Book Review Review of Coe, Cati. Changes in Care: Aging, Migration, and Social Class in West Africa. Rutgers University Press. 2021. pp. 248. Price: $120 (Hardcover); $39.95 (Paperback and eBook). Swetlana Torno Heidelberg University swetlana.torno@hcts.uni-heidelberg.de Anthropology & Aging, Vol 43, No 1 (2022), pp. 74-77 ISSN 2374-2267 (online) DOI 10.5195/aa.2022.388 This work is licensed under a Creative Commons Attribution 4.0 International License. This journal is published by the University Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. Book Review | Torno | Anthropology & Aging Vol 42 No 2 (2021) ISSN 2374-2267 (online) DOI 10.5195/aa.2022.388 http://anthro-age.pitt.edu 74 Book Review Review of Coe, Cati. Changes in Care: Aging, Migration, and Social Class in West Africa. Rutgers University Press. 2021. pp. 248. Price: $120 (Hardcover); $39.95 (Paperback and eBook). Swetlana Torno Heidelberg University swetlana.torno@hcts.uni-heidelberg.de In Changes in Care, Cati Coe provides a comprehensive, historically informed account of societal transformations currently happening around aging and eldercare in southern Ghana. These changes occur within the context of decades-long internal and transnational mobility, rising socio-economic inequalities, and increasing longevity and population aging in the Global South. Coe’s ethnography documents how Ghanaian senior citizens, their families, religious and state institutions, and actors on the emergent eldercare market grapple with caring needs of older generations and search for answers to adequately provide for elders under rapidly changing circumstances. The monograph focuses on rural towns of the Eastern Region and the metropolitan area of the capital city of Accra. Coe’s collaborators are mainly Christian, educated, middle class, and elite populations, whom she met during her numerous research visits to Ghana between 2013 and 2019 (eight months in total). This material adds to the author’s previous research experience in the country (since 1997) and publications on neighbouring topics (e.g., 2013; 2019a; 2019b), which expand the readers’ vision to interconnected processes such as child fosterage, transnational kinship relations, and temporality of migration over the life course. Theoretically, the book advances the concept of “inscription” that Coe began to develop in a collaborative work with Erdmute Alber (Coe and Alber 2018) and which she lays out in the introduction. The notion of inscription is situated on the continuum between societal norms and individual actions and foregrounds transience in social change processes. It describes newly emerging “practices and discourses that are shared by more than one individual” but have not yet become “standardized,” “institutionalized,” or “hegemonic” (3). The analytical value of the concept lies in its potential to capture “episodic and contingent ways” in which social change occurs as well as to understand the limits of such processes (3). Coe notes that different types of inscriptions exist, such as gender roles or life-course stages. Changes in Care specifically focuses on “age and care inscriptions” (5). In the introductory chapter, Coe places the notion of inscription in relation to other theoretical concepts and strands in aging literature. Noteworthy is her use of Bourdieu’s terminology surrounding social norms and coexisting alternative discourses and practices such as “orthodoxy,” “heterodoxy,” and “alterodoxy” (6–9). Coe uses these concepts in the ethnographic chapters to identify the types of processes leading to the formation of inscriptions (11–14). She furthermore positions inscriptions in http://anthro-age.pitt.edu/ Book Review | Torno | Anthropology & Aging Vol 42 No 2 (2021) ISSN 2374-2267 (online) DOI 10.5195/aa.2022.388 http://anthro-age.pitt.edu 75 relation to the agency of individuals by stressing that, for example, older adults are actively engaged in creating new age and care inscriptions by imagining alternative futures of care in old age (14–15). In like manner, institutions can drive the formation of new inscriptions. Later in the book, the reader will also find a refinement of the “global care chains” concept (Hochschild 2001) and “social remittances” theory (Levitt 1998); Coe posits that transnational migration does not directly translate into the emerging commercial care market but rather conjoins other influential social processes (122–23). Chapter 1 (which provides a historical context for the book) outlines the “orthodox script” (30) of eldercare in Ghana, which follows the narrative of “traditional family” and is upheld in state policies, by international NGOs, and by the Christian Church. The focus on the nuclear family and children’s care responsibilities following this orthodox script leaves state, religious, and developmental institutions incapable of addressing the real problems many Ghanaian senior citizens and their carers are facing today. Drawing on archival materials of the Presbyterian Church dating back to the 1860s as well as on sociological and anthropological studies of older people by local and international scholars, Coe shows how this ‘orthodoxy’ was never fully realized in the first place. These sources show that during the 19th and 20th centuries, eldercare was provided by different types of extended kin and non- kin such as slaves and foster children. The book’s ethnographic chapters are organized in two parts and focus on transformations of aging in rural towns (Chapters 2–4) and in metropolitan areas (Chapters 5–7) respectively. The changes in age and care inscriptions in both sites are mainly driven by migration to urban centres or abroad in search for work or higher education, increasing labour demands on women, and the consolidation of a middle- class with distinct life-styles. Rural towns with their limited opportunities for education or employment become unattractive for young and middle-aged people. This consequently reduces the care possibilities of elders residing in these areas. Driven by fears of neglect and abandonment, many seniors in Coe’s study express their openness to the “heterodox possibility” (60) of residential facilities (discussed in Chapter 2). They have become aware of this option via globally circulating images of nursing homes in the West. However, for the time being, such institutional