Social Science & Medicine 71 (2010) 608e615
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Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
Chasing spirits: Clarifying the spirit child phenomenon and infanticide in
Northern Ghana
Aaron R. Denham a, *, Philip B. Adongo b, Nicole Freydberg d, Abraham Hodgson c
a
Northern Arizona University, Department of Anthropology, Flagstaff, AZ, United States
University of Ghana, School of Public Health, Legon, Ghana
c
Navrongo Health Research Centre, Navrongo, Ghana
d
Population Council, New York, NY, United States
b
a r t i c l e i n f o
a b s t r a c t
Article history:
Available online 12 May 2010
In the Kassena-Nankana District of Ghana, researchers and health interventionists describe a phenomenon wherein some children are subject to infanticide because they are regarded as spirit children sent
“from the bush” to cause misfortune and destroy the family. This phenomenon remains largely misunderstood and misrepresented. Based upon both ethnographic research and verbal autopsy data from
2006 to 2007 and 2009, this paper clarifies the characteristics of and circumstances surrounding the
spirit child phenomenon, the role it plays within community understandings of childhood illness and
mortality, and the variations present within the discourse and practice. The spirit child is a complex
explanatory model closely connected to the Nankani sociocultural world and understandings
surrounding causes of illness, disability, and misfortune, and is best understood within the context of the
larger economic, social, and health concerns within the region. The identification of a child as a spirit
child does not necessarily indicate that the child was a victim of infanticide. The spirit child best
describes why a child died, rather than how the death occurred. In addition to shaping maternal and child
health interventions, these findings have implications for verbal autopsy assessments and the accuracy of
demographic data concerning the causes of child mortality.
Ó 2010 Elsevier Ltd. All rights reserved.
Keywords:
Northern Ghana
Spirit child
Infanticide
Child mortality
Verbal autopsy
Introduction
What is a spirit child? It is a child that has a large head, is born
with teeth or a beard, spies on its parents, and vanishes when
the parents are not looking. Sometimes when you give birth, you
don’t know you have given birth to it. A woman who gives birth,
continuously falls sick, and doesn’t get well has given birth to
a spirit child (Elder Nankani woman, 2007).
Although preventable diseases and, ultimately, the effects of
poverty constitute the primary causes of infant and child mortality
throughout the Kassena-Nankana District (KND) in Northern Ghana,
local discourse suggests that a number of infant and child deaths are
intentionally facilitated by family members. In these cases,
deformed or ailing children, births concurrent with tragic events, or
children displaying unusual abilities are regarded as spirit children
sent “from the bush” to cause misfortune and destroy the family.
From the Nankani perspective, spirit children are not human, but are
* Corresponding author. Tel.: þ1 928 600 2074; fax: þ1 928 523 9135.
E-mail address: [email protected] (A.R. Denham).
0277-9536/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2010.04.022
bush spirits masquerading as such. From a biological perspective,
many of these children have disabilities or are chronically ill.
The spirit child remains the subject of considerable speculation
and is frequently misunderstood. Community members, population
health researchers, and development workers have described the
spirit child practice as infanticide, a cause of family misfortune,
a way to cope with unwanted or sick children, and as a primitive
practice grounded in ignorance needing complete eradication.
Although there has been a successful history of child and maternal
health research and intervention in the KND, few have studied the
spirit child directly or have made the phenomenon the primary
focus of their research; rather, it has remained a side interest within
the context of larger studies on child and maternal health.
The few reports enumerating the spirit children are inconsistent.
The Population Council estimated that four percent of child deaths in
the KND are due to poisoning of spirit children (Lothian, 1996).
Allotey and Reidpath, however, estimated that 15% of deaths of
infants under three months in the KND could be due to the spirit child
practice (2001). They concluded that the spirit child was a “significant
health problem” and an “important risk factor for infant mortality
within the district” (Allotey & Reidpath, 2001, p. 1006, 1010).
A.R. Denham et al. / Social Science & Medicine 71 (2010) 608e615
Descriptive data from the Navrongo Demographic Surveillance
System (NDSS) and verbal autopsies from 1995 to 2002 were used
to estimate that 4.9% (n ¼ 53) of neonatal deaths (N ¼ 1068) were due
to infanticide (Baiden et al., 2006). Baiden et al. remarked that in
addition to preventing and treating neonatal infections and having a
skilled attendant at the delivery, a further reduction in
neonatal mortality is achievable with the elimination of infanticide
(2006, p. 532).
Regardless of their accuracy, these estimates do not take into
account the differences between how people talk about the spirit
child, how it is reported in verbal autopsies, and what is happening
in practice. Allotey and Reidpath remarked that, “works of fiction,
anecdotes, and fireside stories remain the strongest indication of
the existence of the spirit child” (2001, p. 1008). Indeed, the limited
research into the spirit child phenomenon has been more of an
exercise in chasing elusive spirits embedded within community
discourse, since few scholars have offered significant evidence that
it actually occurs outside of discourse. Understandably, researchers
have not had opportunities to carefully examine the demographic
data, to attend to the sociocultural and ethnographic context, and
to gather first-hand accounts necessary for accurate description
and analysis of the phenomenon.
