Jana Cunningham:

Hello, thank you for joining me on Humanities Radio. I'm Jana Cunningham with the University of Utah College of Humanities and today in celebration of Women's History Month, I'm speaking with Robin Jensen, professor of communication about her research on Dr. Sophia Kleegman. Dr. Kleegman was the first woman appointed to the New York University College of Medicine faculty of obstetrics and gynecology in 1929 and was a pioneer in fertility medicine. Professor Jensen is here to discuss more about Dr. Kleegman and the history of reproductive health.

Jana Cunningham:

Before we start discussing Dr. Kleegman and your latest project, let's back up a little bit to the very beginning of reproductive health, which as I understand, has some deep roots in experimental and unethical treatment of enslaved women. Can you talk a little bit more about those early years and how reproductive medicine started?

Robin Jensen:

Yes. The beginning of my interest in Dr. Sophia Kleegman was that I have been long studying the science and medicine behind fertility medicine and I traced that ultimately far back. But one of the earlier pieces of history there that's pertinent to this story is that in the mid 1800s, before the Civil War and heading into the Civil War, we had a doctor named – and many of you may have read about him recently – Dr. J Marion Sims. You probably read about him because there have been a number of statues that have recently been taken down. I think at least two in the South, of Dr. Sims, because he's long been known as "the father of gynecology," but it turns out that a lot of his medicine and his experimental studies were done on African-American women who were slaves in his care.

Robin Jensen:

He did multiple experimental surgeries on slave women under his care without anesthesia to solve one very specific health problem at the time, that was quite common, it's a fistula which often happens when there's prolonged labor that a woman has. And then it causes her to have, essentially different parts of her reproductive system are opened up and it causes leaking and horrible pain and bacteria growth. This was very common among slave women at the time who were giving birth under horrific circumstances. They didn't have access to medical care. If the labor was prolonged, usually there was nothing that people could do and so this was a big reason that people developed fistula at the time.

Robin Jensen:

He wanted to try and figure out how to close up the fistula, and what he did was he just did over 40 surgeries, un-anesthetized with three slave women in particular. And he just kept doing these surgeries until eventually he did manage to close up the openings and the fissures, but under horrible pain. And of course, the women didn't have any kind of agency in terms of consenting to the treatment and he really didn't attend to their pain in a way that you might find appropriate for that kind of situation. But what ended up happening is because he did develop these kinds of treatments, he published his experimental data in renowned scientific journals and he developed a name for himself. He made a name for himself. He made a name for US medicine and gynecology via his work in this area.

Robin Jensen:

Then he went on to test some of these procedures and others on immigrant women, largely from Ireland, who didn't have the funds to pay for treatment. So again, he did these kinds of treatments, no anesthesia, horribly painful and then kept publishing about this and other reproductive health experiments. Ultimately all of this translated to wealthy upper-class white women, but it was grounded in these kinds of awful circumstances. And this trajectory of medicine, where you objectify the person that you are trying to treat, and treat them as someone that you're not as concerned about their wellbeing, you're more concerned about solving a medical problem or finding out scientific information, is something that was projected into the 20th century with reproductive medicine, gynecology,and ultimately fertility studies.

Robin Jensen:

So, I was interested in how did this get thwarted? Because we know we're in a much better place now. It's certainly not perfect, but gynecology and fertility science is certainly in a better place in terms of how it treats its patients than it was back then.

Jana Cunningham:

So, how and when does Dr. Kleegman come into this picture?

Robin Jensen:

Her story is really interesting in that she immigrated from Russia, well actually her family immigrated from Russia and then she was born in the United States, but all of her older siblings came over from Russia. Her older sister, Anna, also became a doctor and two of her other sisters worked in factories to help fund their medical education. They had four brothers who died in Russia from various bad circumstances, medical circumstances, so they were all inspired to develop this medical education for members of their own family. So they came over, two sisters worked, two sisters went to medical school. It's a really interesting story that I could go more into, but I'll try and stay on task here.

