Dr. Anna Lenore Skow Southam conducted extensive research and published widely in the area of reproductive health, infertility, and sterility, and performed some of the earliest clinical evaluations of a rapid immunological pregnancy test.

Little is known about her early life, or her decision to embark on a career in medicine. Born Anna Lenore Skow in 1915 and raised in Northern Idaho, she earned her bachelor of science degree from the University of Idaho in 1942. After she married Dr. Chester M. Southam, she and her husband ran a laboratory at Idaho's Moscow Hospital. She began graduate studies around this time and was accepted into the pre-medical program at the Columbia University College of Physicians and Surgeons in New York City, and earned her medical degree in 1947. Following a year-long internship at Bellevue Hospital, she took the position of assistant resident at the Sloane Hospital for Women from 1947 and 1953.

During her time at the Sloane Hospital, Dr. Southam began publishing the results of her early clinical research. This was focused on reproductive problems in women, particularly the endocrinological aspects of infertility. At the end of her residency in 1953, she became a research assistant in the Department of Obstetrics and Gynecology at Columbia, and accepted the position of assistant obstetrician and gynecologist at the Columbia-Presbyterian Medical Center. In 1959, Dr. Southam received her diplomate from the American Board of Obstetrics and Gynecology. She maintained a lengthy affiliation with Columbia University College of Physicians and Surgeons and Columbia-Presbyterian Hospital, eventually becoming associate professor of obstetrics and gynecology at Columbia University and an associate attending obstetrician and gynecologist at Columbia-Presbyterian Medical Center.

Dr. Southam recorded her research on fertility and sterility in dozens of articles and published regularly in the Sloane Hospital Bulletin. At the same time, she directed the Sloane Hospital Endocrine Clinic at Columbia-Presbyterian for many years, where she cared for women who had difficulty becoming pregnant. Southam worked on testing oral contraceptives as well as testing drugs for inducing ovulation. Notably, she performed the early clinical evaluation for a rapid immunological test for pregnancy. Accounts of her clinical work appeared in the American Journal Obstetrics and Gynecology, Fertility and Sterility, and the Journal of the American Medical Association.

Throughout her career, Dr. Southam volunteered for service on a number of professional committees, including Planned Parenthood, the Human Betterment Association, and the National Committee on Maternal Health. Continuing her public service until late in her career, she embarked on a six-week teaching tour that took her to Taiwan in the early 1960s, followed by a six-month tour of duty as a visiting professor at the All-India Institute for Medical Research. In these roles Dr. Southam worked under the auspices of the Ford Foundation's Population Office, for which she lectured widely and conducted research on population control. Although she retired from Columbia University and Columbia-Presbyterian in 1967, she continued her work for the Ford Foundation for several more years. Shortly after she ended her career in medicine, she wrote a note to the Alumni Office at the University of Idaho, providing a rare glimpse into her personal life. Noting that she enjoyed looking back over the past, Dr. Southam described herself at the age of 76 sitting in her apartment in Santa Monica, California, playing with her grandchildren and admiring the ocean at her front lawn. After savoring her well-deserved retirement, Dr. Anna Southam died in November 1994.

I am most grateful to the RAC as they awarded me a generous grant to investigate the newly acquired archives of the Ford Foundation with respect to their Population Program. During my archival research I investigated the following sources:

1. Oscar Harkavy’s office files preserved in 27 boxes

2. Ford Foundation unpublished reports, on paper and on microfilm

3. Ford Foundation “logs” (unsuccessful grant applications) and grants; amongst these, I processed all cases and projects advised by A. Southam and E. Witschi

My stay in September to October 2013 focussed specifically on the Ford Foundation’s efforts to play an important rôle in the field of population politics by building and maintaining a well supported and unique individual grant program from 1959 until the 1980s (cf. Hertz 1984). This program focussed on support for physiological investigations into the reproductive organs in order to find new ways and means for contraceptive measures. My own interest was specifically on the first half of this period, 1959 to the mid-1970s, as it was in this period that the FF Population Program had the largest international impact (on the early Ford Foundation, cf. Walsh and Atwater 2012; Berelson, Anderson, and Harkavy 1965). For the PhD thesis more particularly, I researched the FF’s investment in sterilization and laparoscopy.