Baiden et al. recommended anthropological studies to guide
interventions and further validation studies to “ascertain the
sensitivity and specificity of the use of verbal autopsy to diagnose
infanticide” (2006, p. 536). The purpose of this paper is to begin
filling in the “important gap” in information available on the spirit
child phenomenon; its characteristics, the extent of the practice,
and the role that it plays in child mortality (Allotey & Reidpath,
2001, p. 1008). Specifically, we aim to provide an in-depth
description of the spirit child phenomenon from the stages of
suspicion and diagnosis, to the varied circumstances surrounding
death. We establish that infanticide is not always present in spirit
child cases, that there is significant diversity in how it is used as an
explanatory model for child mortality, and that the practice itself is
not necessarily an “important risk factor” or a major community
health issue as claimed, particularly when compared to mortality
rates from malaria and other diseases.
Methods
A mixed method approach combining ethnographic fieldwork and
analysis of demographic data provided valuable and more holistic
insights into infanticide and the spirit child phenomenon. Ethnographic fieldwork was conducted between 2006 and 2007 and again
in 2009 as part of the dissertation research conducted by AD in
collaboration with the Navrongo Health Research Centre (NHRC) and
AfriKids NGO. In addition to participant-observation, unrecorded
interviews, and informal interactions, over 100 semi-structured and
open-ended interviews were conducted and audio recorded with
community members living within the Eastern Sub-District of the
KND, including soothsayers (diviners), community health nurses,
family members, and local development workers. Notably, 15
concoction men were interviewed on multiple occasions. Concoction
men are the ritual specialists involved in treating spirit children with
symbolic items and sometimes, with poisonous and nonpoisonous
herbal concoctions. AD participated in and observed the simulation of
two spirit child ceremonies conducted by concoction men. Separate
planned and spontaneous focus groups with concoction men,
soothsayers, youth, community leaders, and women’s groups were
also conducted and recorded for analysis. A case study approach was
adopted to follow five spirit children from the initial stages of the
families’ suspicions through resolution. Three of these cases were
followed for three years. Additional ethnographic data were collected
on a wide range of themes related to child rearing, social structure,
609
taboos, history, myth, emotional expression, religious beliefs, and
conceptions of deviance, illness, wellness, and healing. Recorded
interviews were transcribed and, along with fieldnotes, coded and
analyzed with qualitative analysis software.
Post-mortem verbal autopsy (VA) data were analyzed to determine the frequency of which infanticide was determined to be the
cause of death. VA data are collected as part of the Navrongo Health
Research Centre’s (NHRC) Navrongo Demographic Surveillance
System (NDSS). Since the establishment of the NDSS in 1993, NHRC
fieldworkers have systematically recorded vital events in all District
compounds, including births, deaths, in- and out-migration,
marriages, and pregnancies. For all deaths, a trained field supervisor returns to the compound to conduct a verbal post-mortem
interview with a family member. A questionnaire is administered,
and an unprompted narrative account is solicited to obtain background information on events leading to the death. The questionnaire data are then entered into the NDSS database, and the data
are forwarded to three physicians to independently assess the
probable cause of death. In cases where at least two of the doctors
agree on one diagnosis, it is accepted as the final cause of death.
Numeric causes of death codes include infectious and tropical
diseases, non-communicable diseases, gastroenteritis, malnutrition, and birth injury, among others. The available code for spirit
child is treated by the physicians as synonymous with infanticide.
Researchers using VA must be wary of assumptions that
community members understand and report death in similar
distinct terms and categories; that is, clinical categories and
descriptions of terms must coincide with local terms and understandings (Snow & Armstrong, 1992), taking into account the
sociocultural context and its role in local explanatory models for
illness and death. Despite its limitations, VA is regarded as the only
and “best technique available” to determine cause of death in rural
areas (Allotey & Reidpath, 2001, p. 1011). When compared to
household survey estimates, VA offers a preferable attribution of
cause of death “because they provide direct, if crude, measurements of the community mortality experience” (Whiting et al.,
2006, p. 946). A study in rural Ghana demonstrated that VA was
most sensitive and specific when compared to a physician’s
certificate of death, with symptoms that are well defined and
recognized by community members (Edmond et al., 2008). Overall,
the analysis of both VA and ethnographic data in this study proved
invaluable; helping clarify relationships between culturally specific
understandings and biomedical explanations.
NF identified VA cases coded as “spirit child” that occurred
within the Eastern-Sub District from 1996 through 2000, and AD
and NF thematically coded them using qualitative analysis software. Table 1 presents these cases according to sex (13 female and
20 male) and age at death. AD sought to determine whether children were diagnosed as spirit children before or after death, and
whether death was intentionally hastened by the administration of
an herbal concoction. Additional analyses considered circumstances of death, symptoms surrounding time of death, intention
behind death (intentional/unintentional), and decision makers and
care seeking behaviors involved in the illness and before death.
Table 1
Sex and age of VA deaths classified as spirit child.
Age at death
Female
Male
Total
0e7
days
8e30
days
1e5
months
6e11
months
12e59
months
60 þ months
2
3
5
3
3
6
2
4
6
4
2
6
2
7
9
0
1
1
Source: NDSS data 1995e2000
610
A.R. Denham et al. / Social Science & Medicine 71 (2010) 608e615
The University of Alberta Ethics Review Board and the NHRC
Institutional Review Board granted ethical approval for the project.
