at home. The country's Minister of Health, Kesetebirhan Admasu, recently bemoaned these figures, commenting: ‘That [the] majority of women [do] not appreciate the value of institutional delivery, calls for a concerted effort to educate women and families about the importance of skilled birth attendance and postnatal care’ (IRIN 2012).Footnote 2 To the same effect, the Health Survey advises that ‘proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness of the mother and/or the newborn baby’ (CSA 2012: 126). In a country that has one of the highest maternal mortality ratios in the world – 676 deaths for every 100,000 live births (ibid.: 270) – the rhetoric of ‘safe birthing’ has assumed an increasingly alarmist tone; it has also led a rising chorus of national and international actors to clamour for medically supervised births.Footnote 3
That comparatively few Ethiopian women give birth in biomedical settings today is partly due to a lack of historical precedents: clinical health services were established in the country only recently. It was not until 1952 that the Ethiopian government began to develop a network of basic health services, most of which were concentrated in urban areas and, at least initially, staffed exclusively by foreign physicians (Kassie and Kloos Reference Kassie, Kloos, Kloos and Zein1993: 135). But despite the construction of numerous health posts, health stations, clinics, and district hospitals across the country since that time, today many of these institutions are burdened by chronic shortages of trained personnel, drugs, equipment, running water, and ambulances. Rural clinics often have nothing in them except an examination table, a sink, and a limited number of medical supplies. A foreign surgeon I met during my research in Ethiopia in 2010 would frequently cite a staggering figure to underscore this point: in the entirety of the Amhara region of north-west Ethiopia where he worked (which has a population of 17 million people), four hospitals – staffed with nine obstetricians in total – were able to perform a caesarean section in the event of complications during labour.
And yet it would be misguided to assume that the relatively low number of clinical births in Ethiopia could be chalked up to institutional inadequacy or inaccessibility alone. A recent cross-regional study on maternal healthcare in Ethiopia contends that logistical hurdles that are commonly cited as preventing rural mothers from giving birth in a clinic – such as lack and costs of transport, distance to a nearby health facility, cost of treatment,Footnote 4 or the poor state of most clinics – cannot on their own account for these numbers. Instead, the author maintains that ‘important traditions and customs around birth are not recognized by health care providers’, serving to dissuade many Ethiopian mothers from delivering outside the home (Warren Reference Warren2010: 103). Women tend to feel alienated in clinical settings, the article suggests, because they are unable to follow familiar practices: the privacy of the mother during the birthing event, ceremonies to protect the mother and newborn from harmful spirit attacks, access to special foods, and the presence of trusted relatives (ibid.: 101–2). ‘Until these socio-cultural aspects … are incorporated into the care provided at the health facilities’, the author concludes, ‘we will continue to see women giving birth at home’ (ibid.: 103).
In this article, I develop these insights and take them one step further. Rather than focusing on the event of delivery alone, my study highlights the equally central aftermath of childbirth among Amhara Orthodox Christians. One reason for this move is that the categorical chaos and ritual pollution typically associated with the process of giving life are hardly ever resolved with the event of childbirth as such.Footnote 5 In many societies, mother and infant remain bound in a temporary state of structural, physical, and spiritual uncertainty that requires fastidious management, often including a period of seclusion. For Ethiopian Orthodox Christians this period of repose comes with a specific set of cultural coordinates about safety, about purity, and also about danger. These differ considerably from concepts of hygiene and infection propagated in the biomedical setting of a clinic and thus cast an entirely different light on the notion of ‘safe birthing’. This article aims to clarify these disparate ideas by zeroing in on practices aimed at safeguarding mother and baby at home. It therefore adds to an understanding of why most Amhara women feel reticent about institutional deliveries; at the same time, it seeks to elucidate more fundamental elements of Ethiopian Orthodox personhood in their own right.Footnote 6
The material for this study comes from ethnographic fieldwork I conducted on obstetric fistula in Ethiopia in 2010. Obstetric fistula, a maternal childbirth injury that results in chronic incontinence, affects an estimated 2 million women across the Global South.Footnote 7 Caused by prolonged, obstructed labour, fistula renders birthing mothers incontinent of urine or faeces, and sometimes both. In almost all cases the baby dies during the ordeal of labour. At specialized fistula hospitals all across Ethiopia, which are run under the umbrella of the Christian NGO Hamlin Fistula International, afflicted women can access free surgery to try to mend their injuries and regain their continence. I spent the majority of my time at the regional fistula hospital in Bahir Dar, the capital of the Amhara region, where I immersed myself in daily hospital routines, attended patient classes and surgeries, and conducted private interviews with patients and staff. Occasionally I accompanied the hospital's health officer on rural community visits and awareness campaigns and took part in Orthodox Church services in town. For the final quarter of 2010 I moved to Desta Mender, a fistula rehabilitation centre near Addis Ababa that houses incurable patients from across the country. My research methodology there remained essentially the same, and this article draws upon data from both of these research episodes.Footnote 8
