Inclusive language risks ‘dehumanising women’, top researchers argue

Replacing words like “women” and “mothers” with terms like “birth-givers” and “pregnant people” in research risks dehumanising women and would harm decades of work to improve the visibility of women in medical literature.

That is the conclusion of 10 prominent women’s health researchers from Australia, the US, Europe and Asia who will argue in a paper published next week that replacing words like “breastfeeding” with terms such as “lactating parents” risks “reducing protection of the mother-infant [bond]” and “disembodying and undermining breastfeeding”.

An international group of women’s health experts argues removing ‘women’ from maternity literature and information risks harming protection of the mother-baby bond.Credit:Alamy

The authors acknowledge words are changing to ensure inclusion of those who give birth but do not identify as women, but they argue against removing references to the sex of mothers in research and medical information.

“Desexing the language of female reproduction has been done with a view to being sensitive to individual needs and as beneficial, kind, and inclusive,” they write in the paper. “Yet, this kindness has delivered unintended consequences that have serious implications for women and children.”

Official changes to terminology to be more inclusive of trans people has become a contentious issue in Australia and overseas. The paper acknowledges that “the penalty for non-conformity with gender roles can be high”.

Governments and institutions are grappling with how to approach gender terminology. The Age and The Sydney Morning Herald can reveal that a Federal Health Department guide for pregnant and breastfeeding women regarding COVID-19 vaccination and its impact on pregnant women was edited last year to remove the term “women”, introducing errors into the scientific accuracy of the material in the process.

The source information compared disease severity of COVID in pregnant women with non-pregnant women, but when the department removed the word “women” it compared “pregnant people” with “non-pregnant people”, changing the meaning to incorrectly include men.

The department released three versions of the document, the last of which reinstated the word “women”. A spokesperson for the department said the updated guidance was published following clarification of advice from the Australian Technical Advisory Group on Immunisation and was approved by the department.

A co-author of the new paper and former president of the Australian College of Midwives, Jenny Gamble, a midwifery professor at the UK-based Centre for Care Excellence for Coventry University and the university hospitals of Coventry and Warwickshire, said sex-based language “is important due to sex-based oppression”.

The trend to erase the use of the term women or redefine it has started to sweep the world.

“Confusing the idea of gender identity and the reality of sex risks adverse health consequences and deeper and more insidious discrimination against women,” she said. “Sex [a reproductive category], gender [a societal role], and gender identity [an inner sense of self] are not synonymous but are being treated as if they are.”

“Pregnancy, birth and early motherhood are fundamentally sexed issues, not gendered. Pregnant and birthing women and new mothers and their infants have unique vulnerabilities and also require protection.”

Researchers have lamented the exclusion of women from medical research for decades and researchers have campaigned for more biologically targeted research to understand the difference between the sexes.

Professor Gamble said the trend of erasing or redefining the term “women” had started to sweep the world and that “coming from Australia it seems that the way the UK has moved to erase the use of sexed language has been rapid and extreme”.

Transgender spokespeople say inclusion can be achieved without erasing the term women. Advocate and co-founder of Transgender Victoria, Sally Goldner, said it was possible to represent everyone who gives birth and feeds infants, including those from diverse cultural and linguistic backgrounds, who may also require customised information.

“It’s important that we represent everyone. The ‘standard cis-gender woman’ will still be able to get the messages, but then we can add in the messages we need for other groups in terms of breastfeeding/chestfeeding and giving birth,” she said.

“I think there are ways we can do it and include everyone, and make [information] comprehensive, accessible and inclusive,” she said.

“It’s really important each group gets consulted and has a sense of ownership; it’s just about listening to people so the resources are there.” The paper supports this approach.

The term “cis-gender” applies to people whose gender identity fits expectations given their biological sex.

Teddy Cook of ACON, Australia’s biggest LGBTQ health organisation, said: “While the language is changing or emerging, what we’re actually doing is taking courageous steps to be inclusive and affirming with populations who are highly marginalised, highly vulnerable and shouldering a burden of poor health no one in this country deserves.”

He endorsed the use of language such as “pregnant women and people”.

The LGBTQ parenting support group, Rainbow Families, Transgender Victoria and the Royal Women’s Hospital were contacted for this article. A hospital spokeswoman said it was not in a position to comment.

The authors of the paper, Effective communication about pregnancy, birth, lactation, breastfeeding and newborn care: the importance of sexed language, due to be published in the journal Frontiers in Global Women’s Health, include breastfeeding researcher Associate Professor Karleen Gribble of the University of Western Sydney, obstetrician Professor Susan Bewley, of King’s College London and breastfeeding and health researcher, Assistant Professor Susan Bartick of Harvard Medical school.

They stress that some use of desexed words is appropriate, especially when dealing one-to-one with people who prefer it: “And we fully endorse the importance of being inclusive and respectful”.