Permission was also obtained from traditional leaders (chiefs, section
leaders, family heads) and elected officials (assembly members)
within the sub-district. Oral consent was obtained from all interview
participants. The authors did not engage in the provision of care for
spirit children or the direct implementation of health development
programs. AD observed, lived, and interacted with community
members and development workers throughout the duration of the
project. PA, a local social scientist from the region, assisted with
demographic data acquisition and analysis of qualitative data.
Context
This study focused on Nankani families living in the
Eastern Sub-District of the Kassena-Nankana District in the Upper
East Region of Ghana. The KND is a semi-arid, sub-Sahelian guinea
savannah with one annual rainy season. As part of the Volta Basin,
its topography and cultural characteristics are more akin to those
living to the north in Burkina Faso, for example, rather than in the
rainforests to the south (Mensch, Bagah, Clark, & Binka, 1998).
The primary occupation in the district is subsistence farming. Due
to the dependence on a single growing season, food insecurity,
periods of famine, and seasonal malnutrition are a persistent threat.
Childhood within the KND is a precarious time, both in terms of
encountering illness and in the presence of spiritual dangers (Adongo
et al., 1997). The challenges facing children begin beforedand
continue throughoutdbirth. The fetus and infant are at risk due to
high maternal disease burden, care-seeking delays resulting from
geographic or economic constraints, and limited access to health
facilities equipped to handle serious obstetric cases (Ngom,
Akweongo, Adongo, Bawah, & Binka, 1999, p. 142). The maternal
mortality ratio in the KND was recorded as 373 per 100,000 in the
period 2002e2004, down from 636 in 1995e1996 (Mills, Williams,
Wak, & Hodgson, 2008). A descriptive analysis found that prematurity (38%) and infections (23%) were the primary causes of early
neonatal deaths between 1995 and 2002. Infectious causes were the
primary cause (66%) of late neonatal deaths (Baiden et al., 2006).
The leading causes of child mortality in the KND are malaria,
diarrhea, acute respiratory infections, and meningitis (Baiden et al.,
2006). A Population Council report noted that two-thirds of all
deaths among children under 5 years were attributable to
preventable causes: malaria, diarrheal diseases, acute respiratory
infections, tetanus, typhoid fever, and measles (Gouede, 2001)
which often act in “synergy with malnutrition” (Pence, Nyarko,
Debpuur, & Phillips, 2001). The KND has seen significant
improvements in children’s health (under 5 years) in the past
decade, with post infant child mortality (1 to <5 years) dropping
below the national average with 82.9 deaths per 1000 births, an
improvement of 43% over the 1994e1995 data. Infant mortality (0
to <1 year) in the KND has also improved 34% in the past decade
with 84.6 deaths per 1000 births, although it is still higher than the
national infant mortality rate of 64 deaths per 1000 births (Binka
et al., 2007). Neonatal mortality (<28 days) continues to decline,
with rates that decreased from 40.9 per 1000 births in 1995, to 20.5
in 2002 (Baiden et al., 2006). Improvements in maternal, infant, and
child mortality were attributed to the Ministry of Health and
Navrongo Health Research Centre’s targeted health interventions,
education programs, and the expansion of community health
nurses into rural areas (Binka et al., 2007).
Perspectives on infanticide
Infanticide is widely distributed culturally, historically, and
geographically; “rather than being the exception, it has been the
rule” (Williamson, 1978, p. 61). An inclusive definition of infanticide
includes “any form of lethal curtailment of parental investment in
offspring” (Hrdy & Hausfater, 2008, p. xv). In a literature review, Hill
and Ball identified that the most common reasons for infanticide
included low likelihood for survival, inadequate resources, twins,
gender preference, or abnormal births (1996, p. 382). In their
review of the Human Relations Area Files, Daly and Wilson categorized the circumstances in which infanticide occurs into three
commonly occurring general categories: inappropriate paternity,
inadequate parental resource circumstance, and poor infant quality
(deformity or illness). Poor infant quality was the most commonly
reported (2008).
While socio-biological paradigms identify children of poor
phenotypic quality as being at risk for infanticide, ecological
perspectives position survival or investment strategies against
limited resources and tout fitness-related evolutionary theories
(Winterhalder & Alden-Smith, 2000). Indeed, Hrdy and Hausfater
observed that “virtually all cases of infanticide ultimately relate to
competition for resources” (2008, p. xvii). Sociocultural anthropologists have established that global and local political economies
and structural violence play a significant role in parental investment, child health, and survival (Scheper-Hughes, 1992).
The ethnographic literature specific to West Africa indicates that
in parts of Nigeria, twins were previously regarded as bad omens
and were promptly killed at birth (Bastian, 2001). For the Bariba of
Benin, physically stigmatized infants, such as those born with
neonatal teeth, or infants born prematurely or in a breech position
might be rejected and killed as malevolent “witch-babies” (Sargent,
1988). Erratic body movements and language difficulties characterize snake children among the Beng of Cote d’Ivoire (Gottlieb,
1992). Dettwyler described the local response in Mali to children
with developmental delays or disabilities as being evil spirits
(1994). Iran children among the Papel of Guinea-Bissau are often
born with physical or functional abnormalities, such as a large head.