During our conversations at the fistula hospital in Bahir Dar, I sometimes asked patients to recount customary birthing practices in their home region. Despite the trauma of their last birth, many women spoke about local childbirth norms with great clarity. What stood out to me in their narratives, however, was not how these devout Orthodox Christian women talked about childbirth itself, but what they revealed about the chain of events following birth. Speakers referred to this period by the Amharic term aras bét, which can be glossed as ‘childbed’Footnote 9 and connotes the forty- or eighty-day postpartum seclusion of the woman and her baby prior to its baptism.Footnote 10 A particular form of religious ‘othering’ takes place during aras bét: a mother who has just given birth and her newborn were described to me as ‘Muslims’. In the period between the birth of a child and its baptism, women routinely averred, both the child and the mother are called ‘Muslims’. Subsequent conversations with local midwives (awwalaj) in the Amhara countryside confirmed this idea. This raises a number of questions: why are a Christian mother and her baby labelled ‘Muslims’ during their seclusion? What happens during the birthing event and its aftermath that would bring about this temporary shift in their religious designation? And what can an answer to this enigma reveal about Ethiopian Orthodox personhood more broadly?
Below, I first set the stage for tackling these questions. Before moving into the main analysis, I describe the general texture of aras bét and the event of baptism, with a special focus on the ritual prohibitions that accompany both.Footnote 11 Although women's stories contained some local and personal variations, there were enough commonalities among all accounts to permit an aggregate portrayal of these practices (albeit punctuated by a small number of caveats). Drawing upon this baseline, the reader should then be in a position to solve this ethnographic puzzle.
ARAS BÉT: AN ETHNOGRAPHY
If logistically feasible, the expectant mother returns to her natal kin's home for the delivery of the baby. Her own mother or another close relative, functioning as or assisted by a midwife, serves as her primary caregiver during this time.Footnote 12 Although frequently used temporally to describe the period of postpartum isolation at home, aras bét also refers to the physical seclusion chamber of mother and child after the delivery has taken place. This chamber is either located in a separate room of the house that only relatives can enter, or, more commonly, in a partitioned section of the main room, set apart by a curtain that shields the pair from view. For the first ten days after delivery, the mother may not touch anything in the house, nor may she eat with other people – all food is prepared for her, she performs no household chores, and she does not rise from her bed. If her period of repose coincides with religiously prescribed fasts – which it invariably will, as each Wednesday and Friday are fasting days, in addition to multiple longer periods of fasting throughout the yearFootnote 13 – she is the only one in the house exempt from fasting. Thus she is allowed to eat and drink before three o'clock in the afternoon as well as to consume dairy products and meat.
If the financial status of the family permits, the new mother is fed a diet high in animal proteins, accompanied by atmít – a hot and sweet barley porridge meant to restore strength after a period of physical weakness – and gunfo – a volcano-like mound of uncooked t’éf (a millet grain used to make injera), qibé (local butter) and berberré (red pepper). Maternal kin typically prepare and bring these meals to the house as gifts. Many of the food items women consume after pregnancy (meat, porridge, butter, red pepper) are distinguished by their ability to heal and warm the body or to bind and congeal bodily substances.Footnote 14 Some women commented that the consumption of these strengthening foods combined with the rest the mother receives make her ‘more beautiful’ during the period of her seclusion. On a related note, Pankhurst (Reference Pankhurst1992: 193) writes that the mother and baby are sometimes described as ‘the newly married’ during aras bét, referencing the brief period of seclusion of a newly married couple in some regions of Ethiopia, when the bride is also thought to become nicely ‘plump’ (wefram).Footnote 15
But despite positive associations of aras bét with care by close kin and physical recovery, this period constitutes a singularly dangerous and vulnerable time for both mother and baby. Neighbours and unrelated strangers are not allowed to enter into aras bét as they might make the infant sick. One woman remarked that neighbours might have been on the road or in the sun and that the infant might contract an allergy from their sweaty smells.Footnote 16 So-called buda figures, bearers of the ‘evil eye’, are considered some of the most damaging threats to a woman's fertility. During gestation they are known to attack the uterus and prevent the mother from giving birth (Vecchiato Reference Vecchiato, Kloos and Zein1993: 162). Postpartum, buda frequently shift their attention to the newborn, which suggests that these figures are partial to those who are somehow compromised in their bodily wholeness (see also Popenoe Reference Popenoe2004: 67). Moreover, buda are thought to choose their victims because of their beauty or some other pleasing external characteristic that ‘catches their heart’, as one woman put it. Unless remedied, an attack by buda may lead to death.
