Anthropological scholarship in Madagascar has long emphasized ritual practices oriented towards the dead, particularly funerary rites, tombs and ancestral veneration. Erin Nourse’s Water into Bones offers a significant reorientation of this focus by centring birth as a place of moral, ritual and social labour. Based on ethnographic research conducted in the northern port city of Antsiranana (Diégo Suarez), her book explores how women transform newborns, described as zaza rano (water babies), into socially recognized persons. In doing so, Nourse presents a compelling argument about personhood, medical pluralism and the gendered work of social reproduction in a context marked by religious diversity and economic insecurity.
The book’s analytical framework is grounded on a locally salient metaphor: the transition from water to bones. Using idioms of manasitritra (hardening), Nourse shows that infants are viewed as being in a liminal state, not yet fully integrated into the social and ancestral worlds. Personhood is gradually achieved through a series of rituals and practical actions, including postpartum seclusion, ranginaly (bathing rituals), joro (blessing prayers), the observance of taboos, first outings, and teething-related haircutting ceremonies. These practices are viewed not just as symbolic signs of social belonging but as essential processes through which personhood is shaped.
Nourse presents two interconnected claims. First, childbirth and early infancy are intense periods of ethical and relational effort, primarily undertaken by women, through which social bonds are built and futures are protected amid uncertainty. Second, this effort is inherently diverse. Mothers typically incorporate biomedical care along with ancestral traditions and Christian or Muslim rituals. Instead of viewing this diversity as syncretism or ideological inconsistency, Nourse sees it as a practical response to risk and unpredictability. Choices about clinics, midwives, prayers and rituals are driven more by relational responsibilities and concerns for the future than by strict doctrinal beliefs.
The urban and maritime setting of Antsiranana is central to the book’s contribution. As a historically significant port city, it is characterized by linguistic, ethnic and religious diversity, as well as by patterns of migration and economic instability. This context allows Nourse to challenge highland-centric models of Malagasy social life that focus on land, tombs and relatively bounded descent groups. In the north, water functions not only as a metaphor for infant liminality but also as an environmental and historical reality, linked to maritime trade routes and sacred coastal sites such as Nosy Lonjo. Birth, described locally as an ady antsaboa (spear battle), emerges as a moment when gendered risk, social recognition and religious diversity intersect.
One of the book’s strongest contributions is its analysis of care providers and therapeutic practices. Nourse compares the experiences of Alicia, a state-trained midwife posted in Cap Diégo, with those of Bernadette, a renin-jaza (traditional midwife) believed to have been called by an ancestral spirit. Through these portraits, Nourse introduces the idea of ‘creative confluences of care’, showing that biomedical and ritual therapies, both generally known as fanafody (medical remedies or treatments), are often combined rather than seen as mutually exclusive. Women intentionally blend multiple forms of care to handle uncertainty and uneven access to trusted medical services.
The book also offers a nuanced account of reciprocity as both a social and material infrastructure. Gifts to hasin-tanana (care specialists) and the cultivation of indebtedness are examined as active relational strategies rather than as residual traditional practices. In a cash-poor and aid-saturated environment, fihavanana (reciprocity) sustains networks of obligation that extend beyond the immediate context of birth. Ritual efficacy is thus inseparable from social efficacy: the process of ‘making bones’ simultaneously produces persons and relationships.
Religious pluralism is treated with a similar degree of care. Muslim aqīqa (birth ritual) ceremonies may occur alongside ancestral haircutting rituals; Christian baptisms coexist with taboos and ritual obligations; Pentecostal critiques of ancestral practices do not necessarily eliminate ritual debts. Nourse avoids framing these dynamics as competing belief systems. Instead, she demonstrates how women navigate overlapping moral expectations through practical decisions that reflect social ties as much as theological positions.
Nourse’s reflexive engagement with her positionality as a vazaha (outsider) is measured and effective. Discussions of ethical uncertainty and loss are integrated without displacing her interlocutors’ experiences. The use of extended ethnographic vignettes enhances the book’s analytical clarity while maintaining a clear narrative structure, making it well suited to both research and teaching contexts.
Water into Bones represents a significant contribution to African studies, medical anthropology and the anthropology of religion. By foregrounding birth rather than death, Nourse demonstrates that social continuity is actively produced at the beginning of life through sustained ritual, relational and ethical labour. The book offers a persuasive and empirically rich account of how personhood and belonging are constructed in northern Madagascar under conditions of pluralism and uncertainty.
