Gender, State and Medicine in Highland Ecuador: Modernizing Women, Modernizing the State, 1895–1950 by A. Kim Clark (review)

Gender, State and Medicine in Highland Ecuador is a significant contribution to recent scholarship about state formation in late nineteenth- and early twentieth-century Latin America. Like much of that scholarship, which has tended to focus on countries of the southern cone (Argentina, Chile, Paraguay, and Uruguay), Clark’s study focuses on the gendered nature of state formation—specifically, on the ways in which women were both objects and agents of state projects. But it also focuses on the much-less studied country of Ecuador, especially highland Ecuador and the capital city of Quito. As such, the book adds a particularly useful arrow to the quiver of historical studies of state formation in Latin America.

Clark’s book is divided into five chapters. With the exception of the introductory first chapter, the chapters are distinct but connected case studies of the gendered nature of state policy, particularly as related to public health, in the period under study. Chapter 1 sets out the broad historical context for the study (focusing on the employment opportunities available to Ecuadorian women) and, of special interest to readers of this journal, explains the theoretical and methodological perspectives that informed the research. Like much of the state formation literature in Latin America, Clark’s draws on sociological and anthropological approaches to the state as a cultural formation, following the work of such scholars as Abrams, Corrigan and Sayer, and Foucault, who, all, in different ways, frame state formation as a cultural process rather than a mere bureaucratic/administrative one. ¹

Such a perspective always proves fruitful. It enables Clark to discuss child protection programs in Chapter 2 as expressive of the varied assumptions, and conflicting views, about gendered female roles or, indeed, as expressive of the disputed fields of state action (and social policy) or of charitable institutions (and private philanthropy) vis-à-vis vulnerable children. Similarly, it also enables Clark to explore state policy toward venereal disease, as well as how the women targeted by this policy sought to navigate its regulatory and medical framework, as a reflection of gendered orders and assumptions. In Chapters 4 and 5, Clark turns her attention to women trained as agents of the state, either as midwives or nurses, who were forced to negotiate rigid moral structures based on gendered assumptions that limited their field of action.

Clark draws on rich archival documentation in all of her case studies and injects some oral-history interviews. She shows how gendered social policy in Ecuador permitted women, at least some of them, to enter new areas of employment that challenged rigid gendered norms. But she also shows that professions such as midwifery and nursing also reinforced gendered norms and limited the emancipatory potential that the professionalization of female employment could otherwise bring. Clark demonstrates in this important contribution that gendered social policy in Ecuador, as elsewhere in Latin America, was a process that both reflected and shaped that country’s cultural formation.