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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  



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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 



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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 



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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 



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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 

 