Amhara undertake a number of protective measures to pre-empt a buda attack. During pregnancy it is common for a mother to hide her protruding belly from public view. Afterwards she may be similarly wary of exposing her infant in public, until the child reaches the age of about three. During aras bét a mother may keep a rifle handy to protect herself and the baby against buda. A special amulet from a debtera – an unordained church figure sometimes seen to possess occult powers – also functions to deflect the buda's gaze. Worn by small children and many adults, the amulet contains either a herbal mixture or a piece of sacred writing (tsefat) wrapped in animal skin, intended to act like a screen against an assault by buda.Footnote 17 In rural areas young children also often don a special haircut that leaves three small islands of hair on the top of their head in a triangular fashion, while the rest of the hair is shaved off. Women told me that this haircut works as a distraction for buda, who will not look the child in the eye because he or she is fixated on the hair. In the context of Ethiopian famine resettlement camps of the mid-1980s, Pankhurst tells of a protective practice against buda that entailed the cross-dressing of young children to outwardly reverse their gender, especially if the mother had already lost several children (Reference Pankhurst1992: 186). These and similar practices play with the concept of visual illusion, concealment, and trickery to counteract the destructive effects of the buda's glance.Footnote 18
It is only during aras bét, however, that the danger of being afflicted by buda is so high that the mother may keep a rifle next to her bed. This accords with a statement made by another woman who explained that if a mother, for some unforeseen reason, had to leave aras bét early, she would carry a knife or some other metal with her to ward off evil. The wielding of weapons as an added measure of protection during aras bét throws new light on the special vulnerability of mother and child between birth and baptism. As an ambiguous mother–child being, both are susceptible to environmental forces in childbed because they lack bounded discreteness. This dearth of firm, categorical boundedness is metonymically embodied in the knife or metal that must be on hand to effect the social–material separation absent in mother and child.
In his ethnography of a farming community in the Portuguese province of Minho, Piña-Cabral mentions a similar use of metal objects – in his case, scissors placed on the infant's cradle – to protect the pre-baptismal child from witches (Reference Piña-Cabral1986: 108). By virtue of being the most stable and also the most damaging substances available, metal objects are used to ‘mark either a definite break or a strong juncture’ (ibid.: 108). In their usage in childbed, he writes, they ‘create a barrier between the child and the antisocial world from which it has only recently departed, and to which it still partially belongs, as it has not yet been integrated into Christian society’ (ibid.: 117). In the Amhara context, metal objects are considered sources of similar power and danger.Footnote 19 One woman related that after a child receives its Christian cross (mateb) during its baptism, the necklace may not be cut off with a knife or scissors. If the mother wishes to replace the necklace, she has to use her fingernails to wear the thread thin over time, such as when bathing the child, until the necklace comes off by itself. This is done, she explained, to prevent the baby from being compromised in its development and to ensure that it will grow ‘strong and fat’.Footnote 20
The unique vulnerability experienced by the mother–child pair is not just confined to them: it also endangers their immediate environment through potential contagion (see Douglas Reference Douglas1966). The prohibitions that govern the mother's activities in and outside the house vividly exemplify this threat, as does her exclusion from church before her child's baptism.Footnote 21 It is noteworthy what Mansfield Parkyns – an English traveller to what was formally known as Abyssinia (today's Amhara and Tigray regions) – recorded about aras bét at the time of his travels in 1853. ‘The room, and everything in it’, wrote Parkyns, ‘is considered so utterly unclean, both at the moment of birth and afterwards till properly purified, that a man who should enter would be refused admittance to the church for forty days’ (Reference Parkyns1853: 34–5). A man who came into contact with a postpartum mother and her baby – and who was thus exposed to the dangerous substances emanating from them – thereby brought upon himself the same curtailment vis-à-vis his entry into church as the mother and baby.Footnote 22
In her discussion of postpartum seclusion among Azawagh Arabs in western Niger, Popenoe (Reference Popenoe2004) takes up the dual notion of vulnerability and danger I have sketched here (see also Boddy Reference Boddy1989; Hunt Reference Hunt1999; Lamb Reference Lamb2000; Masquelier Reference Masquelier2001; Stasch Reference Stasch2009). Popenoe explains that Azawagh mothers spend their forty-day seclusion period post-labour ‘resting on several layers of mats, wrapped in cloth and blankets, in a separate enclosure in the tent to protect against the entrance of spirits’ (Reference Popenoe2004: 68). Similar to the Amhara case, Azawagh women are perceived as especially ‘porous’ and ‘open’ to outside dangers through precariously open bodily orifices after childbirth; these dangers include spirit infection, against which they must guard themselves through proper closure, seclusion, and veiling to reinforce the body's solidity.Footnote 23 Popenoe writes:
The forty-day postpartum seclusion period is not, as I at first erroneously and ethnocentrically assumed, a chance for the baby to bond with the mother or to be kept from infection. It is a chance for the mother to close herself off again from the dangerous forces childbirth has opened. This is why during these forty days she lies silently, with legs kept ever together, under blankets even in the hot season, within a mat-wall enclosure, within the tent. (ibid.: 145)
When I asked women about the purpose of aras bét, most of them spoke about it in terms of convalescence. Aras bét, they said, gave the mother a chance to recuperate from the trials of childbirth, replace the blood she had lost, and prepare herself for her next pregnancy. ‘Through the delivery, the mother has replaced herself,’ one woman explained. ‘Now she has to be built up again.’ Although my contacts did not overtly refer to this period as impure, it is analytically worthwhile to interpret this practice as some form of purification – meant to restore to order what has been temporarily upset. Consider, for instance, the strict prohibitions governing the mother's conduct regarding food preparation and consumption, physical and visual contact with others, and the handling of household articles. Consider as well that these taboos extend beyond the mother–child pair itself: the midwife or close relative who assists the mother during birth is forbidden from entering a church until she is properly purified by a priest.Footnote 24
Customarily, the priest's visit takes place ten to fifteen days after the birth and is accompanied by a small feast. The mother's soul father (yenefs abbat) – a local priest assigned to the mother's family – comes to the house and pours holy water (tsebel) on the mother, the midwife, and anyone else who has been in close contact with the mother, as well as on all the dishes and utensils that were used by the mother after birth.Footnote 25 ‘In aras bét’, one woman explained, ‘the one who takes care of the baby and washes the baby and prepares the food for the mother should get holy water on the tenth day. Everything we used will be washed with holy water before it gets used again.’ Another woman drew an even clearer distinction between the differential status of a health extension worker employed by the government for prenatal check-ups, a paid midwife, and a relative who doubles as a midwife. Her explanation is worth quoting at length:
There are health extension workers who do not have anything to do with the delivery but who come and check the position of the baby – they do not get holy water. There are traditional midwives [awwalaj] who get paid for the delivery and after helping with the delivery they can eat with everybody else and leave the house. But if the midwife is a relative and if she is the one who helped with the delivery, she will stay with me for ten days and she will be seen as being as me. She will not touch anything that belongs to anyone else and will stay with me and eat with me; she and I will receive holy water together. [emphasis added]
The phrase ‘she will be seen as being as me’ is instructive for the attention it draws to the polluting danger of birth substances, but also to the intimacy of acts of care and food sharing among kin. One midwife, who was not paid for her services, qualified the statement above by maintaining that prior to the priest's intervention on the tenth day, she too was not allowed to eat with other people or go to church. Regardless of the local specifics, it is worth stressing that acts of food consumption and the sharing of bodily substances express significant forms of connectedness, to the extent that these ties translate to a spiritual oneness between the mother and her caregiver during the time of the former's seclusion.
Following the priest's visit, for which the mother joins her guests in the main room of the house, the midwife is allowed to re-enter a church, whereas the mother and baby are still barred from doing so.Footnote 26 The only difference is that the mother may now resume her chores inside the house and venture beyond her bed; nevertheless, she is still exempt from fetching water and firewood, grinding flour and coffee, and engaging in farm activities, all of which are explicitly linked to forms of food production. It is clear that a mother typically remains in aras bét for a minimum of ten days, during which time she is subject to the prohibitions listed above. Some women said that the mother could leave the house after the priestly ceremony outlined here, while most others insisted that she was required to stay at home until the time of her child's christening. But whether a woman was or was not permitted to leave the house, all of my interlocutors agreed that she was denied entry into church until the time of her child's baptism.
BAPTISM
As Piña-Cabral (Reference Piña-Cabral1986: 111) reminds us, baptisms are rites of both purification and incorporation. ‘After baptism’, he writes, ‘the child is a member of society in its spiritual sense, and it therefore enters the realm of order and purity, leaving behind it that of chaos and corruption’ (ibid.: 111). Following its baptism a child thus comes under the full protection of God.
