Second-Wave Neoliberalism

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Preface and Acknowledgments

When I conceived of this project in the late 1990s, I wanted to make a difference with my research. I had studied Latin American women’s movements previously, and this time wanted to contribute to a movement in some way through my research. After feminists had criticized the negative effects on women of structural adjustment in the 1980s and early 1990s, it seemed that a focus on the gendered effects of the “second wave” of neoliberalism—the market-oriented restructuring of state social policies such as health, education, and pensions—was the next logical step. What impact did this latest wave of reforms have on gender equity? How did race and class interact with gender to mediate the effects of these new policies on women and men of different social strata? What were feminist activists in the region doing to address this new wave of reforms? Did gender play into the political process of social policy reform, and if so, how? Answering these questions seemed like a productive way to contribute to already established interests of feminist activists and scholars alike in gender and political economy. Latin American feminists have a long-term interest in reproductive health. In addition, health policy has historically been one of the foundational pillars of Latin American social policy systems. Therefore, I chose to focus on health policy and to do so in the racially and socioeconomically diverse country of Peru.

I began my research by tracing the formulation of Peru’s health reforms, interviewing representatives of all possible interested political players, from labor unions to doctor’s associations and health ministers. While Peruvian feminists, as I had expected, were keyed into debates over national reproductive health care policy, to my surprise, there was little attention paid by feminists or policy makers to the gendered effects of “mainstream” health reforms—things like privatization or decentralization of health services. This lack of attention was surprising given the rhetoric of “gender mainstreaming” at the time emanating from global forums like the United Nations Fourth World Conference on Women—forums that Peruvian feminists were actively involved in. Thus, one puzzle that this book sets out to solve is why feminists failed to intervene in the formulation of “second-wave” social policy reforms, in spite of their flurry of activity related to economic adjustment and given their strong global activism. The absence of feminists’ participation in the mainstream health reform process is also one piece in understanding how the second-wave policy reform process itself was gendered.

As I researched the contemporary process of health reform, history began to draw more and more of my attention. Previous policy patterns and interest groups that had formed in response to these earlier policies clearly played a role in shaping the politics of the contemporary reform process—and they did so in ways that appeared to reinforce or even create new gender, class, and racial hierarchies. I had begun to discern the importance of “policy legacies,” a theoretical concept that refers to previous policy decisions that serve to shape the politics of future reform processes in important ways. Yet my research also led me to further refine the concept by demonstrating how such legacies may entrench the gender, class, and race inequalities upon which they arose. Moreover, my comparison of multiple health reforms in one country allowed me to begin to explain how and why some policy legacies were overcome in Peru’s health reform process, while others remained in place. On this count, I found that transnational “epistemic communities” played an important part in determining the survival or defeat of particular policy legacies in the reform period, and also helped to shape feminists’ interest in gender mainstreaming in the health sector.

But were these neoliberal reforms good or bad for women? Were they better or worse for some groups of women more than others? My second major task was to follow each of the major health reforms from formulation to implementation. I utilized mixed qualitative and quantitative methods to measure the impact of these reforms on gender equity. Market-oriented health policies tend to shift the costs of both biological and social reproduction from states and markets onto women and families—effects that are largely unanticipated in the policy-formulation stage. However, how these policies promote this shift and the extent to which they do so vary substantially according to the specific policy in question. Moreover, the same reform may have a dramatically different impact on different groups of women or men, dependent on race, class, or geographic location.

I hope that this book helps to illuminate for scholars, activists, and policy practitioners how seemingly neutral policies can have highly gendered and racialized consequences. I also hope that it provides some clues as to the political tools necessary to work toward a more equitable future.

While this book concentrates on the post–debt crisis period in Latin America, like many Latin American countries, I find myself greatly indebted today. This book entailed over fifteen months of initial research in Peru, followed by numerous follow-up trips. Many colleagues and friends in Peru were crucial in making this research fruitful. In particular, I thank Marcos Cueto, Ricardo Díaz, Ariel Frisancho, Narda Henríquez, Felipe Portocarrero, Cynthia Sanborn, and Victor Zamora for their ongoing support and assistance. For my major research stint in Peru, the Instituto de Estudios Peruanos (IEP) provided an intellectual home, with crucial library assistance at the IEP provided by Virginia García and Diana Balcazar. For their friendship and support while in Peru, I thank Cecilia Gianella, Farid Kahhat, Rocío Malpica, Caroline Mullen, and Eliana Villar.