These children are often malnourished or have ambiguous sex
characteristics and are sent to the sea or abandoned on an anthill
and burnt (Einarsdottir, 2004, p. 146).
In her ethnographic study of mother love and child death with
Brazilian Alto mothers, Scheper-Hughes (1992) described how
mothers cope with high infant mortality in the context of poverty,
and illustrated how emotional scarcity and selective neglect are an
active survival strategy in the face of economic scarcity. She portrayed how external constraints shape maternal thinking and
practice and how conditions of deprivation can turn mothers into
“survival strategists in competition with their own offspring.”
According to Scheper-Hughes, death due to selective neglect
(passive infanticide) is permissible, since mothers understand such
infants as not wanting to live (Scheper-Hughes, 1992).
In her description of iran children among the Papal, Einarsdottir
(2004) emphasized the cultural variability, including religion and
kinship ideologies, gender relations, and subsistence, in responding
to child illness, abnormality, and death within conditions of scarcity. She argued against the universality of the neglect thesis, which
posits that mothers will selectively neglect and subsequently fail to
mourn children that are weak or disabled in contexts of scarcity
combined with high fertility and high child mortality (2004, p. 7).
Despite the similar “structural prerequisites” between Brazilian
Alto and Papal mothers, their maternal sentiments and responses
differ (Einarsdottir, 2004, p. 168).
What is the spirit child?
The spirit child was just in the olden days of the ancestors; if the
child grows sick or lean then they say that such a child is a spirit
A.R. Denham et al. / Social Science & Medicine 71 (2010) 608e615
child, and they will send the child away. But now, if a child is
sick, they can send for treatment. There is no spirit child
(Middle-aged mother, 2006).
The spirit child is like this example: My mother gave birth to
a child. Just by looking at this child nobody believed that it could
survive. Then some strange things started happening in the
house. All the fowls in the house disappeared. We went to the
soothsayer and discovered that it was a spirit child and [it] was
eating all the fowls in the house (Young man, 2007).
From the perspective of the Nankani, spirit children are bush
spirits born into a family in human form. Although they appear
human, spirit children are not human beings and are not regarded
as persons. Spirit children are not children possessed by an
offending spirit subject to exorcism; rather, their entire being is that
of a spirit, and the only way to remove a spirit child from the family
is though death.
Before taking a human form, spirit children dwell within the
bush actively searching for a possible way to enter a family. The
spirit wants to enter the house to gain access to the “good things”
a family provides, such as food and care. Once born, the spirit child
will take over the house and destroy the family, breaking it apart
through conflict, sickness, and death, only returning to the bush
when satisfied. Community members describe spirit children as
impulsive, wise, crafty, and mischievousdcharacteristics also
regarded as snake-like.
Similar to Daly and Wilson’s (1984) review of infanticide practices, Nankani families expressed concerns regarding inappropriate
paternity as a possible cause of spirit children. Specifically, spirit
child myth and discourse indicated concerns about the purity and
boundaries of the patriline, reproduction, and extramarital relations. This study did not encounter any unmarried mothers with
spirit children; all observed cases and community descriptions
occurred within formalized families.
The easiest way for a spirit to accomplish its goal of passing from
the bush into domestic space is to enter a woman through taboo sexual
activity. Intercourse outside of the home or in the bush can attract
a spirit. Sex outside of the house is, as one youth described, “illegal
sex,” which will attract a spirit to enter the woman. A man explained,
“If a spirit is passing by while you are having sex, [it can enter you]
immediately when you finish, or just before you start, it can move so
fast. That is why it’s advisable for men not to have intercourse with
a woman outside the house.” The location and method used to urinate
is also of concern. Women are discouraged from relieving themselves
in prohibited places, such as where spirit children are buried, and in
other locations identified as spiritually dangerous, liminal, or ambiguous. Community members also describe that eating while walking is
a common way for a woman to attract a spirit child. There is the danger
that the woman will drop the food, both men and woman explained.
“If so, a bush spirit may be watching her, and, thinking that the woman
likes it, will follow her home and have intercourse with her.”
Biomedical explanations for spirit children were frequent when
speaking with women and men who had attended secondary
school, and with women who had participated in maternal health
clinics and women’s groups. Often biomedical causes, for instance
the avoidance of potentially harmful prescription drugs and alcohol
when pregnant, were situated within traditional notions and
frameworks of causation, such as taboos. Poverty was also recognized as a factor contributing to the ability to obtain health care for
sick children, and thus to the attribution of a spirit child. A woman
remarked, “If you are poor and give birth to a child, you can’t go to
the hospital. If the child is sick, you can’t care for the child, you can’t
buy drugs, you can’t do anything. It’s because of all these things that
people say it’s a spirit child.”
611
Community members define the spirit child primarily upon its
physical appearance, its behaviors, and the misfortunes it is
perceived to cause. Families are acutely aware of children that fall
outside of the local understandings of “normal development.”
Nankani descriptions of spirit children position them outside such
local notions of physical and behavioral normality. A mother
remarked, “Before someone can be called a spirit child, the child
must not be like a normal child. There must be something wrong
with that child.”