I acknowledge most helpful support from Lucas Buresch for the Ford Foundation (hereafter FF) as well as Tom Rosenbaum and Beth Jaffe on Rockefeller Foundation related requests.

My research findings will help other historians to define what kind of rôle the FF played in fertility research in comparison to other global actors such as the Population Council and the Rockefeller Foundation, both run by the Rockefeller Family. In a more general perspective, this research helps to reveal the impact civilian and philantropic funding had on political decisions and medical and health innovations in the field of birth control in the 1950s-70s. Research at the RAC supports my argument that specifically after World War II, contraceptive and neo-eugenic innovations and efforts were highly influenced by private foundations in the field who in turn were influenced by individual physicians and scientists.

First, I will outline the theory or rationale of reproductive research presented by the FF for their new Population Program. This will allow to trace the theory on the basis of which the advisors acted and on the basis of which Oscar Harkavy, head of the Population Program, justified his decisions. Second, I will describe the work of two of these advisors, and finally three significant projects in some more detail.

A Program and its Faces: What Did “Reproductive Physiology” Mean for the FF and How Did It Connect to Birth Control?

Oscar Harkavy, an economist by training (Harkavy 1995), chaired the FF Population Program. Harkavy had a crucial role in shaping the profile of the FF’s policy and ideology concerning reproduction and its control by medical means – a policy I termed, in my grant application, “Physiology for Contraception”. Reproductive physiology was neither a clear term at the time nor an established research field with its institutions. The term and the questions it addressed were unsolved for a long period of time.

Reproductive physiology was investigated both in medicine and in biology. In medicine, the active specialties were mainly gynecology and urology, and the more laboratory-based sub-disciplines of histology and pathology. In biology, researchers came mostly from embryology, endocrinology and institutes of physiology that dealt mostly with cells, nerves, fluids and tissue. The main questions were how all the reproductive organs in women and men functioned at any given time and what their important elements were. While biologists worked on the smaller structures, gynecologists and urologists investigated mainly entire organs such as the tubes, the ovaries, or the sperm ducts in men.

The Ford Foundation became convinced, after a few investigations, that its funding rôle should be that of boosting research on reproductive physiology (whatever the term covered) in order to access new knowledge to create new contraceptives of all possible kinds. In short, research into physiology should lead to better population control.

When Oscar Harkavy started this Population Program, he depended heavily on experts from medicine and the biomedical sciences to get an overview of current research and to help define what the FF should be aiming to fund. In order to progress quickly, he invited some of the most noted fertility and contraception researchers of the United States to present opinion papers on their topics. Their 1959 workshop was an important step in formulating the Population Program.

On 9 June 1959, the FF convened a meeting of experts at the FF headquarters in New York Cityi. Invited to this seminal meeting were Willard Allen, Lewis L. Engel, Reuben G. Gustavsson, Allan T. Kenyon, C.N.H. Long, Warren O. Nelson, and Gregory Pincus. The most prominent participants were Engel from Harvard and Pincus from the Worcester Foundation who had both earlier attracted global attention to their research.

When considering the “state of the field”, members of the workshop agreed that “attempts to control conception by steroids” needed additional scientific research. Furthermore, the participants agreed that “the state of present knowledge” did not allow to define “chemical and physical processes” during the “reproductive cycle”: reproductive physiology was not clearly understood. This program was completely in tune with research dynamics in the gynecological infertility community described two paragraphs above. Concerning possible avenues for FF research, it was considered obvious that the “list of the 1958 grants of the Population Council’s Medical Division” supplied a reliable catalog of the best institutes carrying out research on human reproduction. Members of the FF meeting looked with great expectations towards the Population Council’s budget for 1959 (on the interdependence between Pop Council and FF, cf. The Population Council 1965, 1978; Huang 2011; most recently Abrahamson 2013).