Robin Jensen:

Sophia ultimately went to medical school at a point when more women were becoming gynecologists and gynecological surgeons, but there wasn't really a huge field of fertility studies. And when she was doing her residency in both Chicago and in the East Coast, she noticed that lots of the treatments for women who were having trouble with fertility or other reproductive problems, was that they had some kind of surgery and they just removed a bunch of stuff. And that's of course, really colloquial, that there were very specific things that were removed, ovary cysts, lesions, lots of other things. And some of those things that was appropriate, but more often than not, especially in the cases of infertility, they had not tested the male partner to see if they had any role in the reproductive problems happening.

Robin Jensen:

So you had a lot of women who were having these really invasive surgeries, and it turned out that their male partners were the ones who had the reproductive problem. So, it really didn't matter how much surgery they did, how effective they were, that wasn't even the problem in the first place. She would leave the surgical room in the evening, and there'd be these huge bins of reproductive parts that had been removed from women. And there was just this sense that women were, rather than risk making men feel bad or inadequate for testing them for these kinds of things, it's better they felt, to just open up a woman and take out something that might be problematic, or maybe it wasn't problematic, but we'll give it a go.

Robin Jensen:

So you have this really horrible pattern of medical intervention that didn't really do anything. So she dedicated herself to developing essentially what she calls a conservative surgery practice for infertility medicine. Where surgery isn't necessarily the first thing that you turn to and you want to do a whole bunch of testing on all partners involved before you cut someone open and deem to try and do something that's really invasive.

Jana Cunningham:

Did you get a sense of what the medical community's reaction to this was? Because if she was the first person that suggested, "Well, maybe this problem has something to do with the male partner," what was the medical community's reaction? Because that kind of seems like a bold thing to come up with at the time.

Robin Jensen:

Right. I think one of the things that makes her so interesting is that she really managed to blend in with practitioners who were doing something very different than what she was proposing, and had a great skill for not forcing people to face things that they didn't want to face. She really managed to be someone that was upheld by the community, even as she was telling them, "You've been doing this wrong and it's horrific," she didn't say it in that way. She really became, for me, a great model of communication in that, whether she was writing scientific articles or she was speaking with her professional organization and colleagues, or she was speaking with the public, because she also wrote a lot of magazine articles and was kind of a public doctor.

Robin Jensen:

She really had a talent for saying, "Look, this is how we've been doing things and I think we can make that better. And actually this is pretty wrong," but somehow she managed to communicate that message without turning people off and without making them feel like they needed to save face. That's part of the reason that she was able to change the practice because she didn't just come in and say, "This is awful. You're doing it wrong. We need to start something entirely new." She really worked to create a bridge from what people had been doing to where they could go.

Robin Jensen:

And she built upon... There's a long tradition in US medicine specifically, of women doctors who argued in favor of conservative surgery in particular. Sometimes they did that for really what we would think of as maybe misogynistic or maternalistic reasons. So Elizabeth Blackwell, she was the first woman in the US to get a medical degree and she really was able to establish herself as what some have called, and even she called, a lady doctor in that she said, "Look, I'm a really great doctor and other women need to be doctors because we have a better sensibility about how to be sensitive to patients because we are women."

Robin Jensen:

She really grounded her credibility in the sense that she had a different sensibility as a woman, and therefore that's why it was important for her to be a doctor. She said, "We don't want to go in and necessarily carve people up if we don't have to." But her reasoning the whole time was very gendered in that she said, "Women are different than men. And also women's bodies, you have to be really sensitive with their bodies because they're more fragile, especially if they're white women," so there was really a racist kind of element to it.

Robin Jensen:

So Kleegman comes out of that trajectory, but she doesn't employ the gendered stereotypes, and she doesn't employ the racist stereotypes, and opens things up for a more thoughtful surgical intervention. She wasn't against surgeries in the way that Blackwell was. She said, "Sometimes it's justified. If you have something, let's say you have a diseased ovary or something like that, then the only way to take care of it is to do a surgical intervention." If you have a partner where they don't have any sperm and you're operating on the wife, you're never going to solve this problem. She really had a pretty... She said, "Look, there's a problem and no one's addressing it. Let's move forward with this." But she did it in a way that brought people together rather than made them fracture into silos.

Jana Cunningham:

So, Dr. Kleegman, we talked about, it was pretty controversial for her to come up with this idea that infertility may be on the male side, but she also had a number of other controversial views for the time. Can you talk more about those views and how they contributed to this patient centric, holistic approach?

