Part One
Kin, Society, and Religion
One
A Malleable World: Injury, Care, and Belonging
When Yeshi was on her second pregnancy in her early twenties, her husband bought her a leather amulet that contained what she called habesha medhanĂt (Ethiopian medicine), an herbal mixture that was to stave off another stillbirth, like her first one had been. This time, she had attended prenatal checkups at her local clinic in Sanja district three times before the labor pains set in.1 After being in labor for two days, it became clear that the delivery wasnât progressing. Yeshi made her way to the clinic, where she received a glucose injection and was told that nothing else could be done for her there. At great expense, her husband hired a private car to transport his wifeâwho had meanwhile lost consciousnessâto the public hospital in the town of Gondar. Two hours after her arrival, a physician extracted the lifeless body of her baby. When she regained consciousness, Yeshi was shocked to realize that she could no longer control her urine.
Given her strained relationship with her mother-in-law, Yeshi and her husband decided to leave his familyâs compound to take up residence in a nearby town. âI was afraid she would start gossiping about me when she saw the leaking. She was jealous of our relationship,â Yeshi said. At their new home, her husband fetched water, brought firewood, and washed her clothes, all traditionally female responsibilities in the household. âWe sold cattle in the market twice to get the money for the transport to Bahir Dar,â she recounted. âMy husband had heard of someone who had been cured there and he said he would take me. He gave me hope that I would be cured also.â Meanwhile, families on both sides were clamoring for a divorce. His family worried that she would never be able to give their son any children; her family accused her spouse of not being âa lucky husband for her.â But, as Yeshi told me, âthey couldnât divorce us because we have love [fiqir].â Against the wishes of both of their parents, she and her husband stayed together through her treatment. After what appeared to be a successful surgery at the fistula center in Bahir Dar, Yeshi was anxious to return to her husband and get back to her life, though she remained concerned about staying childless in the future.
This chapter explores how Amhara men and women deal with the advent of obstetric fistula in their lives against the background of normative kin, marriage, and social conventions. How do relationships of care play out in a context of adversity? What kinds of negotiations do spousal arrangements undergo when one partner becomes debilitated by incontinence? And how might Amhara womenâs enduring social obligations expose the inadequacy of the conventional âsick roleâ model?
The pages that follow complicate the widespread assumption that womenâs birthing injuries inevitably lead to the disintegration of their familial and wider social connections. The chapter examines mechanisms in Amhara society that bind people to larger collectives and elucidates how these ties are mobilizedâand sometimes reconfiguredâin the face of bodily injury. It shows how notions of kin ideology (which center around the provision of care in the form of food, labor, and support for the sick), flexible marital strategies, and principles of social reciprocity come together to destabilize the narrative of isolation that has so far dominated the publicity of fistula. What emerges is a more fluid picture of belonging that points to the productive potential inherent in bodily affliction. Following Jean Comaroffâs (2007) insights on HIV/AIDS activism in South Africa, I use the term âproductiveâ not to describe positive (or negative) outcomes as such, butâin line with both Marx and Foucaultâto convey the idea of bodily injury giving âbirth to significant forms of sociality and significationâ (203), meaning an array of material and semiotic practices. As Laurence Ralph (2014) puts it in his ethnography on gang-related violence in black Chicago, âI saw how injury could be crippling, but could also become a potential, an engine, a generative force that propelled new trajectoriesâ (17).
This chapter then also looks at the ways that women suffering from fistula struggle to reorganize their lives following the onset of their incontinence. For some, fistula resulted in bitter conflict with loved ones, divorce, and reduced social contact. But although their predicament might provoke a broad range of local reactionsâsuch as sympathy, ambivalence, pity, fear, and disgustâwomen who incur fistula during childbirth donât become social outcasts. During my research, I never came across a single woman whose experience conformed to the social pariah template forwarded by activist and campaign narratives. While some womenâs relationships were severed in the wake of their injuries, others attained a new level of significance. The isolation women did experience was most often situational and self-imposed, in accordance with ideas of shame that carry different valences in different spaces. Women tried hard to navigate the anxious tension between ethical aesthetics of containment and social expectations of being a generous, engaged member of their community: on the one hand, they worried about being smelly; on the other, they were concerned about being seen as antisocial.2
Kinship as Care
There is no question that the sudden incontinence of a wife, sister, or daughterâwhich is often accompanied by other physical disabilities such as foot drop or muscle atrophyâcan place a major strain on relations of intimacy and provision. Amhara womenâs unexpected bodily impairments put their connections to others to the test. This section and the next focus on how fistula affected relations generally classified as kin relationships and sketch the mutual obligations pertained therein. Kinship among Amhara, I suggest, is actualized by a wide array of processes of caregiving, including the provision of food, duties of labor, and bodily care for the sick. Amhara women understand and talk about kinship in ways that foreground this ethics of care.