Common physical characteristics community members identify
as indicative of a spirit child include hydrocephalus, or being born
with teeth, facial hair, or other secondary sex characteristics. Spirit
children are also identified as being born with misshapen or broken
limbs, and may have a variety of physical disabilities. Many of the
spirit children observed and described by community members
were suffering from acute malnutrition. Families interpreted
a child’s failure to eat or loss of appetite as evidence that the child is
secretively obtaining food during its forays into the bush. Children
with chronic and acute illnesses, particularly ones that may result
in permanent debility, might be regarded as spirit children.
However, it is important to note that not all disabled children are
suspected spirit children.
The child’s behavior was also subject to scrutiny. Excessive
crying is the most commonly cited indication of a spirit child in
both the ethnographic and VA data. Families regard excessive
crying as disruptive and indicative that the child wants to kill the
parents and destroy the family. There is significant concern
regarding the eyes. A spirit child may look at you differently, have
a wandering eye, or fail to make eye contact. Families interpret
a child’s failure to make eye contact as its fear of being looked at, or
as evidence that the child is hiding something. Other authors
describe similar characteristics (Allotey & Reidpath, 2001, p. 1009;
Awedoba, 2000; Howell, 1997).
Interviews with community members indicated that there is no
sex preference for spirit children; the VA data supported this
assertion (Table 1). No cases of twin related spirit children were
recorded.
There is broad consensus about a spirit child’s intentions when
it enters the family. Community members’ discourse describes the
spirit child as a “destroyer” that acts out its destructive tendencies
by instigating conflict, causing misfortunes or sickness in the house,
and killing family members. A spirit child may cause the mother
and father to fall ill frequently, may cause infertility, or may not
allow the mother to recover fully from childbirth. A man explained
that, “The child wants to kill the mother, so it’s better they kill the
child first so the mother can live and give birth again.” Families may
blame crop failure or death of livestock on a spirit child. Another
man explained: “Mishaps in the family will be present. May be the
harvest was poor. They [the family] go to the soothsayer and find
out that the child who was born two months before is the cause of
all the woes in the family. He is a spirit child and will destroy the
house, so they will destroy the child.”
Detection and diagnosis
The literature describing the spirit child often portrays the
detection and decision-making process that surrounds suspected
cases as urgent and unilineal, quickly proceeding from suspicion to
poisoning and abandonment. Awedoba noted that “in the past”
such neonates when detected were disposed of as soon as possible,
often within 24 h of birth, as it was in the best interest of the family
(Awedoba, 2000). Allotey and Reidpath also described a case where
an infant was allegedly given an herbal concoction and died within
a day of her birth (2001, p. 1010). This section describes the varied
circumstances and timeframes surrounding a spirit child diagnosis,
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A.R. Denham et al. / Social Science & Medicine 71 (2010) 608e615
emphasizing that decisions around the diagnosis are rarely made
quickly.
Mothers and fathers, as well as other extended family members,
raised suspicions regarding spirit children. While rapid timeframes
were occasionally described, we did not encounter a case wherein
the family detected and killed a spirit child in haste. Rather, it was
more common that an extensive investigation, diagnostic, and
decision-making process occurred before families could confirm
their suspicions and summon a concoction man to conduct the
ritual and administer the concoction. Families expressed urgency
only after completing the necessary investigations and feared that
the spirit child was aware of the family’s intentions; that is, they
feared that the spirit would attempt to kill them first when it
discovered the family knew its identity.
Suspicions and rumor alone are not sufficient to prove that a child
is a spirit child. An extensive confirmation process involving several
steps and multiple forms of evidence is necessary to substantiate
suspicions. The presence of misfortune, death, maternal illness, or
infant disability does not unequivocally prove the presence of a spirit
child; however, the strength of suspicions increases when illness
occurs in conjunction with these misfortunes.
Even multiple suspicions together cannot officially confirm the
presence of a spirit child. Since divination is regarded as the most
valid form of evidence, the head of the household must visit
a soothsayer to confirm its presence. A concoction man described
a typical process:
The man will come home and sacrifice a fowl to the ancestors.
Then he will be rushing here and there seeking a solution to the
problem. Then he will get up again and go to another soothsayer.
He may go to a soothsayer three, four, or even six times in
a month to make sure it is the child who is causing the problem.
The Nankani people frequently consult the ancestors via
a soothsayer for explanations of all misfortunes and involve them in
decision-making processes (Adongo, Phillips, & Binka, 1998). The
divination process surrounding a suspected spirit child can be
complex. At a minimum, the family head, always a male, consults at
least twice, but more often he would visit multiple diviners on
multiple occasions to seek the truth. In one interview a man
explained how the first diviner he consulted confirmed the presence of a spirit child in his house. Days later, he consulted another
diviner and discovered the child was not a spirit child. A third
consultation confirmed the second, and he no longer had any
suspicions.
Indeed, not all children initially suspected of being a spirit child
are confirmed and many families expressed relief when they
determine that a suspected child is not dangerous. During this
study, three children were encountered where families initially
suspected they were spirit children, but the verification process
failed to confirm this diagnosis. “We determined that she is just
disabled,” said one grandfather. In another case, a family’s suspicions were negated after their child’s condition improved with free
nutritional intervention provided by a local NGO.
