The main NHS web pages on uterine, cervical and ovarian cancers have omitted the word ‘woman’. They now use gender-neutral language to include non-binary people or trans men. Sub-sections of the pages still refer to women, but the NHS’ decision to use more inclusive language has drawn criticism and even fear.
There was a similar response last year when Brighton and Sussex University Hospitals NHS Trust announced it would use ‘gender additive’ language in its birth services, with words like ‘breastfeeding’ as well as ‘breastfeeding “.
Some people felt that cisgender women might be further invalidated or silenced in their experiences within a system that already does this in myriad ways (I’ve written an entire book on this). This fear is understandable.
When bitter debates about gender and trans rights saturate our news, it is human to see these stories and think, “This sounds important. What is my opinion? »
It is human to align ourselves or form strong opinions based on the information we receive, as well as the painful experiences we may have had. But when it comes to inclusive language – who deserves it; who should use it; who might be left behind – in a public system like the NHS, apparently for everyone, it’s especially important to pause and think about the nuances.
One way is to look beyond the polemics and read the policies in question. The Brighton and Sussex University Hospitals NHS Trust policy document, for example, said: ‘The vast majority of users of midwifery services are women and we have already put in place language with which they are attuned. easy. This does not change and we will continue to call them pregnant women and talk about breastfeeding.
Expanding their language wasn’t about excluding anyone at all: it was about bringing in more people.
Another way would be to think of Why language evolves. The process often begins with activism within minority communities as a way to gain power. The term “BME” (Black and Minority Ethnic), for example, has its roots in the idea of ”political blackness” – a term used in the anti-racism movement of the 1970s. The term evolved into “Bame” (incorporating “Asian”) to reflect other minority ethnic groups as well as black people.
For some people in the community, the term is a powerful sign of inclusion. For others, “Bame” is a problematic catch-all phrase that obscures individual identities and experiences. We must respect everyone’s right to use terminology with which they feel comfortable. Expanding the language gives people more options to choose from – or even reject, if they so choose.
In health care settings, the careless use of language can make people feel rejected. This might be true for a woman who might feel, for whatever reason, that she cannot say “woman” and might be true for a trans man who might feel invalidated by the widespread use of the term in some services.
As I have said before, much of the responsibility for stoking rage back and forth lies with certain sectors of the media. However, it seems unfair to me to ignore that LGBT+ people experience disproportionately worse health outcomes and often struggle to use health services. Language is a key part of the story.
If I identify as part of a minority community, health care providers’ assumptions about my personal characteristics may make me feel ashamed, embarrassed, or anxious. It creates an active health risk, if a problem is missed because I’m afraid to ask for help again. I know LGBT+ people who were scared. As a lesbian with, shall we say, a “complex” gynecological history, I have none. But I felt shame and disappointment.
I have endometriosis and have been offered embryo freezing on the NHS following scarring of the fallopian tubes which would ‘naturally’ make conception more difficult. I have had two surgeries to remove adhesions (scar tissue) that are causing me significant pain. In more interactions than I could count, I had to correct the basic assumption that I’m straight.
Doing this once or twice is fine. Having to go out again and again is boring and demoralizing. Emotional work becomes mine, when I’m in a vulnerable position – literally, legs apart. The idea of a trans man or non-binary person with pelvic pain (which could indicate something serious) trying to get that pain taken seriously, while navigating language that could make them dysphoric, to me makes you very sad.
Personally, I don’t judge the (probably overworked) person who makes assumptions about my sexuality. But I judge a state system that does not train its employees to work on the basis of individual difference. For me, the recent additions to the NHS website – a massive public interface – that talk about these differences, like advice on getting pregnant as an LGBT+ person, make the whole system kinder and safer.
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On the issue of safety, a lead author of a recent study on gendered language at birth and in childcare said: “I think the changes to gendered language are well intentioned, but we find that they make communications less clear…”
Some campaigners argue that those with low literacy or who don’t have English as their first language might miss some health messages that apply to them. The risk that already low cervical screening participation rates will be further affected by desexed language has also been discussed. All of these fears are valid. They also talk about the importance of working harder to achieve everybody.
We need an awareness of individual variation among the people that certain words describe. The NHS is not asking anyone to choose an “appropriate” term, but is trying, admirably, to have a more inclusive public interface. To say that words are important is to say that we need oxygen to survive; we use them to codify ourselves in the world.
So it’s vital to keep talking about vaginas and uteruses, and to use the word ‘woman’ as much or as little as we want. We can still do that and find ways to include people who, although a small minority, deserve to be treated fairly for something that binds us all together: health.
Eleanor Morgan is a journalist, author and trainee psychotherapist