Contemporary theories of kinship have done much to draw our attention to the care-based logic that underlies a variety of global kinship forms, both within and without blood ties (Carsten 1997, 2004; Stasch 2009; Garcia 2010; Klaits 2010; Sahlins 2011a, 2011b).3 These studies have revealed the ways that kin relations are âmade and unmade in actionâ through concrete, material activities that signify varying levels of attachment (Stasch 2009, 107). Stressing the processual, action-oriented nature of kinship ideology in Malaysia, Carsten (1997) writes, âKinship is a process of becoming, not a fixed state. The process is brought about through a variety of means which include feeding, living together, fostering, and marriageâ (12). She extends this insight to her work with adoptive families in Scotland who âstrongly assert the values of care and effort that go into the creation of kin tiesâ (Carsten 2004, 150). More recently, Sahlins (2011a, 2011b) has gone so far as to suggest that âmutuality of beingâ through actions like caregiving is the basic essence of kinship.
Existing accounts of Amhara kin relations have not emphasized an ethics of care when it comes to kin dynamics. In fact, previous studies (Levine 1965, 1974; Weissleder 1965; Hoben 1970, 1973) have characterized the entirety of Amhara social relations as hierarchical, competitive, and individualisticâa system of patron-client relationships that permeates nearly all aspects of life. âThe reports of all observers of Amhara society confirm the generalization that its social relationships are organized to an overwhelming degree on the basis of hierarchical patterns and individualistic association,â remarks Levine (1974, 123; original emphasis). Even though Levine acknowledges that among kin (zemed) âa much warmer ideal of human relations obtainsâ (1965, 82), his sense of the household boils down to âa vertically ordered set of status-rolesâ (1974, 123). More recent work on Amhara love and kinship by Malara and Boylston (2016) challenges this narrative of authoritarian power and suggests that care is, in fact, an integral part of kin-related hierarchies (though this care is itself hierarchical).
Drawing on these insights, I contend that kin relations, broadly construed, are of critical importance to Amhara men and women and that the very concept of relatedness is articulated through the idiom of caregiving tasks of various kinds. Whereas care can indeed contain seeds of asymmetry and mask relationships of vulnerability, the care extended by close kin in times of need also offers unparalleled potential for protection and affection. I am of course not suggesting that kin relations are always idyllic or inclusiveâconflicts exist here as anywhere. In Yeshiâs case, her injury brought to the fore an already problematic relationship with her mother-in-law, prompting her and her husband to move to a new town. Still, the current tenor in Amhara kinship studies leans too much toward hierarchy and submission, and care complicates the picture. In what follows, I begin by establishing some key pillars of Amhara relatedness.4
One prominent act and expression of kin relations is the common consumption of food. The Amharic term for family (bĂ©teseb) refers to âany group of people who live together in a single homestead and who depend on a common source of foodâ (Hoben 1973, 43). BĂ©teseb thus does not necessarily refer to a discrete kin unit (although it can) but to those who dwell and eat together. The theme of food sharing threads itself through a number of Amharic kin designators, highlighting the importance of commensality for forging and affirming bonds of closeness. The terms for stepmother/father or stepdaughter/son, for example, are all prefixed by the word injeraâthe flat, round, sponge-like bread that is the regionâs staple food. The designation for stepmother is yeinjera innatââmother of injera.â5 Similarly, the term for a foster child is yemadego lij, with madego deriving from the word for hearth (midijja), thus translating to âchild of the hearth.â The act of consuming food together and providing for another personâs bodily nourishment therefore index a primary mode of belonging.6 In this way, food provision becomes metonymic of kin relations.7
For instance, as patients in our focus group discussions at the Bahir Dar center told me, when a girl becomes accomplished at baking injera, people in rural areas generally say that she is ready to marry and become the caretaker of a household of her own. Relatedly, when two families are merged through marriage, it is important that both parental households put on major feasts to properly seal the new affinal connection. During mels, the âreturnâ visit of the bride and groom to her parentsâ house after the âmain weddingâ (yewanna serg) at his house, the brideâs parents must try to match the groomâs familyâs lavish provision of food.8 As one fistula patient put it, âMels takes place to make the two families closer. If a groom doesnât have mels at his new wifeâs house, he will be like someone they know from the market.â If the brideâs family cannot afford to provide a proper feast for mels, the relationship between the groom and his wifeâs kin remains confined to one of social distance.
Sometimes, the feasting doesnât stop there. One woman related the following during a group discussion on marriage: âIn our area, after mels at my parentsâ house, we might stay with them for seven to ten days. Then there is something called asertu [the tenth]. There will be a big festivity at his house on the tenth day. His best men will be called again. They will bring ten injera each and we will receive a new name for us, yedabosim [the name of the bread]. They break the bread and we each get a new first name, though nobody really uses that name.â These examples underscore the fact that in-laws donât become family without care. The sharing of multiple, elaborate meals between in-laws ratifies the new connection. As Boylston (2013) points out in his discussion of Ethiopian Orthodox food practices, âSharing food does not just represent social togetherness, but produces itâ (262).