In addition to divination, families may seek additional tests and
verification. One man described a common test: “You can’t just
determine that a person is a spirit child by physical appearance. If
a family gives birth to a child, they will put some oil on the feet. In
the morning, if they find dirt on the feet, it means the child has gone
out walking. The child cannot walk. Where did he go?” Families will
also place ash or sand at the entrance to the room where the child is
sleeping to see if the child is visiting the bush at night. In the
morning they look for footprints or ash on the child’s feet.
It is important to note that during the period of suspicion,
families will often engage in a wide variety of help seeking
behaviors. Both mothers and fathers initiated care seeking,
although permission from the male family head was often required
before taking the child to a healer or clinic. While consulting
diviners, family members also commonly visit herbalists and
traditional healers, health clinics, and hospitals. VA data showed
that families often sought biomedical attention multiple times as
resources permitted. Frequently a family’s financial means limit its
help-seeking activities, and the spirit child diagnosis is arrived at as
a last resort when all other interventions have failed. A woman
remarked, “When we give birth to such children, we will always try
to find treatments for them. We will go to many herbalists. When
we fail, we will go to the soothsayer’s house and find out if such
a child is a spirit child. Then the concoction man is summoned.”
There was diversity in how mothers responded to spirit child
suspicions and accusations. Some mothers refused to accept
suspicions; others expressed ambivalence or supported the diagnosis. Multiple and complex interacting factors influenced
maternal decision-making and sentiments, for example, poverty,
previous number of births, family conflict, religious beliefs, age, and
education. Future papers will further address family sentiments
and moral complexities, local interpretations, the role of gender
relations, and decision-making.
After collecting the necessary evidence and confirming that
a child is indeed a spirit child, the family must conduct one final
test: the dongo. The dongo, or “horn” is the ritual and medicinal
object used by concoction men to send a spirit child back to the
bush. The term “dongo” signifies the black medicine or concoction
used to kill the spirit child, the spiritual power present within the
concoction, and the ritual objectda sheep, goat, or cow
hornditself. Ultimately, a woman remarked, despite all the other
tests, “It’s only the dongo that has the power to determine if a spirit
child is a spirit child or not.”
Determining the cause of spirit child mortality
The VA data, subsequent demographic results, and the available
literature attribute all spirit child deaths to infanticide. Upon VA
data analysis, however, it was determined that there is considerable
variation in the use of the spirit child phenomenon as an explanation for a child’s condition or family circumstances, and how
children are or aren’t treated. Not all spirit child cases are homogeneous and result in intentional death causing behaviors. In fact,
when a family describes a child’s cause of death as due to it being
a spirit child, no reliable actual cause of death is implicated. This
section describes how designating a child as a spirit child does not
always signify infanticide.
While concoction men did use the dongo to send living spirit
children “back to the bush,” the interviews and focus groups indicated that they frequently performed ceremonies for spirit children
that were identified post-mortem. In these cases, families identified and reported children as spirit children to the VA fieldworker
after they had died from illnesses, such as malaria. Depending on
the year, each concoction man performed anywhere from three to
seven post-mortem rituals per year, compared to an average of one
ceremony on a living child per year.
Our finding that the term “spirit child” is not a reliable indicator
for cause of death is also supported by the VA data. VA data
revealed 12 cases (36%) coded as spirit child wherein the actual
cause of death was not intentional; that is, no evidence of infanticide occurred. Table 2 summarizes the analysis of VA deaths classified as spirit children. Eight (24%) of the 12 non-infanticide cases
were post-mortem spirit child diagnoses detected during the
traditional divination that follows the death of any family member.
Such post-mortem VA cases often contained a narrative similar to
the following recorded by the demographic fieldworker after
interviewing the mother: “The child was said to be a spirit child.
A.R. Denham et al. / Social Science & Medicine 71 (2010) 608e615
Table 2
Analysis of VA deaths classified as spirit child.
N ¼ 33
Intentional
Death
Hastening
Other causes
(no death
hastening)
Circumstances
Surrounding Death
n
Percent
of total
Illness or disability
reported
No illness/disability, or
inadequate data to
determine presence
of illness
10
30.3
11
33.3
Postmortem diagnosis
of spirit child
Spirit child diagnosis
occurred before death
8
24.2
4
12.1
n ¼ 21 (63.6%)
Female n ¼ 5
Male n ¼ 16
n ¼ 12 (36.4%)
Source: NDSS data 1995e2000
This was revealed in their consultations with a soothsayer after the
child’s death. Child was crying one evening and died later in the
night.” In the remaining four cases in this category, families identified the sick child as a spirit child while living, but these children
passed away without administration of a concoction.
The ethnographic evidence supported by the VA data indicates
that it is unlikely that all deaths coded as spirit children are infanticide deaths. The spirit child is not necessarily a cause of death, but,
more accurately, is an explanatory model for illness, disability, and
misfortune. The spirit child best describes why a child died, rather
than how the death occurred. There is a disjunction between how
spirit child deaths occur and how they are categorized, enumerated,
and interpreted. Greater specificity that accounts for local understandings and variations in the enumeration of the spirit child
within the VA or NDSS framework will improve the demographic
accuracy and understanding of this practice. When conducting
verbal autopsies, fieldworkers should inquire if a spirit child diagnosis was attributed pre- or post-mortem and should obtain more
information to determine if infanticide was the actual cause of death.
