Pop, Cristina A. 2022. The Cancer Within: Reproduction, Cultural Transformation, and Health Care in Romania. New Brunswick, NJ: Rutgers University Press, ISBN: 978-1978829589

Cristina A. Pop’s 2022 monograph, The Cancer Within: Reproduction, Cultural Transformation and Health Care in Romania, offers a contemporary anthropological investigation into sexual and reproductive health care in postcommunist Romania, where prevalence of cervical cancer in the population is disproportionately high compared to their European counterparts. At first glance, The Cancer Within merely offers an anthropological analysis which deepens historical background and cultural nuance to better interpret the epidemiological rates and trends of cervical cancer in Romania. Yet more than simply adding context to incidence, the findings expose and explore Romanian citizens’ present day reckoning with the exigent legacy of communism’s brutal pronatalist and patriarchal sexual and reproductive health care regimes (1946-1989). Using history as the point of entry, Pop situates Romanian cervical cancer incidence and its prevention efforts (i.e., human papilloma virus [HPV] vaccination) as an ultimate manifestation of the cobbled transition to a postcommunist medical system that “aligns the state and the market, public and private health care providers, policy makers, and ordinary women” (7). The central argument of the book posits that contemporary resistance to cervical cancer prevention efforts are less to do with cancer itself and are more a product of “systemic contingencies” of changing political, structural, and moral forces on the historical and personal unfolding of Romanian’s reproductive lives.

Structurally, the book is divided into two parts, each punctuated by an interlude that summarizes government-led or NGO-driven developments (e.g., free mobile clinics) toward – albeit ineffectual – cervical cancer prophylaxis

Part one, “Women’s, Men’s and God’s Will,” centers Pop’s interlocuters (ordinary Romanians who are subject to preventive care campaigns) and the everyday moralities that govern their sexual and reproductive lives. Chapter 1, “We All Descend from Communism,” considers the historical trauma arising from forces that shaped Romanian women’s reproductive health under communist rule. Using “reproductive life history,” Pop excavates invasive pronatalist policies that repressed female sexuality (e.g., banning contraceptives, prohibiting abortion, imposing taxes on childless couples) but aggressively endorsed motherhood (e.g., subjecting women to mandatory pelvic exams, bodily surveillance during pregnancy, termination of midwifery in favor of state-sanctioned male OB-GYN doctors). Alongside the legacy of repressive regimes, Chapter 1 also sheds light on the informal tactics that women have always used (e.g., “back-alley” abortions”) to manage fertility. Chapter 2, “Reproductive Invisibility,” locates men as subjects of changing approaches to reproduction. By cross-referencing men’s and women’s private accounts of men’s roles with state propaganda about gender expectations, Chapter 2 suggests that the cervical cancer crisis is enabled in part by extant patriarchal relations. Contemporary HPV prevention campaigns “invisibilize” the biological and moral role of men in HPV transmission, thereby exculpating male sexuality from the physical and social consequences born to women. Chapter 3, “Beyond Rationalities,” takes up God’s will as an actor within the sexual and reproductive lives of women. In the absence of support from the state or their male partners, women mobilize “lived religion” (McGuire, 2008) – everyday adaptations of institutional religious beliefs and practices – as a decision-making resource to generate nonsecular rationales for sexual and reproductive health management, including abortion as contraception and refusal of prophylactic biomedical care.