In Orthodox Christian Ethiopia, the sacrament of baptism is part of a child's christening (kristinna) during which it receives its Christian name and cross (mateb).Footnote 27 Kristinna represents the child's initiation into religious life and is performed by a priest in a separate church building called the bethlehem. Boys should be christened forty days after birth, girls at eighty days. This practice has its roots in Judaic law, particularly in the Old Testament passage from Leviticus cited in the epigraph (in the passage, one has to add seven days plus thirty-three days of purification for a boy, and fourteen days plus sixty-six days of purification for a girl). Ethiopian Orthodox Christians follow this biblical prescription, and many others from Leviticus, both precisely and seriously. The difference is that, in Leviticus, purity is regained by the sacrifice of a lamb and a pigeon to a priest, whereas in contemporary Ethiopia purification is obtained by christening and the sacrament of baptism.Footnote 28
Among Christian Amhara, the mother is also sprinkled with holy water during her child's christening. Although this maternal ritual should not be construed as a re-baptism as such – unless treated figuratively – it carries with it very similar connotations of cleansing and re-admittance into church. If one understands the postpartum body in a processual state of reclosing, the mother's symbolic baptism functions as a sealing mechanism of sorts. Even if her baby died in childbirth, a mother still has to attend to ritual obligations in relation to her own body and religious persona. An illustration of this maxim comes out of my work with fistula patients. Owing to their postpartum leaking of urine, fistula patients generally stay away from the inside confines of a church. They harbour an intense fear of defiling sacred church space, not only by potentially polluting the holy water springs located inside the church compound, but also by dripping urine onto the church floor (Hannig Reference Hannig2013). Yet although most of these women did not emerge from childbirth with a live baby, they were eager to be ‘baptized’ after the forty- or eighty-day period of seclusion at home, and in addition to the priest's visit described above.
In one case, a woman talked to her soul father about receiving holy water after the stillbirth of her infant girl. Reportedly, the priest said it was not going to be possible to perform this rite inside the church due to her leakage; however, he offered to come to her house after eighty days, perform a biblical reading over the holy water he would bring, and sprinkle her with this water. In another instance in which the mother's baby survived, she initially wanted to send her own mother to the christening of her child because she was terrified of defiling sacred church ground with her excretions. The priest insisted that she come herself to receive holy water and advised her to collect her urine in a bucket that she could empty outside the church after the service.
The simultaneous baptism of mother and child resolves the ambiguity associated with their religious status after the birth. Baptism paves the way for the child's admittance into Christianity and thereby into society at large. By conferring an Orthodox Christian identity upon the child, it is a rite of acquiring personhood sui generis, which renders the period preceding the child's christening all the more precarious. The symbolic re-baptism of the mother resurrects her religious persona and publicly signifies the end of her postpartum isolation, during which she temporarily found herself outside the confines of her own faith by virtue of her maternity. Baptism also enacts the separation of the oneness between mother and child that had previously determined their existence by redrawing both individuals' discrete bodily boundaries. It thus enables the two of them to become agentive participants in their wider community.
Before going any further, I want to dwell for a moment on the issue of the unbaptized child, because this question contains important insights. Among Amhara, an unbaptized child may not be buried inside the confines of the churchyard, which is normally the prerogative of all Orthodox Christians.Footnote 29 As one midwife put it, ‘a baby who is born dead or who dies soon afterwards will not reach the fence of the church’. Usually such a child is either buried behind the house or somewhere outside the church boundaries. It does not receive a proper Christian burial: its body is neither washed, nor bound, nor sprinkled with holy water before the funeral.
When I asked patients if such a child would go to heaven they were unsure, although most eventually answered in the affirmative. A number of patients opined that since the child had done nothing wrong and was innocent ‘just like an animal’, it should go to heaven. Even though women did not compare pre-baptismal children to animals ontologically, they expressed the notion that a human being's sins were accumulated over a lifetime of sinful behaviour, rather than being present at birth. Having no concept of right or wrong, an animal – by contrast – was not guilty of any sins even after a whole lifetime, just like a newborn child. One person said that whether an unbaptized child would go to heaven depended on whether God would take pity on the child. None ventured the opinion, however, that the child should go to heaven because it was Christian (since, in fact, it was not).
The issue of premature child death also offers access to critical concepts of religious personhood among Christian Amhara. When fistula patients spoke about their experience of losing a child during or shortly after birth, they commonly described such a child as ‘lost’ (t'effa). And yet hardly any of the women I talked to expressed a sense of grief or bereavement over this loss.Footnote 30 ‘When a bird falls from a tree and dies’, one woman remarked, ‘we don't think that we lost anything. So when a baby dies inside of us, it does not affect our feelings because we never saw this child.’ The notion of ‘seeing’ (ayye) is a synonym for experiencing, knowing, or cognizing more generally (Marcus Reference Marcus2001: 206). It conveys that the woman was never able to experience this child as a lived person or make it her own. The idea of not having ‘seen’ the child was invoked nearly every time I asked fistula patients about their stillbirth.
