Freshwater tells the semi-autobiographical story of the protagonist, known to the reader as 'The Ada'. The main narratorial voice of the novel is an ogbanje, a deity from Igbo religion, that occupies the Ada, and manifests in multiple distinct and characterised personalities, both helpful and antagonistic.

The plot follows a fragmented account of the Ada's life. The first main segment of the novel discusses the Ada's birth and the nature of the ogbanje, followed by a general account of her childhood in Nigeria, narrated in plural first person by the dormant ogbanje living inside her. Following her childhood, the Ada moves to the United States to study biology, where her first college boyfriend, Soren, repeatedly rapes her. The trauma of this event causes the dormant ogbanje to change inside her, leading to the development of a unique personality known as Asughara, who acts antagonistically to the Ada's body in the favour of the ogbanje spirit that resides inside her. At the same time, another personality known as St Vincent emerges, with an emphasis on masculinity, including binding and eventually undergoing top sugery. Following the emergence of these unique ogbanje personalities, there is a constant struggle for control over the Ada's life, the outcome of which includes self harm, exploration of sexuality and gender identity, and experimentation with intoxication. The plot climaxes as Asughara attempts to kill the Ada, which is seen as both murder from one personality to another, and also as suicide. The attempt fails, and after the Ada's hospitalisation, she travels back to Nigeria for the closing action of the story, where she is seen to by a priest. In the final section of the novel, the Ada reflects on her personalities and the nature of the ogbanje in an introspective manner, as she gains a sense of wholeness to her identity.

The story of Freshwater is broken up and fragmented through both time and narratorial voice. The narrator often changes between chapter, between the initial first person plural of the ogbanje, Asughara, St Vincent, and eventually the Ada herself, who doesn't gain a voice in her own story until well into the novel. The organisation of the story within the novel is arranged so that the action is more centred around the ogbanje's journey and conflict than the Ada's.

Emezi explores their Igbo heritage's views on spirituality and gender roles alongside those of Western construction and invites their audience to think critically about this spirit/body binary.^[3][1]

The New Yorker called Freshwater "a startling début novel";^[4] The Guardian called it "a remarkable debut";^[7] and the LA Times called it "dazzling".^[8] Freshwater was longlisted for numerous significant awards.^[9] Freshwater was a New York Times Notable Book,^[10] was named a Best Book of the Year by the New Yorker^[11] and NPR.^[12] Emezi is also recognized as a 2018 National Book Foundation "5 Under 35" honoree.^[13]

In 2019, Freshwater was nominated for the Women's Prize for Fiction — the first time a non-binary transgender author has been nominated for the prize. Kate Williams, the chair of the judges, called it a "historic moment". Williams said that the panel did not know Emezi was non-binary when the book was chosen, but she said Emezi was happy to be nominated.^[14] Non-binary commentator Vic Parsons wrote that the nomination raised uncomfortable questions, asking: "would a non-binary author who was assigned male at birth have been longlisted? I highly doubt it."^[15] After the nomination, it was announced that the Women's Prize Trust was working on new guidelines for transgender, non-binary, and genderfluid authors.^[16]

After Emezi posted tweets regarding Nigerian author Chimamanda Ngozi Adichie's association with transphobic public figures,^[17] Adichie (who had previously helped publish Emezi's work in an online magazine) asked that all references to her name be removed from the "about the author" section of the book jacket on all future copies of Freshwater.^[18]

• 2019 Nommo Award,won ^[19]
• 2019 Otherwise Award, won^[20]
• 2019 Women's Prize for Fiction, nominated

In May 2019, news announced that the novel was optioned by FX for a TV series adaptation.^[5] Emezi will write the screenplay and executive produce the series with Tamara P. Carter. FX Productions will produce it alongside Kevin Wandell and Lindsey Donahue.^[6][5]