Part two, “Medicine and Its Moralities,” scales up to spotlight the structural forces that shape the provision of services in the context of “postcommunist restructuring of state medicine, privatization of medical care, and the (re)emergence of inequitable forms of care” (17). Chapter 4, “Dismantling Medicine,” investigates the ways different generations of Romanian women experience and conceptualize strategic changes of state-subsidized medicine toward new regimes of private care; and how their informal tactics to access – or reject – sexual and reproductive care simultaneously change considering these transformations. Chapter 4 works to make sense of why women often deny free HPV prevention, and why such refusal is a consummate projection of Romanians’ rebuff of the former “communist state’s centralized paternalism” and the current “postcommunist state’s centrifugal fragility” (109). Chapter 5, “The Other Hospital,” exposes Romanians’ ambivalence and anxieties about unprecedented proliferation of health care options. In learning to navigate novel medical systems, Romanians both argue against and fantasize about the proverbial “other hospital,” whether the unfamiliar-yet-excellent private clinic, or the legible-yet-substandard public one. Finally, Chapter 6, “Locating Corruption,” submits that pervasive preoccupation with the moralities of sexual purity via HPV vaccination are in fact a function of the anxieties produced by the transition from state to private medicine. HPV vaccination programs, which promise to “inoculate” the individual body against the impurity of disease, provide Romanians with a platform to express their conflicting views about “corruption” in the social body. As such, mothers who divest from preventive vaccination on behalf of their daughters may do so to resist corruption writ large. To close, Pop offers a conclusive chapter, “The Space Between Informed and Non-Informed Refusal,” which summarizes how Romanians conscript agency by staking claim to the space between informed and non-informed refusal; that dismissing preventive care is less about lack of knowledge or awareness of cancer risk and more about privileging a set of culturally and historically situated rationalities about their sexual reproductive lives. In the end, in the wake of patriarchal pronatalism and amid newfound democracy, for Romanian women it is ultimately “control over one’s body that outweighs health” (91).

The Cancer Within is published as a volume within Rutgers University Press’ series titled “Medical Anthropology: Health Inequality and Social Justice” (ed. Lenore Manderson). To that end, the monograph aims to – and succeeds in demonstrating – the effective use of ethnography to interrogate a medical issue that lays bare the sociocultural mechanisms at play in a particular place and time, which produce and sustain inequality or injustice. Pop achieves this aim through her well-articulated use of canonical sociocultural theory. To diagnose the etiology of traumatic state intervention into women’s reproductive lives and its resultant medical mistrust and divestment, Pop deftly assesses cancer’s conditions of possibility (Kant [1781] 2018), communism’s hauntology (Derrida 1994] 2006), and genealogical history of emerging forms of medical care (Foucault 1977). The ethnography is also made effectual by its robust plurality of evidence, including Pop’s own first-person accounts. As a girl coming of age during communism and a woman receiving sexual and reproductive care after its fall, Pop turns the autoethnographic gaze upon herself to impart her own experiences of menstruation, pregnancy, and childbirth in Romania. Pop’s personal voice adds a compelling layer of vulnerability (Behar 1996) as well as validity and confirmability to her study. The applied contributions of the book advise policy experts to strategize for a healthier future by unequivocally confronting the reproductive vulnerabilities of the past, for both women and men. To advance this application, a greater ethnographic understanding of Romanian policy makers, health care providers, public health specialists, hospital administrators, and politicians – whose perspectives are largely absent from the book – would be needed. Future investigation into public and private actors who deliver sexual and reproductive care would enhance the actionable insights derived from citizen/patient interlocuters in The Cancer Within.

The central thrust of the theoretical, ethnographic, and practical arguments of The Cancer Within culminate in an urgent call to holistically address Romania’s cervical cancer crisis: the country’s cancerous present cannot be understood – nor improved upon for the future – without confronting the embodied legacy of its communist past.

Works Cited:

Behar, Ruth. 1996. The Vulnerable Observer. Anthropology that Breaks Your Heart. Boston: Beacon Press.

Foucault, Michel. 1977. Discipline and Punish: The Birth of the Prison. New York: Vintage Books.

Derrida, Jacques. (1994). 2006. Specters of Marx: The State of the Debt, the Work of Mourning, and the New International. New York: Routledge.

Kant, Immanuel. (1781). 2018. The Critique of Pure Reason. Translated by J.M.D. Meiklejohn. Overland Park, KS: Digireads.com Publishing.

McGuire, Meredith. (2008). Lived Religion: Faith and Practice in Everyday Life. Oxford: Oxford University Press.

Nina J. Francis-Levin (she/her) is a National Institutes of Health T32 Postdoctoral Fellow in the Division of Metabolism, Endocrinology, and Diabetes at the University of Michigan. Her interdisciplinary research centers on issues at the crux of oncology and reproductive medicine – known together as oncofertility. Francis-Levin’s most recent ethnographic project examines the ways in which LGBTQ+ adolescents and young adults with cancer re-negotiate body image, gender identity, sexuality, and notions of kinship in light of a cancer diagnosis.

© 2023 Nina J. Francis-Levin

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