Robin Jensen:

Yes. She was very woman centered, I guess, is what you might say, as was her sister Anna, who was also a doctor and also interested in women and reproductive health, so they were kind of an interesting team. But when she came over from Russia, she was very supportive of movements, such as the contraceptive movement. She supported ultimately abortion, which at the time was really controversial, remains controversial. She was talented, as I said, at bringing people together, even as she presented them with ideas that many of them inherently disagreed with. And she always did this from the belief that individual people, be they women or men, should have the agency and the ability to make their own choices.

Robin Jensen:

She wasn't arguing about the inherent ethicalness or morality of certain things. She was saying, "Look, people need to make their decisions and we need to give women the decisions to build their families or not, as they see fit. And if we don't do that, we're just going to have many more problems." So the infertility piece fit along with the sense that women should have the contraception they need, if they want it. If they desire to have any kind of intervention, including an abortion, she felt like they should have the autonomy to do that.

Robin Jensen:

And then all of the advocacy for infertility was to say, "Look, in the same way that I'm fighting for people to start families if they want them, we should be supportive of people if they're on the other side of things and they want to limit their family, or they don't want to have a family." She really spanned all of those areas and every single one of them was controversial in a different way. She was able to use her kind of deliberative sensibility to manage that and bring people together to solve problems, even when they disagreed.

Jana Cunningham:

Another controversial idea she had that I wanted to talk about briefly was, she had advocated and implemented sex education into the curriculum at New York University Medical Center where she was on faculty. And that, from what I understand, was the first time that sex education was even introduced into any sort of curriculum. How did that change the course of treatment for women and couples?

Robin Jensen:

Yes, it definitely did. And it's still, if you go on to her alumni page for her medical school and where she was an instructor, they're still talking about how she was the one who instituted sex education for medical students, which today doesn't sound so wild, but back then was considered pretty daring. And part of that came with the idea, she was one of the early practitioners of believing that there was a psychosocial element to issues of contraception. She has all these stories about people who come into her care and say, "Look, we're having trouble, it looks like we're in fertile," and it turns out they thought they were having sex and they really weren't, or just basic things where you have people not having the sex education they need.

Robin Jensen:

And then of course that also happens for medical students like it happens with anyone else, so her argument was we have to talk about basic sex education, even though it would be shocking to some folks that people might not have that, but a lot of people didn't and still don't. So we need to talk about basic sex education, and also what might be called medical couples therapy or something like that. Or just medical information where you're saying, "This is the basics of what sex is and how contraception happens, and how conception happens," so that when people are trying to make decisions about families or about not having families or whatever it may be, they're actually working with information that is accurate.

Robin Jensen:

Also there is an element, there was research that was starting to come out at the time. Some of it overlapped with some Freudian psychoanalysis stuff, which that was not entirely factual there. But what came out of that movement was the idea that there is a psychological element in some cases to certain aspects of reproduction and you want to look at every possibility so that you're not saying, "Okay well, it looks like you're not actually having sex, and that might be why you are having trouble with infertility," as opposed to, "Let's have a surgery and open someone up and see what's wrong with their organs," when really that's something you would want to do long after you've come up with all of these kinds of basics.

Robin Jensen:

It all kind of fell together in terms of her saying, "Look, in order for women to have the ability to advocate for themselves and what they need, we need to make sure that our medical students know these things, so that they can pass them on and have an open conversation." Because when we're talking in terms of not straightforward language and we're using hyperbole about sex, and we're not being straightforward even in a medical consultation, communication is really at the heart of making sure that that everything's going okay, or identifying a problem. So that element of the medical education became central for her, and then that proliferated in other medical schools after that.

Jana Cunningham:

Because I mean, it seems like something that would be completely common sense in medical school. I mean the very basics, and I guess in the twenties or the thirties, when Dr. Kleegman was on faculty, it was kind of a new concept, interestingly enough.