“For those who are pregnant, birthing, and breastfeeding but who do not identify as women, the individual’s preferred terminology for themselves and their body parts should be used wherever possible,” they say.

As debate about gender terminology escalated in 2021, the Australian Breastfeeding Association was criticised for producing a tailored booklet on feeding for transgender parents in 2021, including the term “chestfeeding”.

The right to breastfeed or chestfeed at work was enshrined in Victorian law last year.

An article on language in women’s health by Melbourne University political philosopher, Holly Lawford-Smith, was live on the website of O&G magazine for less than a day in 2021, reportedly taken down after a backlash.Credit:

In late 2021, when the Royal Australian and New Zealand College of Obstetricians and Gynaecologists published an article titled Those birthing people – they’re women, by the Melbourne University political philosopher Holly Lawford-Smith in an O&G magazine edition on language in women’s health, the article was taken down within a day.

In the now-archived article, Dr Lawford-Smith, who describes herself as a gender-critical feminist, argued “considerations against gender-neutral language for female-specific health issues include the history of struggle for women’s representation in language, which our feminist foremothers fought hard to win”.

Dr Lawford-Smith has been labelled a TERF – or trans-exclusionary radical feminist – by critics of her views.

A RANZCOG spokesperson said an editorial in the same magazine stated, “the most appropriate language to use is, as always, an ongoing conversation.”

The organisation – which confirmed Holly Lawford-Smith’s article is no longer up – agrees with the researchers’ opinion that “it is a continuing challenge to apply language in a way that is clear, concise and preserves the dignity of all people being described.”

Associate Professor Gribble said she noticed sex-specific language starting to be phased out four years ago, when she was writing a paper on lactation and “someone suggested I not use the word ‘mother’.”

She and colleague Hannah Dahlen, a midwifery professor, were also prompted to examine the issue of desexed language by the 2021 cover headline on The Lancet, which read “Historically, the anatomy and physiology of bodies with vaginas have been neglected”.

Their paper says the headline, which caused fierce international debate, was part of the trend to replace the word “women” which can diminish women.

Professor Dahlen said the “very good intention” of making language inclusive “is starting to exclude women and cause rampant misrepresentation of sex in scientific data”.

Chief executive of Gender Equity Victoria, Tanja Kovac, said she was “regularly asked by our own members to comment on [the removal of sexed language]; it’s a significant feminist issue.”

“While we don’t have any time whatsoever for TERF feminism, that does not mean we don’t see a need to provide very tailored policy differences and responses for men, women, trans people who identify as women and other non-binary and gender-diverse people, who need specially, tailored policy for them,” said Ms Kovac.

A push towards desexed language, or “a great generic” removed choice around how people define themselves.

“What we’re seeing is, at an elite level, an attempt to linguistically deny the capacity for people to choose how they want to self-describe … organisations and policy settings need to respond to people’s unique needs, you can’t pretend that nuance doesn’t exist,” she said.

“I don’t think it’s healthy for anybody to have diminished nuance in healthcare, particularly. ”

The Australian Breastfeeding Association’s Naomi Hull said the organisation agreed there were risks attached to blanket removal of sexed language. Its counsellors “tune into and mirror the caller’s language, adapting terminology as needed”, but “within mass public health messaging, such personalisation [it] is rarely possible”.

“Clear and easy to understand [and translate] concepts are pivotal, and ABA’s approach is to use sexed language, where it’s relevant to the communications.”

Jacquie Ducat, a breastfeeding educator, does not have concerns about the language used about pregnancy, birth or motherhood shifting towards less use of sex-based words.Credit:Luis Enrique Escui

Breastfeeding community educator Jacquie Ducat, whose children Michael and William are five, and 15 months, said she did not take issue with such language changing as she realises desexed terminology still includes her.

“I can appreciate for some people it may feel like erasure, maybe [due to] the things they base their identity on, by changing the language it makes it feel like that is being taken away from them,” said Ms Ducat, from Melbourne.

“I can appreciate how some people feel [but] some of my circle who are more gender fluid or don’t have the typical family dynamic, [have told me] stories about how it has been very difficult to feel included, and that things are for them because there’s a lot of assumptions made.”

“Not everyone who births uses the word ‘mother’, but I can appreciate how difficult the dynamics are and the changing structure of society, and it’s happening very quickly.”

Lara McGirr, an anthropologist and breastfeeding mother, is among those who believe there are risks attached to removing the words “woman” and “mother” from maternity resources, research and information.Credit:Brook Mitchell

Anthropologist and breastfeeding mother from Sydney Lara McGirr said the erosion of the use of sexed language around pregnancy, birth and feeding set women back.

“This stuff is not in women’s best interest,” she said. “I think we can get it right, we can support the trans experience and validate and accept it whilst also letting mothers be ‘mothers’, and supporting and empowering them.”

“I don’t think we can do that without using the word ‘mothers’, that word permeates every language on earth and goes back thousands of years, how can we eliminate it?”

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