With regard to the papers given, G. Pincus described his Puerto Rican field trials and he was eager to state that the Pill was safe to take: “many of the reported side effects […] diminish with time of use”. There were no “pathological side effects”. Under the heading of “Obstacles of Research”, it was discussed that the “principal obstacle is the lack of trained personnel”, especially MDs in comparison to PhDs. It was mainly PhDs in “biochemistry and physiology” who “carried” the field. The group identified a particular obstacle to clinical research by MDs in the liability of physicians for any “unforeseen adverse consequences” of experiments in the United States.

The meeting’s report underlined that organizations including the government spent $900,000 per year on medical research geared towards population control, of which $215,000 was provided by the Population Council. However, the FF deplored that the NIH, for instance, only supported research explicitly not related to birth control.

The FF program also identified “investigators overseas” as a possible group of grantees, especially with regard to the situation in the medical disciplines. In conclusion, the FF decided to support bio-medical efforts in a broad sense, be it MDs or PhDs, who worked on the physiology of reproduction, or more directly on birth control methods.

By 1969, the focus had shifted somewhat. Experience with working with MDs made the FF define the research to be carried out no longer as “physiology” but as “biology”. The “Foundation strategy” communicated in 1968ii declared: “We continue to assign highest priority to a greatly expanded worldwide program in reproductive biology directed toward the development of radically new concepts in fertility control. Our estimate of $ 150 million a year as an optimum level of support for biomedical research in fertility control is taken seriously by responsible government officials.” The FF would contribute to these efforts a budget of $ 8 million in fiscal year 1969.

The emphasis on physiology in 1959 and on biology in 1968 shows that there was a gradual shift in understanding reproductive research within the FF. It is likely that over the years, the more biologically oriented projects looked more promising. Margaret Rossiter’s research at the RAC in 2012 (Rossiter 2012) identified a similar change of mind in Warren Weaver, the Rockefeller Foundation’s program director responsible for biomedical sciences and one of the main actors in defining “physiology” for the twentieth century. During his lifetime, Weaver became more favourably inclined towards funding projects in the history of science. Likewise, Harkavy shifted from the term “reproductive physiology”, in the 1950s much more medical than biological in definition, to the term “reproductive biology”.

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Anna L. Southam and her Impact on the Ford Foundation’s Funding Patterns

Anna L. Southam (1915-1996) was the FF’s second medical/scientific advisor and supported some projects in her own sphere of interest just like Witschi did. She started this position in 1965 and in 1968, Southam broadened the scope of her work becoming responsible for projects in Asia, together with Lyle Saunders.xvii

It is noteworthy here that she is one of the few female fertility researchers, alongside Sophia Kleegman also based at New York and Elizabeth Palmer (wife of the eminent Raoul Palmer) in Paris, who were part of the international community of infertility experts in the 1960s.

Besides being a physician at the Columbia College of Physicians and Surgeons, she also worked as a medical advisor to the [Ford Foundation]. At Columbia, Southam was based in Howard C. Taylor’s (1900-1985) department who advised the Population Council in clinical matters. One could therefore say that the Columbia College of Physicians and Surgeons/ Department of Obstetrics and Gynecology advised the Rockefeller Foundation and the Ford Foundation. A detailed study of the intricate relations between Columbia and these two or more philanthropic organisations as well as their impact on population control programs is still missing.

Southam had made a name for herself, together with her Columbia colleague C. Lee Buxton (later head of department at Yale), as co-author of a 1958 book on infertility (Buxton and Southam 1958) in which both displayed their interest in a specific form of infertility investigation in women, namely culdoscopy. Culdoscopy is an endoscopic technique of viewing the contents of the abdomen and, more specifically, the internal genital organs such as the tubes and ovaries, through a rigid optic tube called the culdoscope. The culdoscope, an instrument which is no longer in use, was a rigid endoscope developed in the 1940s that was inserted through a small incision in the vagina next to the uterus. The physician inserted the culdoscope through the vagina; this vaginal endoscope thus served to look at the tubes and ovaries without surgically having to open the abdomen.