facilities are an imaginary— not a real alternative for eldercare—and are rather used by Ghanaian elders to critique the state and the church for neglecting their needs. In contrast, another institutionalized age inscription is on the verge of acquiring “the status of an orthodoxy” (117) in Ghana: senior day centres and fellowship groups run by churches. These institutions primarily diagnose the problems of Ghanaian older adults as caused by loneliness and lack of medical attention during the day (96) when other household members have left home for work or school. In Chapter 4, Coe examines the histories and activities of four day-care centres, which offer games, physical exercises, medical check-ups, seminars on health, and opportunities to earn some money. This is well documented in the accompanying ethnographic film Making Happiness: Older People Organize Themselves. The major critique raised by the author in this chapter is that the centres mainly include the well-off and mobile older adults in their activities and exclude the bedridden elderly with chronic conditions. Chapter 3 documents those age and care inscriptions that are not openly diverting from the “orthodox script” but are still becoming more common in the rural towns of the Eastern Region. These inscriptions comprise the adaptation of historically existing practices for eldercare purposes. In this care- arrangement, children do not provide care directly and instead use a fostered adolescent, distant (often) female kin, or unrelated middle-aged woman to provide care for their parents. Children supervise the care-work as “care managers” (78) from a distance and pay for these services in the form of schooling fees, remittances for living expenses, and work renumeration. Coe argues that this care inscription http://anthro-age.pitt.edu/ Book Review | Torno | Anthropology & Aging Vol 42 No 2 (2021) ISSN 2374-2267 (online) DOI 10.5195/aa.2022.388 http://anthro-age.pitt.edu 76 actually supports “the orthodoxy of kin care because adult children [are] viewed as caring for their parents by paying for their care by others” (79). A variant of this practice is when the elder moves in with one’s daughter, who might care for the parent herself or recruit a paid caregiver if she has a prestigious full-time job. In Chapter 5, Coe directs her attention to the newly emerging eldercare market in Accra. This market consists of home care agencies and a small number of nursing homes, which cater to the needs of the growing urban middle-class and international migrants, who are able to pay for these services. The market is still small and highly volatile due to economic instabilities, lacking awareness of special care needs of older adults, and the reluctance of the state to regulate this field. Nevertheless, the new demand for eldercare brought about changes in the field of higher education through the introduction of the new healthcare assistance study program, which is the subject of Chapter 6. Coe points out that the program was initially supposed to train home carers for the elderly but transformed its educational goals towards a stronger resemblance with nursing. Drawing on Bourdieu’s concept of cultural capital, she discusses the “social life” (147) of the new academic credential and reveals the disjuncture between the students’ “educational enchantment” (165) and actual employment possibilities. The lacking recognition of the healthcare assistance certificate in hospitals and by home care agencies leave most young graduates disappointed about their wages, the workplaces where they end up, and their concomitant social reputations. The last chapter deals with yet another aspect of the newly emerging care market and examines the confusion of home carers as a new inscription with “adjacent relations” (168). Within the field of social and professional hierarchies in Ghana, the novel occupation as home carer is placed between the employment as household help (no professional training) and nursing profession. Coe finds that the introduction of a new occupation reflects and stabilizes existing social inequalities and is visible in home carers’ engagement in “symbolic boundary work” (168): They mobilize their academic certificate, medical knowledge, and similarity to the nursing profession to reassure their higher status in comparison to household help. However, their education and work do not possess cultural capital yet, which leaves them without the respect and social status they feel they deserve (186). Summarizing her results in the conclusion, Coe provides recommendations on how to improve eldercare education and enhance its status. Changes in Care offers a much-needed contribution to literature on population aging and accompanying social transformations in the Global South. Its insights on the emergent eldercare market in a context where commercial services and institutionalized facilities seem unprecedented are particularly relevant and invite for further discussion and comparison. The book is lucidly written, well organized, and would be interesting for students, scholars, and professionals working on aging, generations, transnational families, eldercare, and social change. References Coe, Cati. 2013. The Scattered Family: Parenting, African Migrants, and Global Inequality. Chicago: University of Chicago Press. Coe, Cati. 2019a. The New American Servitude: Political Belonging among African Immigrant Home Care Workers. New York: New York University Press. -----. 2019b. Making Happiness: Older People Organize Themselves, Bethel Presbyterian Church, New Tafo, Ghana, July 2019. Rutgers University. https://doi.org/10.7282/t3-thke-hp15. http://anthro-age.pitt.edu/ https://doi.org/10.7282/t3-thke-hp15 Book Review | Torno | Anthropology & Aging Vol 42 No 2 (2021) ISSN 2374-2267 (online) DOI 10.5195/aa.2022.388 http://anthro-age.pitt.edu 77 Coe, Cati and Erdmute Alber. 2018. “Age-Inscriptions and Social Change: Introduction.” Anthropology and Aging Quarterly 39 (1): 1–17. Hochschild, Arlie Russell. 2001. “Global Care Chains and Emotional Surplus Value.” In On the Edge: Living with Global Capitalism. Edited by Will Hutton and Anthony Giddens, 130–46. London: Vintage. Levitt, Peggy. 1998. “Social Remittances: Migration Driven Local-Level Forms of Cultural Diffusion.” International Migration Review 32 (4): 926–48. http://anthro-age.pitt.edu/