Review of The Book of the Unnamed Midwife (The Road to Nowhere, Book 1)

Author: Meg Elison
Rating: 4.5 Stars
Review By: Shana

Science Fiction is my favorite fiction genre, but I admit to often approaching apocalyptic/post-apocalyptic books with a sense of dread. But if you feel the need to be well-read in the SF canon, you cannot very well avoid such books - especially those that have garnered excellent reviews. In Elison's Book of the Unnamed Midwife, such dread is warranted but not overwhelming.  

It is present-day-ish and a pandemic is sweeping the United States (and perhaps the world?). While everyone is at risk of this creeping fever, it strikes with especially fatal and tragic results on women and babies. Which is to say, every single birth ends in a dead infant and most of the time it also claims the life of the mother. Our unnamed, titular narrator is a nurse who works mainly in maternity wards and she sees, firsthand, the initial impact of the fever. She, too, succumbs, but manages to survive. When she awakens she finds herself in a world utterly devastated, most people dead and of those surviving, ten men for every living woman.

Told both in journal form and from the general point of view of our narrator, the escalating disaster and eventual aftermath are immediate and sometimes piecemeal. For the most part, we only know what our narrator knows, there is no omniscient point of view or the vantage point of a highly placed official to relieve the uncertainty and fear. And what she finds is what you might expect. With men outnumbering women, women have become a scarce resource and are treated as such. That isn't to say they are treasured, but rather hunted and hoarded. One is reminded that the veneer of civility and the facade of rights depends on social order, authority, and shared values. Stripped away, you take people as you find them. I give Elison credit here, for while there are horrors to be found (slavery, rape, trapping), there are not only horrors. We need look no further than our primate cousins to realize that even with disparate power, all men do not subjugate, and some humanity and kindness remains. 

Our narrator decides early on that she will travel in the guise of a man (made easier by her height) and that her raison d'etre will be to provide medical care and contraception to women. With the fever still at play, any woman who becomes pregnant has all but been given a death sentence. What follows is a memoir of her travels and a look at the new world she encounters. The account is visceral, the details believable, and the vast spaces and ensuing loneliness palpable. As she meets people along the way, we get interludes where we follow those characters for brief chapters, to see what becomes of them. And we occasionally are told, outside of the main narrative, that no children were born in a particular year or other details of global import.  

This book was harrowing but not entirely depressing. It wore on me as a reader, because it felt immediate and in too many ways real. The existential crisis facing a species that can no longer produce young is striking and the book makes clear just how desperate and pointless this could make life for almost everyone. In the end, as years pass, we see pockets of civilization gel and there is hope. And between the excellent writing, realistic situations, insight into what it means to be a woman in the world (whether the one imagined by Elison or our real one) and how we move through that world, I highly recommend this book.