The tendency not to mourn a stillbirth illuminates the importance of the socialization process of a newborn child and the risks of incomplete socialization. This logic underscores an emphasis on concrete material actions in creating belonging. Only after having ‘seen’ – that is, having come to know a child grow, eat, or behave like a human being in other ways – do women say that they experience sadness or grief over this child's passing.Footnote 31 Pankhurst, who conducted research in the famine resettlement camps of Ethiopia between 1986 and 1988, notes that a child who died before its baptism was called ‘a child of blood’ and hardly mourned (Reference Pankhurst1992: 186). This attitude, he writes, stands in sharp contrast to public displays of grief during ordinary funerals. He goes on to cite the case of a mother who lost one of her twins immediately after birth and the other a few months later. When the second twin died, people exclaimed: ‘“If only she had died before we got to know and love [her], [she] was such a beautiful child”’ (ibid.: 193).
The denial of grief over stillbirth also points to the newborn's infra-social status prior to its baptism: the child does not yet constitute an appropriate object of grief. The designation ‘a child of blood’ supports this notion of the pre-baptismal child as an incomplete, unsocialized being that I have developed here. The unbaptized child lacks subjectivity since its Christian identity still needs to be formed – it is not a proper person yet. The special protective gestures that surround the mother and her newborn after birth lucidly express this sense of heightened ontological insecurity. Having established this basis, I now return to the ethnographic problem laid out at the beginning of this article.
RELIGIOUS OTHERNESS
As glimpsed earlier, an Orthodox Christian mother and her newborn are called ‘Muslims’ during aras bét – the reader has almost all the tools now to solve this puzzle. It has become clear, I think, why the event of childbirth leads to a shift in the religious identification of a Christian mother and her offspring. During childbirth and its attendant dangers, a labouring woman is immersed in the loss of self, the ambiguous mother-and-child being, and the bloodiness of the not fully human. In her intimate linkage with the child she brings into the world, she temporarily shares in her offspring's ambiguous religious status. She thus slips – at least symbolically – outside the margins of Orthodox Christianity. Despite the perceived oneness of mother and child before and after birth, the child does not automatically receive its Christian identity from its mother; its identity is not derived from her but must be made. In fact, the oneness of mother and child after birth is so pronounced that the mother momentarily loses her own nominal status as a Christian on account of having given birth to a not-yet-Christian.
Moreover, a postpartum mother and her baby do not behave as ‘proper’ Christians during their seclusion, and therein lies the second half of the solution to the puzzle: they do not follow the prescriptions that define their faith. I outlined injunctions against the pair's entry into church until the forty- or eighty-day period preceding the child's christening has passed. I also noted that the mother is exempt from fasting for the time of her seclusion, which, in the eyes of one woman, amounted to her being a ‘sinful’ person, ‘because she eats everything’.Footnote 32 Another woman declared that the mother has to take off her Christian cross during aras bét (although some others disagreed). It is striking, in this respect, what one Orthodox Christian monk answered in response to a colleague's question about why Christians wear crosses: he responded that not wearing a cross amounted to being a Muslim. Infants from Christian mothers who die before their baptism are also customarily described as ‘Muslims’. When I asked a patient what would happen if a live infant did not get baptized, she replied: ‘When Jesus got baptized as a baby, there were the same rules for Christians then as there are now. If we do not follow these rules, we are Muslims.’
Failure to adhere to established Orthodox Christian practices – such as fasting, wearing a cross, baptism, or entering a church – thus becomes synonymous with not being a Christian. This logic sheds new light on how Orthodox Christian identity is constantly produced, rather than given, and requires continuous affirmation in concrete, sacred acts. These maxims accord with broader Orthodox Christian tenets that emphasize material processes, the physicality of objects, and symbolic re-enactment as central pillars of the faith (see Boylston Reference Boylston2012).