This research depended upon the openness of policy makers, members of civil society, local community members, and health professionals in Peru who agreed to be interviewed. Those who wanted to be named are listed in the bibliography, and I thank all of those interviewed for generously sharing their time and thoughts. For help in facilitating my community studies, I thank Dr. Danilo Fernández and Antonio Moreno. I also thank my survey research assistants, Claudia Gianella, Rocío Malpica, and Madeleine Pariona Oncebay.

I am grateful to a number of institutions for their generous financial support. My major stint of fieldwork from January 1998 through April of 1999 was funded by grants from the Fulbright Foundation; from the Ford Foundation–funded exchange between the Red Para el Desarrollo de Ciencias Sociales en el Perú and the Duke/UNC Program in Latin American Studies; and from the Institute for the Study of World Politics. A Woodrow Wilson–Johnson and Johnson Dissertation Grant in Women’s Health funded my expenses for interviews with representatives of international institutions in Washington, D.C. I also benefitted from a Paul Hardin Dissertation Writing Fellowship from the Royster Society of Fellows at the University of North Carolina at Chapel Hill.

This project began while I was a graduate student at the University of North Carolina at Chapel Hill. For early advice and encouragement as well as ongoing support to this day, I thank especially Evelyne Huber and Jonathan Hartlyn. Others who provided early support include John D. Stephens, Catharine Newbury, and Carol Wise. For guidance in my survey analysis I am grateful to José Sandoval. Friends and colleagues who commented on early portions of what would eventually become this book include Merike Blofield, Jenni Brier, Ethel Brooks, Sarah Brooks, Anne Marie Choup, Anne Eckman, Maxine Eichner, Jessica Fields, Claudio Fuentes, Robin Greeley, Shuchi Kapila, Michelle Mouton, Waranee Pokapanichwong, and Carisa Showden.

The University of Wisconsin–Madison provided a stimulating and supportive environment for revising and completing the final book manuscript. I especially appreciate the generous colleagues at UW–Madison and elsewhere who read and commented on the final versions of this manuscript. Jane Collins, Joseph Harris, Yoshiko Herrera, and Rosalind Petchesky read the entire manuscript and provided detailed comments. Many others provided useful comments on one or more chapters or inspiring conversations, including Marcos Cueto, Wendy Chavkin, Paul Gootenberg, Alice Kang, Robert Kaufman, Florencia Mallon, Joan Nelson, Tricia Olsen, Joe Soss, Natasha Borges Sugiyama, Aili Tripp, and Kurt Weyland. Myra Marx Ferree helped me to get the framing right. Kerry Ratigan provided expert research assistance on the final manuscript.

Publication of early versions of some chapters allowed me to test out arguments made in this book. An early version of chapter 5 was published as “Global Processes, Local Consequences: Gender Equity and Health Sector Reform in Peru,” in Social Politics 13, no. 3 (Fall 2006). The story of family planning that appears in parts of chapters 3, 4, and 6 was published as “Hijacking Global Feminism: Feminists, the Catholic Church, and the Family Planning Debacle in Peru,” in Feminist Studies 32, no. 3 (Fall 2006). Some of the empirical material from chapter 4 appeared previously in “Piecemeal but Innovative: Health Sector Reform in Peru,” in Crucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America, edited by Robert R. Kaufman and Joan M. Nelson (Baltimore: Woodrow Wilson Center and Johns Hopkins University Press, 2004).

I am especially grateful to Sandy Thatcher of Penn State Press, who agreed to take on this project and has provided helpful suggestions throughout the process. I am also grateful to Lynne Haney and another anonymous reader who reviewed the manuscript and provided constructive and useful comments, resulting in a much stronger manuscript.

My mother and father, Marianne and William Ewig, have been sources of support throughout this long process. My son, Gabriel, has been the best distraction, reminding me each day of the many beautiful things the world has to offer (beyond writing books!). Most importantly, I thank my partner, Will Jones. In addition to the critical commentary he provided on multiple versions of this book manuscript, his dedication to sharing in the tasks of social reproduction in our household, his willingness to allow me to travel for research for long periods while he cared for our family and home, as well as his unflagging intellectual and emotional support have made this book possible.

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