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184 Conclusion A central dimension of state formation is what historical sociologist Philip Corrigan has called “the materiality of moral regulation and the moralization of material reality.”1 This book explores both, examining some of the concrete ways that women’s moral behavior was regulated in a range of different social arenas as well as how women’s efforts to deal with some of the material constraints they faced were perceived and addressed in moral terms. In each chapter state projects are scrutinized. What lent such projects considerable legitimacy was not so much their ability to impose behaviors, but rather the ways that they enabled certain kinds of actions or possibilities for differently situated Ecuadorian women. They enabled poor women to find (particular kinds of) solutions to their need to feed and educate their children, or to find free medical attention or sterilized milk for those children. They enabled some women who went so far as to register themselves with the venereal prophylaxis service to find a solution to their economic difficulties in prostitution (sometimes temporarily), providing them with medical treatment for sexually transmitted diseases. They enabled quite different kinds of women to seek new educational opportunities and to professionalize themselves as midwives and nurses, which might lead to state employment. There were ways in which all of these programs acknowledged, furthered, and sometimes even dignified women ’s aspirations and situations, at the same time as they disallowed or undermined other dimensions of women’s behavior and identity. The chapters range widely over women’s lives, state practices, and health issues in highland Ecuador—especially, but not exclusively, in the capital city CONCLUSION • 185 of Quito—in the first half of the twentieth century. Nonetheless, some issues weave their way through several chapters, and one of the prominent themes is sexuality. While sexuality was repressed (for women), it was also everywhere— a prominent window through which women’s behavior was judged and a primary way in which their role was understood. Its prevalence can be seen, too, in the number of male secondary school students who were sexually active from their adolescence, often with the many women who prostituted themselves regularly or occasionally to make ends meet. It can also be seen in the behavior of medical students: in a kind of voyeurism or salaciousness they could not seem to help exhibiting with pregnant women in the Maternidad, or when they hung around the offices of the Servicio de Profilaxis Venérea hoping to get to know some of its clients (registered prostitutes). Nurses, too, found it difficult to forge a new professional space in which they would not be treated primarily as sexual beings; it is no wonder that nursing leaders concluded that only a nunlike persona could help nurses project an appropriate image within the hospital. Unattached women who took up positions in the Public Health Service’s outreach program of maternal-infant health might also be accused of sexual transgressions by their supervisors. A registered prostitute in Guayaquil recounted in 1951 that she had tried to make a living in other ways, including working “like a man” cutting and moving rock in the municipal quarry, but once her male coworkers discovered that her name was in the registry, they made her life impossible. This incident led the director of venereal prophylaxis in Guayaquil to conclude that women were only ever considered as sexual objects by men, who were interested in possessing them (and if they failed, hated them), but who had no interest in understanding them.2 Emphasizing their sexuality in these ways, in contexts where women did not themselves foreground it, was a way that men exercised power over women. A related theme that appears frequently in these pages is morality, including in the obvious double standards of morality that judged women harshly for missteps that were commonly accepted for men: indeed, men’s sexuality was seen as a natural, instinctual urge, in a way that women’s rarely was. Perhaps more interesting is the very different ways that morality was seen as problematic for midwives and for nurses. The main moral issue for midwives seems to have been abortion, and it was suspected that they were likely to identify too much with the conundrums of their female clients (or simply seek the fees they could earn for an illegal service) rather than to keep in mind their obligations as medical professionals. They worked alone in people’s homes or in their own private practices by...


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