Despite being an alternative to open surgery, enthusiasm for this tool was minimal in the gynecological community interested in infertility: the cumbersome procedure demanded from the woman a so-called knee-chest-position i.e. being on all fours on the operating table. The technique was internationally known after its inventor Decker had described it in the widely read American Journal of Obstetrics and Gynecology (Decker and Cherry 1944). There were a few vocal proponents of the technique in New York where culdoscopy had been developed and at Hopkins (cf. TeLinde 1948; Decker 1952). Anna Southam believed it had a promising future.

It is in this perspective that one needs to see her and the FF’s support of a project of operative culdoscopy, culdoscopy used to sterilize women for population control. Starting in 1973, the FF poured hundreds of thousands of dollars into a project of “operative culdoscopy” for female sterilization as a contraceptive method at the University of the West Indies in collaboration with the State University of Floridaxviii. After one decade, both the head of the project and the FF had to acknowledge that they had failed to develop a viable technique of performing sterilization on large numbers of women. The FF also learned that the travel budget for sending staff from Jamaica to Florida had mainly been used for beach holidays.

More interesting than the description of a failed project and the money spent on dubious procedures, is the broader context in which Southam and the described technology operated. The year the project started, 1973, was a point in time when a very different technique of endoscopic surgery had already proven useful in sterilizing hundreds of women in a day, if needed and wanted, for the purpose of population control: laparoscopy.

Laparoscopy is a method in which a rigid endoscope is inserted through an incision below the navel. As an abdominal technique, it has the advantage that the abdominal organs are better visible. The woman can lie on her back rather than being on all fours. Laparoscopy in gynecology had been developed at the same time as culdoscopy, in the 1940s, yet until the late 1960s it had been used in Europe only (widely read books are Frangenheim 1972; Steptoe 1968). From 1967 onwards, the technique was used in the United States. It came with instruments to coagulate and thereby sterilize the tubes, and a handbook that showed how to do it (Steptoe 1968). The method revolutionized population control in developing countries, especially India (a history of the implementation of the technique in India is yet to be written but hints towards it can be found in Connelly 2008).

By 1973, a number of plastic and metal clips were available for tubal sterilization in case the surgeon wanted to avoid, or did not have available the necessary electrical current, to perform coagulation of the Fallopian tubes. This had proven effective in developing countries with poor operating conditions. By 1973, a professional organization called the American Association of Gynecological Laparoscopists (AAGLxix) had formed and hosted its second international meeting in the USA. Southam knew about all this, as did everybody else engaged in population control. Yet Southam chose, with the means at hand, to take a more political stand.

She chose to support research into an alternative technique, a technique that was not likely to be successful but one that she had helped to disseminate in the late 1950s. As a medical advisor to the FF, Southam supported a technique that was close to her heart: operative culdoscopy. It can be debated whether this was compliant with the FF’s declared policy of seeking objective external advice. What is more interesting to the history of population policy is that foundation money was used with the intention to change current medical practice and to make political claims, however unrealistic they may have been. Southam used the FF, an agent much more powerful than herself, to have her say in the discussion about mass-sterilizations.

Southam was not against mass-sterilizations, therefore she went with the general flow of gynecologists interested in contraception in the 1960s. Southam wanted to have her own technique, funded through her initiative, implemented by her and, we can suppose, eventually to be named after her if successful. The University of the West Indies served as a risk-free test-area for that technique, and if it failed, this could always have been attributed to untrained personnel. Southam’s favoured technique would have a chance to prove itself.

The case of culdoscopy in the West Indies shows two points very clearly: First, the institutional power the FF’s advisors had to to effectively approve or reject projects. Second, the fact that a woman in the generally male business of population control did not act in any way different from her male colleagues: she did not put forward any argument concerning the userfriendliness of her technique for women, she did not criticize mass-sterilizations and she did not question the fact that few women were trained in the program supported by her. Southam was not a feminist, and in her pursuit of a technique of her own she mimicked her male counterparts. This finding counters a general trend in the historiography of women in science to describe women as victims of male agency. Southam was not a victim, she was as powerful as her male counterparts. However, she was not interested in strengthening the voice of other women, or of the women subjected to her culdoscopic operations.

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