Birthmarked by Caragh O’Brien

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Summary: After losing her parents, teenage Gaia becomes her neighborhood’s midwife and is embroiled in the politics of birth and adoption.

The first three babies each midwife delivers every month are “advanced” to the Enclave, a walled inner city where the best and brightest have been living (and marrying) for years.

As a brand-new midwife, Gaia is only following the policies she’s lived under for years. But after she returns home from her first delivery, and her first advancement, she returns home to find that her parents have been arrested.

There’s a crisis in the Enclave. Rampant inbreeding in the years since the Enclave formed has led to hemophilia and death, with mandatory blood tests before anyone can marry.

Gaia’s parents hold a secret, a secret about the babies who have advanced, one that Gaia must uncover if she ever hopes to keep them alive.

"Because she was scarred, she had had no chance of being advanced to the Enclave. In some ways, her case was the supreme example of why it was better to give the babies over within hours. Years ago, they used to leave babies with their mothers for the first year of life, but the mothers were growing increasingly careless, and the children were getting injured or sick before their twelve-month ceremonies. With the current baby quota system, the Enclave recived healthy, whole babies the day they were born, and the mothers could get on with becoming pregnant again, if that’s what they wanted to do.

...

No deformed babies were ever advanced, for any reason. For Gaia, one accident had guaranteed a life of poverty outside the wall, with no education, no chance for good food or leisure or easy friendships, while the girls her age who’d been advanced were now in the enclave, with boundless electricity, food and education. They were wearing beautiful clothes, dreaming of wealthy husbands, laughing and dancing."

Confession time here: I love dystopian fiction. Suzanne Collins' The Hunger Games is one of my favorite books.  While Collins' and O'Brien's worlds are completely different, the same sense of dread, menace and ideal pacing make these books among my favorites.

How did the world end up as it it did?

“The cool age ended when the fuel was used up, and it was too late for the masses to adjust, I guess. Crops failed. Some illness. A few wars. They coldn’t move around  what little food they could grow, I guess. It takes a lot to feed people, Gaia. We forget. We’re lucky here. There are smart people running the Enclave, and we don’t do so badly ourselves outside the wall.”

Many hard-working, decent people kept the foundry, glass factory and mills going to produce useful goods. There were things to respect here, lives that weren’t all brutality.

My few minor complaints about the book are spoilers, but you can find them in the comments section.

A complete satisfying read. The author completely left the book open for a sequel but I hope it won’t be like The Forest of Hands and Teeth.