Treating spirit children: concoctions and concoction men
While a portion of the spirit child deaths are not due to infanticide, a majority of the cases offer direct evidence of infanticide.
When confronted with a spirit child, a family may attempt to appeal
to the ancestors to take the spirit child away, but in most cases the
ancestors are not powerful enough to facilitate its death. After
a period of suspicion and help-seeking, a concoction man is sought
by the family to treat the spirit child with the dongo. The concoction man is the ritual specialist with the power and authority to use
the dongo and the knowledge necessary to send spirit children back
to the bush. Each concoction man uses the dongo according to his
family’s tradition, thus there are variations in the rituals performed
and in the concoction used. Multiple interviews with 15 concoction
men provided insights into the similarities and variations in spirit
child rituals and the composition, preparation, administration, and
effectiveness of their concoctions.
Ethnographic interviews indicated that when treating a spirit
child, the majority (10) of the concoction men prepare a tea or
herbal infusion usually from a root referred to as bunbunlia. Additionally, a small amount of what is referred to as “black medicine,”
no more than a half teaspoon, is removed from inside the dongo
and added to the tea. The black medicine is prepared from a variety
of herbs that are lightly burnt or charred then mixed with shea oil
and stored inside the dongo. A chemical or toxicological analysis
was not performed on the bunbunlia or on the black medicine.
613
Depending on the family’s tradition, the concoction man or an
elder woman in the family forces the spirit child to consume the
mixture. The actual amount consumed also varies, ranging from
a half liter to 50 ml or less. The concoction men indicated that the
quantity was not important, since even a small amount of the
concoction was enough to “catch” the spirit.
Two of the concoction men interviewed used the black medicine
alone with unheated water to treat the child. Upon watching the
preparation of this type of concoction, the half teaspoon of black
medicine did not mix with the cool waterdit merely clumped
together and floated on the surface. When the concoction man
showed the technique and amount of concoction administered to
a spirit child, it appeared unlikely that the child ingested even
a small portion of the black medicine. Again, when questioned
about the amount ingested, the concoction man emphasized that
the actual amount does not matter.
Three concoction men did not use any herbs to treat the child.
Two simply poured water over the exterior of the dongo, collected
the runoff below in a calabash shell, and administered the water to
the child. One stated, “It is not about the medicine, it is about the
power of the dongo. When the water flows around the dongo, its
power makes the child pass away. The power goes inside of the
water. If it is a spirit child, then it has to die.” Finally, one concoction
man explained that he ritually places the dongo in the room with the
suspected child and does not give a concoction. He believed that the
presence of the dongo itself would cause the death of a spirit child.
Community members also cited numerous examples indicating
that the administration of the concoction was often unnecessary
and that the amount consumed was not important, and noted that
children often spit out a great deal of the concoction. The black
medicine itself is not solely responsible for the death of spirit
children, they remarked; rather, the deadly power rests primarily
within the dongo. For example, concoction men and community
members described situations where the mere presence of the
dongo would cause the death of a spirit child. An elder explained
that, “The concoction man only needs to come and stand at the
entrance with the dongo. That alone, the concoction man standing
there, will make the child inside the room start crying and it will
die.” During a community meeting, a woman emphasized that the
death of the spirit child also involved the beliefs of the family and
the spirit child’s inclination to want to return to the bush. The
following elder woman’s perspective illustrated how some spirit
children are not the victims of infanticide: “It’s not the dongo that is
killing the children; they have to die because they are spirit children. They will die on their own. For my family, when we give
birth to a spirit child, if it is a spirit child, it will go on its own.”
The concoction men and the families of spirit children indicated
that the consistency of the child’s feces is the primary indicator that
the child is a spirit child or that the dongo has “caught” the child. “It
will not look like the feces of a normal human,” a woman said. “The
child will keep releasing animal-like feces. That is how you know it
is not a normal child. It keeps doing that until it becomes tired and
dies.” Alternatively, some community members and concoction
men remarked that if the child does not urinate or defecate after
receiving the concoction, it means that it is not a spirit child.
Although the concoctions may be of questionable potency and the
amounts given or ingested is often minimal, suspected spirit children are often already malnourished, physically weak, or ill. Even
a mild toxin may dehydrate or discourage a child from eating or
drinking. This toxin may hasten fatal illness.
In theory families indicated that if the child does not die from the
concoction or ritual use of the dongo, it is not a spirit child and the
test has failed. However, two case studies and community member
accounts illustrated situations wherein the concoction was administered multiple times over a period of days until death occurred.
614
A.R. Denham et al. / Social Science & Medicine 71 (2010) 608e615
Clarifying the spirit child
We have posited that a portion (36%) of spirit child deaths are
not due to infanticide, since some diagnoses are post-mortem or
the child dies naturally. We have also examined the preparation
and administration of the concoction, showing that in some
traditions a limited amount or no poison is given, bringing into
question if infanticide actually occurred in some cases. This final
section examines the VA and ethnographic data to further describe
the circumstances surrounding the intentional deaths of spirit
children, concluding that severe illness or disability accompanies
a significant portion of spirit child cases where infanticide occurs.