As with food provision, kin relations entail duties of labor that express an ethics of care. The reciprocal side of parental care is most prominently contained in a childâs duties of labor. The responsibility to assist with household chores is considered part and parcel of a childâs position in the household, especially in rural areas: it is expected that young children work in the household or the fields of their parents or other kin (H. Pankhurst 1992). Girls usually fetch water, grind grain, learn to spin and cook, and herd animals, while boys help with the harvest, weed, herd animals, and learn how to plow. If a family has few means, parents may send their daughter or son as a worker to the household of a more affluent relative in town, where he or she can also sometimes attend school. In old age, parents then expect to be cared for by one of their children, usually the youngest.
The so-called gift (sitâota) marriage further elucidates this principle of labor as care. If a son or a daughter comes from a family whose parents are either sick or divorced, he or she may initiate such a union primarily to gain access to a household helper to assist with daily chores. A sitâota marriage is one of the only marriages that is usually not sealed by formal festivities or a priestly blessing. If a woman agrees to this type of arrangement, she will take care of a sick or dying parent-in-law and run the household.9 If a man enters a sitâota union, he will take over the plowing needs of the homestead and help with heavy-duty farming activities. Once the in-laws pass away, the âgiftedâ spouse can lay claim to a large share of their inheritance.
Besides the provision of food and duties of labor, offering bodily and material care in times of sickness falls squarely within the domain of kin responsibilities. In our conversations, fistula patients routinely identified care provider tasks as clearly marked kin duties. The way they spoke about nurse aides who cared for them at the fistula center illustrates this obligation well. Some patients stated that the work of these women, who scrubbed their bodies, spoon-fed them when they were weak, and changed their soiled linen, amounted toâand sometimes even exceededâthe intimate bodily care required of close kin. In the words of Yashume, a seventy-year-old woman from the South Gondar zone, nurse aides âdo work that not even our fathers and mothers would do.â When talking about her own relationship with patients, Tigist, one of the Bahir Dar nurse aides, similarly remarked, âI am very close to my patients. They consider me as part of their parents.â10 These sentiments reinforce the normative principle of caregiving among kin who are expected to look after you when you are unwell.
If they contain this central element of care, other interpersonal relations areâat timesâlikened to kin relations. When my research assistant and I visited Yashume at her home on Lake Tana, her neighbors reportedly told one another afterward that âYashumeâs mother came to visit her.â I must have looked confused when Yashume shared this detail with me a few months later, because she smiled and quickly offered an explanation: âThey called you my mother, because you cared about me like a mother would, and you came to my home to see me and to check up on me.â While everyone understood that I could not be the genealogical mother of a woman who was twice my age, the term was meant to communicate the assumption that I had come to look after Yashume in some âmotherlyâ way, for instance by providing her with material articles, such as food or money.
Kinship and Fistula
The primacy of care in Amhara kinship ideology gains particular significance in the home care of women suffering from fistula. Ties to those considered kin, which can include godparent relationships as in Yashumeâs case, proved to be critical resources in the aftermath of womenâs birthing injuries. Most women returned to their natal home for the delivery of (at least) their first child, where they typically remained following the onset of their incontinence. In the face of their growing anguish over their relentless leaking, they recounted how parents and siblings volunteered to wash their bodies and clothes, fetched them holy water from the local church, procured expensive meats to speed up their recovery process, and expended large sums of money on various treatment options for them.
Genet, a twenty-three-year-old woman from the Agew Awi zone, was the secretary of the Womenâs Affairs committee in her hometown of Jawi when she became pregnant at the age of twenty-two. She had been married since she was ten. As her husband was away at law school during most of her pregnancy, she went back to her parentsâ home in her fifth month to give birth there. âThey took good care of me,â Genet related. âThey wouldnât even let me fetch water for myself.â Genet had intended to deliver at a clinic, but her mother was against it: she had already lost her other daughter to a clinic and didnât want to lose Genet, too. In the end, her parents did take Genet to a clinic a few hours after her labor began. After half a day at the clinic, it was clear that things werenât going anywhere: âThey told us it was beyond their ability and sent us to a private clinic. They didnât have the equipment to help a woman in labor.â Upon their arrival at the private clinic, Genet was bleeding profusely. Staff at that clinic berated her parents for not having brought Genet in earlier; even so, âthey said they couldnât help me and told my parents to take me back home.â Her parents briefly considered transporting Genet to a hospital, but they knew they couldnât find transportation in time. The next morning, they boarded a bus to a town with a twenty-four-hour emergency clinic. In the middle of the ride, Genetâs stillbirth came out by itself.
Her parents held a feast for Genet to console her for the loss of her baby. A few day...