But why are the pre-baptismal child and its mother described as ‘Muslims’ in childbed, rather than, say, ‘pagan’? In the Amhara region the two main religious faiths are Orthodox Christianity and Islam. Orthodox Christians constitute the vast majority. There are very few Protestant believers, as missionaries have been prevented historically from entering the Orthodox Christian north (although this is now changing, especially in the cities).Footnote 33 Still, today most towns in the Amhara region are made up of a majority of Orthodox Christians and a smaller minority of Muslims. The latter were long barred from owning land and, to this day, tend to be traders and shopkeepers who settle in towns. Relations between Ethiopian Muslims and Orthodox Christians are generally characterized as amicable rather than antagonistic.Footnote 34 Even though there is no intermarriage unless one spouse converts to the other's religion, Muslims and Christians engage in networks of social reciprocity and attend each other's weddings and holiday celebrations. Muslims and Christians do not, of course, share meat. When Muslims visit their Christian friends at Christmas or Easter – occasions for the consumption of large quantities of meat – they are served vegetarian dishes and non-alcoholic beverages. But during the multiple, extensive periods of Orthodox fasting, Muslims consume ‘forbidden’ animal products, since they do not adhere to the Orthodox fasts.Footnote 35
When a mother is referred to as a ‘Muslim’ during aras bét, one explanation is that a woman in childbed does not follow the fasting regimen of her church, just as a Muslim would not – she eats what she desires. In the same way, she does not attend church services or wear a cross, just as a Muslim woman would not. This logic, once more, foregrounds an emphasis on material, embodied religious practices that not only come to index a believer's membership in the faith but, more importantly, require constant affirmation. More broadly, then, it makes sense to think of the term ‘Muslim’ in the negative, meaning as not being properly Christian, or as embodying a lack of ‘proper’ Christianity. During the time between birth and baptism, the mother and her newborn behave as ‘negative’ Christians by being barred or exempt from crucial material practices that are key markers of their faith. For Orthodox Christians, the descriptor ‘Muslim’ therefore becomes a general signifier of religious alterity.
But why not classify mother and child simply as ‘non-Christian’, then, without having to invoke Islam? After all, the two do not behave positively as Muslims: they do not frequent a mosque, pray to Allah, eat Muslim meat, or fast during Ramadan. Conversations with colleagues who work in Ethiopia have suggested that it is unimaginable for most Orthodox Christians that a person would not adhere to any religion at all. Saying that someone has no religion is akin to saying that she is, in fact, sub-human; it is a grievous insult, reserved for the outcast groups living in the area.Footnote 36 In contrast, a postpartum mother and her newborn are not viewed as lacking religious subjectivity altogether, and so they are called ‘Muslims’ since Muslims constitute the principal religious ‘Other’. Being described as ‘Muslim’, however, is not the same thing as being a ‘Muslim’. Rather than connoting an ontological shift in religious identity, ‘Muslim’ becomes a catch-all term for non-Christian.
It deserves mentioning that Muslim women in Ethiopia also undergo a forty-day period of isolation post-birth, which is also termed aras bét among Amharic speakers. During this time, the mother is not allowed to leave the house or to perform the Muslim prayer. If her seclusion period coincides with Ramadan, she is also exempt from fasting. None of the Muslim patients I spoke with referred to a woman in aras bét as outside of Islam, although she is barred from entering a mosque during her forty-day repose. One Muslim patient, however, reported that, for the first three days after birth, mother and child cannot sleep in a bed but must sleep on the floor – conceivably to transition from their infra-social status postpartum to the world of human beings. Among some postpartum Muslims in Ethiopia it is common to dig a hole inside their hut and to light a fire therein, over which the mother squats for extended periods of time to ‘get hot’ and dry out the wounds inflicted by childbirth. Among Mawri in south-west Niger, Masquelier (Reference Masquelier2001) describes a similar practice as a curative measure against the influx of coldness that may have entered the body of the parturient through her enlarged vaginal opening. Here, ‘a constant application or ingestion of heat will stop the bleeding after childbirth’ (ibid.: 234). There is, of course, no baptism that concludes the period of aras bét for a Muslim woman in Ethiopia, although, as one woman explained, relatives of the mother will clean her hair, her body, and the baby after their time of seclusion is completed (see also Boddy Reference Boddy1989).
CONCLUSION
In this article, I showed that Orthodox Christian Amhara draw from a wider cultural repertoire in dealing with the precariousness and potency they associate with human reproduction. I argued that religious alterity offers a means to both explain and understand how Amhara men and women make sense of the risky reproductive work of the belly, and that Muslims help Orthodox Christians conceptualize and rein in the uncertainty of birthing. The centrality of baptism underlines the extent to which entering Amhara society is – at its core – linked to obtaining religious personhood; the two processes are essentially isomorphic. With the help of prescribed avenues of religious incorporation and a concomitant separation from the mother, a newborn has first to be brought into its own existence. The ethnographic material presented in this article clarifies who is considered to be a full person in Amhara thought and what difficulties can beset a child's journey into complete personhood.
