How would you feel if you had just given birth and people kept calling you the wrong name, or got wrong central facts about your identity? Perinatal care covers pregnancy, labour, birth and the period immediately after birth. These are often times when we are at our most vulnerable.
Authors
Fiona Woollard
Professor of Philosophy, University of Southampton
Jules Holroyd
Senior Lecturer in Philosophy, University of Sheffield
Matthew Cull
Interdisciplinary Research Fellow in Biomedicine, Self and Society, The University of Edinburgh
A recent report from the UK's parliament into birth trauma has put perinatal care into the spotlight, but the mainstream discussion has largely ignored the experiences of LGBTQ+ families.
One key problem for LGBTQ+ families is that the language used to give information about pregnancy and birth often assumes that only women give birth. Trans men, genderqueer and other non-binary people are often misgendered, and so are disrespected and marginalised. Using inclusive language in information about perinatal care is a key part of improving their experiences.
A study from the LGBTQ Foundation on the experiences of trans and non-binary people accessing perinatal care found that 28% of were not treated with dignity and respect during labour and birth. One interviewee said:
I felt there was no framework of language that was inclusive of people who do not identify within the gender binary so it was consistently a triggering experience
Our research shows that the best approach is to have a range of different strategies that can be used and carefully choosing the right one for each situation. Most common worries about inclusive language can be solved by adopting this approach.
Approaches to inclusive language
It isn't just medical professionals who should make an effort to use inclusive language - we can all contribute to better experience for LGBTQ+ families. Many people want a simple recipe for inclusive language: a set of instructions they can follow in every case, for example, "replace all gendered terms with gender neutral terms". But a simple recipe like this doesn't always give the best results.
When trying to make language inclusive, it is important to pay attention to the specific situation you are in. It matters whether you are writing on social media, making a website, producing leaflets or writing a policy, or writing to a colleague or friend.
Do you need to keep your message under a set number of characters? Can you include links to further information? Who will see your message? How formal does it need to be?
Often, the easiest way to make language inclusive is to use the second person:
All pregnant women in England are offered a blood test to find out if they carry a gene for thalassaemia.
Becomes:
If you are pregnant you will be offered a blood test to find out if you carry a gene for thalassaemia.
This avoids any issues of having to specify gender. It is also warmer and more welcoming: it addresses the patient directly, talking to them rather than about them.
Another simple option is to replace gendered terms with gender neutral terms:
All women who give birth should be offered a postnatal check at 6 weeks.
Becomes:
Everyone who gives birth should be offered a postnatal check at 6 weeks.
In some cases, the gender neutral option may be confusing. Suppose we say:
Everyone with a cervix between the ages of 25 and 64 should go for regular cervical screening.
This is not very helpful for people who do not know whether they have a cervix. In this case, we can use a gender additive strategy:
Everyone with a cervix (most women and trans men, and many genderqueer and other non-binary people) between the ages of 25 and 64 should go for regular cervical screening.
We could also add:
Talk to your GP if you are unsure whether this applies to you.
We can also consider targeted communication, for example, producing a leaflet addressed to women as well as one addressed to trans men, and many genderqueer and other non-binary people.
More than words: inadequate research
In some cases, trying to make language inclusive shows up bigger issues.
Consider the Australian Government Department of Health's statement about the COVID-19 risks during pregnancy, discussed here:
Pregnant women with COVID-19 have a higher risk of certain complications compared to non-pregnant women with COVID-19 of the same age…
The message ignores the existence of pregnant people who are not women (pregnant trans men and non-binary people). It is not clear whether the advice applies to them. The Department of Health later changed the wording to a gender-neutral message:
Pregnant people with COVID-19 have a higher risk of certain complications compared to non-pregnant people with COVID-19 of the same age…
This is more inclusive. But it doesn't mean the same thing as the first statement. We are now comparing pregnant people to non-pregnant people rather than non-pregnant women. It's unclear whether the original data includes all pregnant people, or just cisgender women. Often research isn't carried out or reported in ways sensitive to the gender diversity of pregnant people.
This doesn't mean that we should give up on gender inclusive language. Instead, we have to make sure we use it accurately. We also need to communicate clearly where there are data gaps because of a lack of research on trans pregnancy and birth.
Some people are worried about attempts to make language inclusive. They say that inclusive language may be:
- Difficult to understand especially for members of vulnerable groups
- Dehumanising, reducing women to their body parts
- Inaccurate or imprecise
If we are careful to use the right strategy for the situation we are in, then we can avoid many of the common concerns about inclusive language. None of the examples described above are difficult to understand or dehumanising.
Inaccuracies can arise if care is not taken, but this applies to the use of "pregnant women", a term which excludes trans and non-binary people, also. Attention to inclusive language can show where more precision in research and information is needed.
Fiona Woollard was part of the Better Understanding the Metaphysics of Pregnancy (BUMP) project funded by European Research Council. She has also received funding from the Arts and Humanities Research Council; the Economic and Social Research Council (through the University of Southampton ESRC Impact Acceleration Account); the Southampton Ethics Centre and the Mind Association. She is an ordinary member of the Labour Party as a private citizen.
Jules Holroyd and Matthew Cull do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
