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

BOOK REVIEWS GENDER, STATE, AND MEDICINE IN HIGHLAND ECUADOR: MODERNIZING WOMEN, MODERNIZING THE STATE, 1895–1950 by Kim Clark. Pittsburg: University of Pittsburg Press, 2012, p.255, $27.95 Kim Clark’s Gender, State, and Medicine in Highland Ecuador contributes to an extensive literature on everyday forms of state formation analyzed through the lens of gender, public health, lived experience, and on-going negotiations between social actors and the state. While Mexico, Brazil, Argentina, Chile and Peru have enjoyed considerable attention from scholars in the field, Clark’s study of Ecuador is a welcomed addition to a still burgeoning scholarship that looks at similar processes in other countries like Colombia and Bolivia. In 1895, liberal elites from Ecuador’s coast seized power and began to sponsor social programs and build institutions to fulfill their vision of a secular, modern, and prosperous nation. Gender, State, and Medicine examines how the implementation of child welfare programs, the regulation of prostitution, and the establishment of a school of midwifery and nursing in Quito impacted the lives of women. In particular, Clark is interested in women who were neither privileged nor completely marginalized, those who benefitted from their ambiguous positions in Ecuador’s social hierarchies and enjoyed greater autonomy from close social scrutiny experienced by elite women or the constraints experienced by Quito’s poor. Women like Matilde Hidalgo, the first graduate from Universidad Central’s medical school, and unlicensed midwives like Carmela Granja played an active role in configuring and challenging state agencies and projects. Gendered assumptions entered child welfare programs at several levels . First, these projects emphasized the roles of women as mothers and guardians of the health of Ecuador’s future generations. Second, Ecuadorian women participated in the implementation of these programs as social workers and state employees. Lastly, the state was seen as paternalistic and in charge of protecting the nation’s vulnerable populations. State programs to control venereal disease and regulate prostitution brought women and their bodies under close surveillance. Similar to government attempts to regulate this trade in Bogota in the early decades of the twentieth-century, Ecuador’s Servicio de Profilaxis Venérea placed the burden of prevention on individual prostitutes, rather than on brothels. Unlike Mexico where under the post-revolutionary state brothels became sites for state intervention , in Ecuador individual prostitutes were held accountable. Explaining the differences in policies between countries like Ecuador, Colombia, and Mexico opens new lines of research. Clark’s analysis also highlights how various social actors used a language infused with morality, respectability, and honor to make demands on institutions and/or challenge state projects. For instance, some women C  2013 Southeastern Council on Latin American Studies and Wiley Periodicals, Inc. 143 The Latin Americanist, December 2013 registered in Quito’s Sanidad who were no longer working as prostitutes or others or who claimed were mistakenly entered on the registry chose to challenge their immoral and illegitimate status. To do so, these women relied on networks of men who could vouch for their respectability and honor. These men represented a form of social capital for these women. Like former prostitutes, women who entered Quito’s midwifery or nursing program needed to prove their good conduct and often provided letters from respectable men, former or current employers, neighbors, relatives, etc. These fascinating instances show that women in Ecuador actively engaged with existing power structures and manipulated them for their own benefit. Clark relies on institutional records from the Servicio de Sanidad, the Junta de Beneficencia, the Hospital San Juan de Dios, the Escuela Nacional de Enfermeras, and oral sources from women who received training and employment from state institutions. These records give Clark insight into how state projects tried to modernize women, turning them into objects of state intervention through child welfare and anti-venereal disease campaigns while opening spaces for them to participate in the making of the state, through their professional training as scientific midwives (obstetrices ) and nurses. The women in Clark’s narrative negotiated their positions and pressed the limits of the Ecuadorian state. It was precisely in these spaces between experience, agency, and structure where Clark argues the state was formed. Clark’s narrative allows us to see...