Robin Jensen:

Right. And in the US, medical education even is a relatively new idea. I mean, we're a young nation in the first place, but it was only at the end of the 1800s and early 1900s when we started to institutionalize education, medical education and what that meant. Up until that point, it was a little like, "Well, I followed along another doctor and saw what they did and then I started doing it too, and I became a doctor." Really in the 1930s, '40s, '50s, we were still establishing what it meant to be a doctor, what your credentials were, what you needed to learn before that could happen. She stepped in and said, "Hey, let's make sure we've got the basics of sex education on the table here before moving forward."

Jana Cunningham:

Before we end, let's talk a little bit about your project funded by the National Endowment for the Humanities. You're focusing on Dr. Kleegman, so can you tell us a little bit about what you're doing for this project?

Robin Jensen:

Yes. This is a project where I started out really looking at the history of infertility and fertility medicine, and noticing that there were some central figures in that history that we don't know much about. And Kleegman was one of those who really rose to the top for me, in that she played a major role in changing fertility medicine. Of course it's still not perfect, but she was a pivotal role in saying, "Look, we're doing things that really make no sense. Let's change course and make sure we're solving the problems that we want to be solving." I went to Harvard University and they have the Schlesinger Library there and they have her papers and it turns out that there actually isn't that much there on Kleegman because her family threw out a lot of her papers when they were going through her office after she passed away.

Jana Cunningham:

Oh no.

Robin Jensen:

So part of this is, to all of you out there who are taking care of papers as a family, maybe hold on to them to make sure that they're not something that others could use in terms of research or things like that. Anyway, her families threw out a lot of her papers, but there was a lot there and Dr. Kleegman did publish a lot. She was engaged in a lot of advocacy efforts and she wrote letters upon letters and correspondence upon correspondence, so there is sort of a rhetorical path or traces of her rhetorical history that exists. And I just thought, let's figure out how she intervened in fertility science to make it into a more humane, ethical medical trajectory. And certainly it wasn't like she came in and said, "Done, done, done, everything changed. I am the savior." And that's part of why she was successful. It's also part of why we don't know much about her.

Robin Jensen:

There just really isn't a lot of information on her because she played within the dictates of what was expected as much as possible, and then changed things within those dictates. I'm really interested in figuring out all the different ways that she communicated to make that change without blowing the whole thing up. There's also this really interesting story about her family who came over as immigrants from Russia and her sister who was also a doctor. And a whole story about the sister who ended up being a specialist on women's menopause and making the argument that women after menopause could still be sexually active, and that that was really healthy for them. As you can imagine, that was also a pretty controversial line of study.

Robin Jensen:

The two of them together were just doing really interesting things and they made a real significant impact on how we look at reproductive health, fertility, things that are really prevalent right now. And certainly they're not perfect. We have a number of problems that still exist so I don't mean to make this into a story of the Kleegman sisters came in and they changed everything, and now we're better. No, we still have medical racism happening, we still have women who are being treated poorly. We still have really high mortality rates among African-American women and infant mortality rates, and all of these problems that we still need to deal with and continue to deal with. But I think we can take lessons from Kleegman, Sophia in particular, about how to make changes in ways that are productive and keep things moving forward so that people can receive better care and receive the kind of care that they need.

Jana Cunningham:

She seems like she has done so much for women in the medical community. I was so shocked that I couldn't find more information about her online. I thought I would find tons of stuff so I'm glad that you're doing this project. It's really interesting.

Robin Jensen:

Well, and I think from what I have found, she was also just a real character too. I think that's always interesting. Just in her life she had a ton of energy and she lived about 40 lives in the span of how most of us live one. So it makes for just really, really compelling historical research on a lot of levels. I think it's inspiring in so many ways that people can come from basically, she had nothing at the beginning of her life and she worked together with her family to really change a social structure that she wasn't even a part of when she started, and just unbelievable.

Robin Jensen:

At that time it was hard to even become a doctor as a woman, let alone an immigrant woman and all of these other kinds of things. So she really spoke a lot about class differences and how in fertility medicine, in particular, we tend to experiment on people who can't pay for it and then charge people who can, and that makes for really unfortunate reproductive outcomes. So she's a great person to look back to to understand how we might move forward.

Jana Cunningham:

That was Robin Jensen, professor of communication. For more information about the University of Utah College of Humanities, please visit humanities.utah.edu.