She has happily embraced femininity, and was lucky enough to fall in with a group of “horsewomen” – trans women who know the secret of distilling estrogen from mare’s urine – so she has had some hormone treatment as well. Eddy is joined by Flora who was sold as a catamite when very young and has been castrated.

Eddy embraces his masculinity, though she has to go back to being Etta when at home in Nowhere.

Unlike with the Midwife, this is not simply a disguise. The title character was assigned female at birth but spends a lot of time on the road as Eddy. The Book of Etta is more of an exploration of gender. Same sex relationships are also accepted in some places, though some communities cling to old-world religious beliefs and others fetishize the need to breed. With fewer men, and many women not being fertile, in the world, polyandry has become commonplace. The Book of the Unnamed Midwife is to a large extent a book about sexuality. It has, however, made childbirth much more difficult, and this has inevitably made things very bad for women. Although the plague has killed more men than women, it was not a Y chromosome plague of the type beloved of apocalypse writers. The first book tells of an ob-gyn nurse from San Francisco who travels the world disguised as a man (for safety) helping rescue women, and helping effect successful pregnancies. The series title is a bit of sleight of hand because one of the major locations of the series is a community called Nowhere which, at least for a time, is shown as semi-utopian. Significant climate change has also happened, because it is possible to sail from Florida to California. The books are set in a post-apocalyptic world in which plague has drastically reduced the population of the USA and civilisation has collapsed. And The Book of Flora was on the Otherwise Award Honour List this year. The sequel, The Book of Etta, was a finalist for that award. The first volume, The Book of the Unnamed Midwife, won the Philip K Dick Award. The Book of Flora is the final part of Meg Elison’s Road to Nowhere series. The third book in a trilogy is not an easy thing to review on its own.

The unnamed midwife trilogy