Pregnancy and baby content for LGBT+ parents - gender neutral language

[Chloephilippou]

What

Guidance surrounding NHS.UK pregnancy and baby content. This should include information about how user needs for LGBT+ parents are different and how to make sure all content is free from gendered language.

Why

• Mission team 2 have evidence from interviews with trans men who have given birth to their children that their needs for pregnancy and baby content are different from cis gendered users. We also know that their needs are not being met by pre-existing pregnancy and baby content. Recent publications from Brighton and Sussex University Hospitals (https://www.bsuh.nhs.uk/maternity/our-services/specialist-support/gender-inclusion/) have useful information about how to communicate with the trans community with regards to this content and we should align our content with theirs. Poster-Gender-Inclusive-Perinatal-Care.pdf

Anything else

https://www.bsuh.nhs.uk/maternity/wp-content/uploads/sites/7/2021/01/MP005-Perinatal-Care-for-Trans-and-Non-Binary-People.pdf

[sarawilcox]

Feedback received via the service manual inbox:

"I have recently noted the use of 'pregnant people' in NHS social media posts, and that it frequently causes a great deal of negative feedback. I must admit, having read comments on this and now being pregnant myself, that I understand how this language can be seen as exclusive rather than inclusive.

I wondered if you had/would consider the expansion of the terminology to say 'pregnant women, trans men and non binary individuals', which is inclusive of all relevant groups.

This principle could apply to any sex-specific situation (cervical screening, prostate checks, for example), to include everyone being targeted for the information. This is especially important when considering that research suggests high % people do not know that a specified body part mentioned in health literature relates to them.

I understand and appreciate the principle of gender neutral language but where something is sex-specific, it ought to be possible to be more explicit."

[Zeno001]

Sara said:

I wondered if you had/would consider the expansion of the terminology to say 'pregnant women, trans men and non binary individuals', which is inclusive of all relevant groups.

The one thing all pregnant people in any of these group have in common is that they are female, so it is already fully inclusive. Is there any evidence that anyone in those groups who was pregnant wouldn't know they were female? It's undoubtedly true that many will not necessarily understand the medical terms Sara mentions, but surely everyone knows what the two sexes are and their unique roles in reproduction?

[AJSMITH1512]

Sara as mentioned we have tried to avoid pregnant person and just use non gendered text (you) but I can see this being useful in specific areas where you want to make it clear it is for these groups.

The usage of the terms needs to be balanced and having a justification for the inclusion helps with dealing with enquiries.

[Chloephilippou]

We have slowly been making our pregnancy and baby content more inclusive and here are some tips:

• ‘pregnant people’ is inclusive and we do use the term ‘pregnant people’ on our page about mental health in pregnancy

• there is a community of cis gendered people who do not like the term ‘pregnant people’, so we do try to avoid it in content where we can address the user as ‘you’ …

• we mostly make our content inclusive by changing the language from, for example, “Pregnant women may feel sick or be sick” to “you may feel sick or be sick” such as on signs and symptoms of pregnancy

• there are cases where it’s not as simple as this, for example, we have evidence that trans men disengage with content about breastfeeding so we are working on creating chestfeeding content to meet this need

• Brighton and Sussex University Hospitals have gender inclusion midwives with great resources, especially this PDF

[Zeno001]

@Chloephilippou said:

we have evidence that trans men disengage with content about breastfeeding

Do you have a link to that evidence?

[Zeno001]

This new paper in the bmj by Dr Sara Dahlen needs to be read by all: Do we need the word ‘woman’ in healthcare?:

When Brighton and Sussex University Hospitals (BSUH) NHS Trust launched their guide to ‘Gender Inclusive Language In Perinatal Services’,1 the document came under significant public scrutiny in the UK.6 This guide included a table of suggestions to expand on existing clinical terminology, such as using ‘breast/chestfeeding’ instead of ‘breastfeeding’ and favouring ‘maternity or perinatal’ over ‘maternity’. Unlike some approaches to adopting gender inclusive language (where words like ‘woman’ might not appear at all), BSUH guideline authors aimed for an ‘additive’ approach, writing: ‘if we only use gender neutral language, we risk marginalising or erasing the experience of some of the women and people who use our services’”1 Despite this strategy, the debate around gender neutral phrases and when it is appropriate to associate the word ‘woman’ with female reproductive biology reached the UK House of Lords, as Lord Hunt asked: ‘do we really want to see demeaning terms such as ‘menstruators’, ‘individuals with a cervix’, ‘birthing bodies’ or even ‘chest feeders’?’.7 It is not unreasonable to expect that some women may feel debased by a term like ‘menstruators’, and clinicians have the same obligations to them not to use language that deeply offends.

When introducing their rationale for gender neutral language, Ross and Solinger noted: ‘the danger that excising the word ‘woman’ in order to include transgender persons in our reproductive justice analysis can have the effect of effacing the particular lived experiences of women’.2 Indeed, it seems difficult to justify routine omission of the word woman, if some women object to being described by various alternative phrases. Logically, the same arguments that support gender inclusive language for transgender people apply equally to women who may feel erased or dehumanised by terminology labelled ‘neutral’. If the aim is to maximise respect for every person’s sense of self, it must follow that female patients who simply understand themselves as women cannot either be expected to ‘go along silently with language in which they do not exist’.2

A further consideration for this language is the intended audience. Perry asked: ‘This kind of language is feted as ‘more inclusive’, but the question we should be asking is, inclusive of whom?’.8 Indeed, if writing for the general public, the use of some gender inclusive formulations may go against principles of jargon-free communication. Using simple words instead of convoluted phrases or anatomical terms is clearer, especially as survey data suggest widespread lack of knowledge regarding the female reproductive system.9 There may also exist other barriers to understanding a phrase like ‘people with a cervix’, for example: disability, differing socioeconomic, cultural or educational backgrounds, or limited knowledge of English.

[sarawilcox]

New report from the LGBT Foundation: Trans and non-binary experiences of maternity services

[sarawilcox]

‘Inclusive’ language on maternity care risks excluding many women - in the Guardian

[Zeno001]

A survey by Jo’s Cervical Cancer Trust showed that: Half of women don’t know what the cervix is

Almost half of women (44.2%)[1] are unaware of what the cervix is, unable to correctly identify it as the neck of the womb (uterus). One in six could also not name a single function of the cervix with less than half (41.40%) aware that it connects the womb to the vagina and only one in three knowing that it provides a seal to hold the baby in when pregnant.

The use of clear, simple, and accurate terms is vital in all areas of care.

[Zeno001]

The UK Network of Professors of Midwifery and Maternal and Newborn Health has just published a position statement on the use of sexed language in relation to women’s reproductive health:

Position Statement: Use of sexed language

Their position seems to be eminently sensible and, importantly, evidence-based.