Table 2 categorizes spirit child cases into intentional death
hastening and other non death hastening causes. The analysis
indicates that 21 of the 33 VA cases (64%) can be categorized as
involving intentional death hastening activities surrounding the
death of the child. The 12 non death hastening cases were discussed
in the previous section. In the analysis of the circumstances
surrounding the 21 intentional deaths, it was determined that 10
cases within this subset (47%) were children that were ill before the
family summoned the concoction man. The following example
illustrates a VA case of a 4-year-old-boy. His mother reported to the
fieldworker that before his death he had a “hot body,” “weak neck,”
and could not sit up. The VA narrative reads:
The spirit child’s illness started when we were at Kumasi [large
city 550 km away from the KND]. He used to have hot body and
cry all the time. Back at Kumasi the spirit child was taken to
hospital and other clinics on several occasions. The spirit child
was almost three years but could not even sit down. The neck
was very weak and could not also hold his head upright like
a normal human being. When we returned home we consulted
several local medicines. It was there that we discovered that he
was a spirit child. Hence he gone to the bush.
All the spirit children encountered during ethnographic fieldwork were suffering from an illness or had a disability; commonly
the effects of endemic illnesses or congenital disability.
The remaining 11 VA cases (33%) were identified as inconclusive
because the VA forms did not contain enough data to reliably
determine the circumstances surrounding the child’s death. For
example, several VA narratives described the child as “behaving
abnormally,” offering little indication as to specific illness, developmental problem, or misfortunes attributed to the child. While it is
possible that these cases included infanticide deaths of easily treatable or healthy children, it is most likely, based upon ethnographic
data, that the cases within this category were ill or severely disabled
children that could otherwise be placed within the illness category.
The ultimate decision that a family makes regarding a spirit
child is complex and involved. Evidence indicates that coming to
a decision that a child is “not for this world” is rarely hasty or an
easy way out. Interviews and care seeking behavior indicate that
family members recognize the suffering of the child due to illness
or disability. Families also express tremendous frustration when
treatments fail or a child’s condition does not improve, and relief
when children are not deemed spirit children. Families concurrently engage in other help-seeking behaviors, including biomedical care, and seek multiple confirmations before ritual treatment.
When a spirit child is intentionally killed, families do not necessarily regard their actions as murder; the spirit child is understood
as a spirit, not as a person or a human being. Furthermore, the
concoction men perceive their services as a treatment for children
and families and do not view their actions as “killing” or
“murdering” children. Many traditional community members
describe the concoction men as dedicated to saving, not taking,
lives. Williamson remarks that people who practice infanticide
shouldn’t be regarded as lacking love for their children. Rather,
“killing a newborn is often explained as a caring act” done to save
the life of another sibling (1978, p. 63). From this perspective, in
some cases, a severely ill or disabled spirit child might put other
children or family members at risk, particularly if the child requires
constant maternal care and additional scarce family resources
(cf. Daly & Wilson, 1984). Additionally, community members often
cite kinship and reproductive imperatives as a reason why spirit
children must go; they prevent the growth and continuity of the
family. The mother caring for the disabled or chronically ill child
would not be able to care for an additional child if the previous
child cannot walk or join the appropriate children’s group.
Characterizing the spirit child phenomenon solely as an act of
infanticide and significant cause of child mortality is hasty and
incomplete. This paper demonstrated that the spirit child
phenomenon is more complex and not solely an infanticidal practice as previous perceived, since it includes post-mortem diagnoses, cases of natural death where the spirit child is used as an
explanatory model and, albeit less frequently, use of benign
concoctions or ritual without a concoction. When compared to
child mortality rates that are a result of malaria, diarrheal diseases,
and respiratory infections, the Nankani spirit child is not necessarily an urgent public health concern. It is not an epidemic in need
of eradication or necessarily an “important risk factor” for child
mortality. Rather, because most spirit children are sick or disabled,
elements of the spirit child phenomenon are connected to and
exemplify the root public health issues confronting Nankani life:
poverty, food insecurity, limited health care options, no support for
disabled children, and the omnipresent need for more infant and
maternal care and education.
We posit that the incidence of the spirit childdincluding natural
deaths, post-mortem diagnoses, and infanticide casesdwill
decrease as improvements in these root causes, specifically in
maternal and child heath, occur. Undeniably, there is evidence that
this is already happening. Community members indicate that the
prevalence of spirit children today is lower than that of the past,
and that these reductions are a result of improved access to care
and maternal health programs.
Finally, as Allotey and Reidpath (2001) have indicated and we
herein emphasize, verbal autopsies and the enumeration of similar
practices in other settings should consider the complexity and
sociocultural context surrounding local understandings for the
varied causes and explanations for child mortality and complex
practices such as infanticide. For example, the identification by a VA
fieldworker of a spirit child case could trigger additional interview
questions to clarify the presence of concomitant illness or disability,
and whether the spirit was identified and treated pre- or postmortem. The neglect of such considerations may only result in
attempts aimed at chasing spirits.
Acknowledgements
This research would not have been possible without strong
collaborative relationships between the University of Alberta,
Northern Arizona University, the Navrongo Health Research Centre,
and AfriKids, a child rights NGO working to address the root causes
of spirit child phenomenon. Special thanks to James Phillips, the
Population Council, and the community members of the KassenaNankana District.
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