This article brings into relief the gendered tensions and contradictions that have resulted from Peru's neoliberal health sector reforms. Previous studies were clear that economic adjustment had a negative impact on women and gender relations. I show more nuanced effects of neoliberal policies when applied to health sector reforms. To evaluate these policies, I utilize the distinction between redistribution and recognition. I depart from the supposition that policies serve either redistributive or recognition ends and show that single policies can have both types of effects. I conclude that policies based on neoliberal principles in some instances have a negative impact on women, in other instances reify existing unequal gender relations, while in still others open up spaces for positive change. On the whole, however, neoliberal health reforms have had a negative impact on gender equity.