Kim Clark's work, Gender, State, and Medicine in Highland Ecuador, focuses on the role that female health-care workers played within state-building processes in Ecuador. Clark elaborates on the relationship between science, gender and citizenship, showing how midwives, nurses, female doctors and child welfare workers acted as ‘both objects and agents of state formation’ in the highlands of the country. Using sources such as official correspondence and records of internal communications from hospitals, schools, universities and social welfare institutions, the author analyses how the field of medicine became a gendered social space through which women's experiences contributed to the consolidation of the country's modernity.

Drawing on Foucauldian concepts such as biopolitics and governmentality, Clark's book focuses on two main themes: state formation and women's agency. The author suggests a connection between the evolution of nursing, medicine and midwifery, and the transformation that Ecuadorean society experienced from the 1895 Liberal Revolution to the 1950s. Clark convincingly demonstrates how, despite some religious restrictions common to the Latin American context, medical schools in Ecuador were the first to accept women among any other universities in the Andean region. Moreover, the author shows how Ecuadorian women, through the exercise of medical professions, became state agents. In doing so, Ecuadorean health-care workers contributed to the development of state-run projects that aimed for the modernisation of Ecuadorean social policy, such as the foundation of unique institutions like the Escuela Nacional de Enfermeras in 1942. By discussing Ecuadorian women's experiences in the field of medical education, Clark's intervention helps us understand the country's history from an innovative gendered perspective (within Ecuadorean historical literature, at least). That, she claims, allows the revealing of ‘dimensions of women's actions and experiences that are not currently well known’.

In the first chapter, which also works as an introduction, Clark details the main gendered experiences in the processes of state formation, and consequently in the teaching of medical professions, in Ecuador. While describing the importance of education and health, the author also highlights the way in which women from urban sectors openly participated in the making of public policy. Clark shows the remarkable advances that Ecuadorean women made within the medical field, and how women's rights in Ecuador intersected with the political context of the mid-1920s, which among other things witnessed the triumph of the Revolución Juliana and the overthrew of Liberal rule. In the second chapter the author describes some of the welfare protection programmes that the country implemented in the first half of the twentieth century. She contends that, as in most of the western hemisphere, child protection and education were ‘terrains for gendered social policy’. Describing the institutional impact that two state institutions, the Junta de Beneficiencia and the Servicio de Sanidad, had on child health and welfare, the chapter explains how children's health was thought to be an expression of national progress, human capital and state development. This chapter also depicts the creation of the gota de leche programme, a social initiative of ‘gendered social action’ in which women freely expressed their ideas and exercised their policy-making capacities.

In the fourth chapter, Clark shows how women's bodies were controlled by society and the state. By monitoring women's sexuality, the state pretended to control both motherhood and diseases. In this chapter the author describes the anti-venereal disease campaigns used by the Ecuadorean government, which considered such diseases, syphilis in particular, a ‘racial poison’. Also, the author shows how health policies in Ecuador often expressed disagreements among state agents, something that she characterises as diverse approaches to ‘preventive hygiene’. Clark's arguments prove that the Ecuadorean state in the first half of the twentieth century was more than just institutions. In fact, it is taken to have also been the people that worked for it, which included women. This chapter also portrays and discusses gender ideologies regarding sexuality, disease and behaviour of the Ecuadorean state, and how until the 1950s men continued to have a protective, supervisory – that is, paternalist – role.

Chapters 4 and 5 focus on the role that women had as providers of state services; in other words, how women acted as state agents in the country. In chapter 4, the author focuses on the programmes of maternal infant care and the role women had as midwives, which she describes as a scientific discipline called obstetricia. Chapter 5 concentrates on the creation of the first national nursing school, founded in 1942. Built by the Ecuadorean government with the support of the United States, the Escuela Nacional de Enfermeras is described by Clark as a space where ‘the many possibilities’ that professionalisation offered to Ecuadorean women were expressed. It is in this chapter that Clark mentions Afro-Ecuadorean women, who, like indigenous women, were for the most part excluded from the modern projects described by the author.

Clark concludes that, in the first half of the twentieth century, Ecuadorean women's behaviour was ‘regulated in a range of different social arenas’ in which women actively intervened as state agents. This regulation was, moreover, an expression of the relationship between morality and state formation. Clark thus claims that her book accounts for the lives, practices, sexuality and morality of women in the highlands, and provides a narrative in which Ecuadorean women can self-recognise. While her interpretation may seem overstated, given the fact that the book talks mainly about Quito, the country's capital, and mentions indigenous and Afro-Ecuadorian women only marginally, her effort to portray the lives of non-elite women and their role as state agents and medical professionals constitutes a significant advance not only for Ecuadorian historiography, but also for the literature on gender history in the Andean region.