In the 1990s, hundreds of poor, mostly rural indigenous women with little access to health services were coercively or forcibly sterilized in Peru under a state-sponsored family planning program. Some died as a result of botched surgeries. The abuses were first denounced by Giulia Tamayo, a Peruvian feminist activist, and later investigated and documented as part of a pattern of abuse by the Latin American and Caribbean Committee for the Defense of Women's Rights (CLADEM) and the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). In 2011, former Health Minister Alejandro Aguinaga, whose term coincided with those abuses, denied any wrongdoing and told reporters that the forced sterilizations were isolated cases (in El Comercio, 31 May 2011).

Why did the abuses take place, and what attitudes facilitated the denial of these abuses? Christina Ewig's Second-Wave Neoliberalism answers these and many other questions by discussing the development and implementation of the 1990s family planning program, as well as multiple other ways that health policies intersect with beliefs about gender, race, class, and location to result in discrimination against specific groups of Peruvians (usually those who are poor, live in rural areas, and are indigenous). The book balances the examination of top-down health policies with bottom-up insights on the effects of the implementation of policies, particularly during periods of neoliberal reform.

Ewig employs a multidisciplinary approach to support her point that unequal access to basic health services is informed by, but cannot be understood exclusively through, the lens of neoliberal reforms or even of internal colonialism or racism. Relying on an intersectional approach and historical attention to the role of legacies, the author uncovers multiple ideas and practices from the past that inform contemporary implementation, forms of discrimination, and the denial of services. She infuses her macro analysis of the health sector with ethnographic insights that prevent her—and the reader—from losing sight of the connections of health policies to the everyday lives of the women affected by those policies. In the introduction, for example, Ewig draws on her fieldwork in rural areas of Ayacucho to provide ethnographic details of everyday life for a poor family. These glimpses help readers understand the experience of rural poverty and how it intersects with gender, race, and class as it affects access to health care. Interviews with Peruvian feminist activists in nongovernmental organizations (NGOs) and with service providers further enrich what would otherwise be characterized by a top-down approach.

The book consists of seven chapters, a conclusion, and a methodological appendix. Ewig begins by introducing a historical lens to examine health policies. She employs a policies legacy approach to underscore ways in which contemporary policies are informed by, and break away from, political and class-specific interests, public expectations, and the impact of previous policies. She ties some practices and forms of implementation to legacies that date back to the late nineteenth century and covers policies that include the family planning program and public and private health insurance plans.

In analyzing the neoliberal reforms implemented by then-president Alberto Fujimori in the 1990s, Ewig states that gender equity was not part of the neoliberal reform agenda. Rather than respond to women's basic health needs, programs consistently privileged demands for efficiency and embraced racist, discriminatory attitudes. She reminds us that Fujimori positioned seemingly innovative and feminist-inspired family planning programs within his broader struggle against poverty, noting that “he viewed family planning as a means to reduce poverty, rather than to promote women's rights” (p. 91). Rather than let us think that this sort of behavior has no precedent, earlier in the book Ewig points to “a continuum of policies in Peru dating back to the nineteenth century that have viewed women's bodies as a tool of economic development” (p. 7). More specifically, it has been indigenous women's bodies that have been devalued, manipulated, and controlled.

As Ewig rightly notes, references to and theories of intersectionality are increasingly common. She discusses the value of an intersectional approach and takes into consideration gender, race, class, and location in examining the development and implementation of health reforms and policies to provide a well-balanced theoretical, as well as empirical, analysis. While its focus is Peru, the sort of analysis and general categories presented here could also serve as a useful model for scholars focusing on the health sector and its impact on individuals in other regions of the globe. It is also part of a growing and recent body of work by feminist scholars that engages and further develops intersectional lenses to examine institutions, individual lives, and policies in Peru. Ewig does not refer to any works by these authors, yet Jelke Boesten's Intersecting Inequalities: Women and Social Policy in Peru, 1990–2000 (2010) on women and social policy, as well as my own book, The Woman in the Violence: Gender, Poverty, and Resistance in Peru (2010) on intersecting forms of violence in mestiza and indigenous women's lives, both published in the same year as Ewig's book, also employ and refine intersectional lenses to provide both theoretical and empirical examinations of contemporary issues relevant to Peruvianist gender studies.

Ewig's research included interviews with feminist activists in NGOs. She refers to Peruvian feminists in many parts of the book, particularly in discussing their relationship to the state under Fujimori and how his co-optation of feminist discourse to promote family planning services resulted in large-scale human rights abuses. Through her interviews, she found that feminists were interested in family planning but generally disengaged from broader activism and discussions dealing with health-sector reforms that were not directly related to family planning. She also notes that feminists were divided regarding their allegiance to the Fujimori government. A different approach could have included a more in-depth discussion of feminists' relationship to race in Peru historically, and of how those feminist legacies may have affected contemporary views and activism. At points, I also wanted to know more about the educational, geographic, racial, and class background of feminists she referred to, and of the relationship of individual, self-identified feminists to the state. The book, however, contains a significant amount of information and this is one small point among many other very good points and analyses provided by the book.

Because of its multidisciplinary grounding and multimethod approach, Second-Wave Neoliberalism may be an especially good fit for interdisciplinary courses, such as those in gender and women's studies and Latin American studies, as well as for methods courses. It would also work well in political science, anthropology, and sociology courses and for those interested in health policies. In 2012, a Spanish edition of the book will be published in Peru, making Ewig's work accessible to even more readers.