The question of why most women in Ethiopia prefer home over institutional births needs to be placed within a broader context that takes account of these and other socio-religious dimensions that are attached to the giving of life. The protection afforded to mother and child during aras bét – their seclusion from worldly and otherworldly dangers, their purification on the tenth day, and the provision of special foods – provides a form of postpartum care that is currently at odds with clinical demands in most biomedical settings in Ethiopia. The latter include an exigency for unrestricted contact with mother and child during their period of convalescence (in a publicly accessible ward where unrelated outsiders come and go); the use of eating utensils and other items not purified through a priest's intervention from previous pregnancies; doctors and other medical staff who, unlike local midwives, are also not purified following previous deliveries (at least not with holy water); and different ideas about cleanliness and the ubiquitous risk of infection (not by the hand of malevolent spirits but by invisible microbes and bacteria).Footnote 37
The rhetoric of ‘safe birthing’ advocated by the Ethiopian government and international organizations privileges this latter biomedical view and has trouble accommodating different paradigms of safety and danger. The postpartum practices I described here, which are concerned with establishing ritual purity, closure, and protection of the bodies of mother and newborn, posit one such alternative conception. Depending on which model of care and danger is favoured, efforts to ensure ‘safe birthing’ can thus take on a variety of different orders, valences, and emphases. I am influenced here by the work of Stacey Langwick in Tanzania, who notes the ‘complexities of different modes of ordering bodies, times, spaces, and actions’ that surface when biomedical paradigms encounter other forms of health and healing (Langwick Reference Langwick2011: 121). National and international support for TBA (traditional birth attendant) training programmes in Tanzania, writes Langwick, ‘seeks to stabilize a biomedical vision of the body of the pregnant woman, the fetus, and those things that threaten them during home births’ (ibid.: 121). In similar fashion, clinical care in Ethiopia is geared towards offsetting a particular set of dangers faced by the postpartum mother and her baby: bacterial infection, haemorrhaging, and communicable diseases, to name but a few.
My purpose is not to champion one of these paradigms over the other, but to delineate their possible points of contention. In the context of obstetric fistula, which is caused precisely by a lack of emergency obstetric care, the stakes could not be higher. Hamlin fistula hospitals in Ethiopia are among those that have begun promoting the move of expectant mothers from the home into the clinic – and not just for complications, as is currently the case. At present, the Ministry of Health seeks to increase the number of babies delivered in clinics and has taken steps to discourage ‘traditional’ midwives from assisting during home births. The ministry no longer provides midwives with free gloves, for instance, thus prompting many to use porous, store-bought plastic bags instead. The government has also started training health extension workers, one of whose functions is to encourage mothers to deliver at a health facility.
And yet it would be a mistake to frame fistula prevention in terms of institutionalized birthing alone. Going to a clinic to give birth is often futile. As I mentioned above, most clinics and hospitals in rural Ethiopia lack basic equipment and trained personnel; the vast majority are currently unable to perform C-sections in the event of obstructed labour. Even if women intend to give birth in a clinic, they are often dismayed by what they find when they get there. One Amhara fistula patient shared that, despite making three prenatal visits to a clinic before her second pregnancy, when her labour became obstructed she was told that nothing could be done for her there except a glucose injection. A referral to the regional hospital in Gondar proved meaningless, as she could afford neither the money nor the time to embark on the two-day journey in her state. As a result, the baby died inside her.
Further research is required to determine how the hospitalization of birthing in Ethiopia has begun to change social norms and ideas about maternal healthcare. What are the possibilities for re-inscribing clinical births as home births?Footnote 38 Currently, most of the practices described in this article can be observed only at home and with the help of close relatives. As Boddy argues, birth in the West has long been seen as a ‘pathological event requiring biomedical management’ (Reference Boddy2007: 216). When British colonial agents in northern Sudan attempted to medicalize the process of birthing, one of the first things they did was to abolish ‘rope births’ – during which women, with their bodies erect, hung onto a rope for support during labour – as they considered these to be a ‘brutish and unnatural’ way of delivering babies (ibid.: 219). Reportedly, most health facilities in Ethiopia do not allow women to squat or sit during labour, but compel them to give birth while lying down (at times with their legs in stirrups). As men are customarily not allowed to attend births, the presence of male health professionals in these clinics probably makes some women in labour feel ill at ease. If we add the structural factors of difficult health access, cost, and the uneven quality of health facilities to the mix, it is of little surprise that most women in Ethiopia, at the current moment, resist biomedical births.
ACKNOWLEDGEMENTS
I am indebted to the patients and staff at the Bahir Dar Fistula Hospital and at Desta Mender. I also thank my research assistants in Ethiopia, particularly Bethlehem Hailu. Special thanks to Tom Boylston for reviewing many drafts of this article and to Jean Comaroff, Adeline Masquelier, Emily Osborn, William Mazzarella, George Paul Meiu, Julianne Weis, Bernard Dubbeld, and John Dulin for their generous help with earlier versions. Financial support for this research was provided by a Century Fellowship for Graduate Study from the University of Chicago, a Wenner-Gren Dissertation Fieldwork Grant, and a Mellon Dissertation Fellowship.
