The Cancer Within: Reproduction, Cultural Transformation, and Health Care in Romania By Cristina A. Pop, New Brunswick, NJ: Rutgers University Press. 2022. pp. 228.
University of Manchester
The Cancer Within is a powerful book that illustrates how historical, political, and social ramifications inform experiences of cancer. Focused on cervical cancer in Romania, Christina A. Pop’s work starts from epidemiological evidence: Romania has the highest incidence and mortality rates for cervical cancer in Europe, a trend in opposition to neighboring countries, which are experiencing sharp reductions of the incidence and mortality of cervical cancer. The central question “How can we account for Romanian women suffering and dying from a mostly preventable condition in such higher numbers?” (4) drives The Cancer Within. The answer lies in a compelling ethnographic account that elucidates the complexity and ambiguity of the country’s charged political past and its difficult transition to a market economy. In the book, Pop explores how the intersection between the pro-natalist policies of the communist era, the dismantling of the public healthcare system, and social and religious ideas about reproduction and gender roles shape the risk of cervical cancer, and she investigates the individual and institutional responses that have been put into place. An important aspect of Pop’s work is that the social and political context of cervical cancer occupies a central position in the book, sometimes becoming even more relevant than the cancer itself.
Pop’s innovative way of presenting cervical cancer is based on the understanding of the cervix as a liminal reproductive organ, making cervical cancer itself a liminal cancer, situated—more than other types of cancer—at the interface of illness, individual reproductive choices, and public policy. This perspective of cervical cancer as an interface of multiple difficulties allows Pop to complexify the statistical data from which the analysis starts. Pop explicitly states that cervical cancer in Romania cannot be fully understood using only epidemiological concepts as an endemic or epidemic phenomenon. She instead uses Merril Singer’s concept of the syndemic, which “integrates social, political, and economic forces into an ‘explanatory model’ … that challenges biomedical and public health approaches to disease as a discrete biological entity” (8).
Pop further revises the concept of syndemic to argue that, in the case of cervical cancer, the forces influencing Romanian women’s experiences are both systemic and contingent. They “make visible the unpredictability and ordinariness of everyday life” (9) and, accordingly, we see the ordinary and unpredictable lives of Romanian women unfolding across the book’s six chapters (as well as introduction, conclusion, and two interludes). The first two chapters consider, on the one hand, the aggressive pro-natal policies introduced by dictator Nicolae Ceaușescu between 1967 and 1989 and, on the other hand, how the patriarchal organization of society has made men invisible in reproductive processes, an invisibilization that has increased the burden on women. In contrast, the third chapter explores how Romanian women use religion and what Pop defines as “local moralities” to navigate the difficult context within which their reproductive choices take place. Building on this, the fourth chapter examines how everyday interpretations of religious beliefs can offer women the moral flexibility necessary to navigate healthcare and reproductive landscapes, providing some support to women faced with difficult choices, despite conflicting with established religious views. The last two chapters shift the focus from the intimate and individual sphere to the social domain, analyzing how changes that have impacted the healthcare system in the transition from a socialist economy to a free-market economy and an increasing privatization have altered women’s experiences. In this context, giving gifts or money to medical personnel, although mostly understood as a form of corruption, is rooted in pre-communist Romanian traditions, and it represents for the women interviewed a resource for navigating a difficult and often unsympathetic healthcare system.
The ethnographic data used derive from long-term fieldwork and are enriched by analyses of historical materials, promotional materials produced as part of medical campaigns for HPV vaccination, and documentaries and films. One aspect that illuminates the book and its choice to present cancer through the lens of the reproductive biographies of women is the strong presence of the interviewees in the book. Their lives, past experiences, dreams, and family relationships inform the different chapters as much as—and perhaps more—than their experiences of illness.
The Cancer Within also exemplifies the opportunities offered by conducting research in one’s own country and on topics in which the researcher is directly involved. Pop intertwines the stories of her interviewees with her experience as a Romanian woman who found herself navigating the same healthcare system and reproductive policies. In this sense, the book challenges the idea of the ethnographer as an observer of distant realities, and it shows how deep and enlightening it can be to bring an ethnographic gaze to one’s context of origin.
Pop presents the experience of an Eastern European country that, more than the other countries of the former Soviet bloc, has implemented aggressively pro-natalist and patriarchal policies, but the book is not simply an exploration of the past. Pop also illuminates the contradictions of the present. Granted entry into the European Union in 2007, Romania has experienced massive privatization in several key sectors, including across its healthcare system. This transition has ramifications beyond Romania and other ex-Soviet countries: more broadly, European health systems are increasingly permeated by market elements. Pop’s analysis of the Romanian case shows an acceleration of this phenomenon, as she explores how neoliberal approaches are absorbed and reinterprets preexisting habits and customs, such as the religious beliefs and gift-giving practices that are used as tactics to navigate contemporary difficulties.
This book addresses key themes relevant to not only medical anthropology but also to the anthropology of gender and the history of the countries of the former Soviet bloc. Although experiences linked to cervical cancer diagnoses and treatments are less explored in the book, the text still represents a useful reading for anthropologists and social scientists (including graduate students and PhD candidates) interested in how cultural and political contexts can define cancer. This is an important contribution that makes it possible to better understand not only Romania and its history but also the history of Europe, which is too often analyzed as a homogeneous and univocal whole.