Why the use of gender-neutral language risks excluding one minority group that includes another

The hospital where I will be born in a few months currently allows partners to monitor pregnant women for up to three events: the first recording, the second recording and the birth itself. To reduce the risk of coronavirus transmission, partners must also wait in front of the maternity ward before an appointment. Arriving at my first video, my husband was caught, the receptionist looked at the couple and, despite the fact that I hadn’t shown it yet, he knew exactly when to get up in the cold. “You, get out!” she said pointing to the male who meekly leaned over to wait in the parking lot.

I remembered that moment recently, when the University Hospitals of Brighton and Sussex NHS Trust became the first in the UK to officially adopt a language that includes gender in its perinatal services. This means avoiding feminine pronouns, where applicable, referring to the “person giving birth” (formerly known as “mother”) and removing the word “breast”, recommending the terms “breastfeeding” and “human milk” instead.

This change will apply to the language used in the official NHS literature. Yet, even in uber-progressive Brighton, I think it’s unlikely that a significant number of health professionals will actually start using the term “breastfeeding” (along with “breastfeeding”) when talking to patients, given his clumsiness and that, at least in my experience, people working in maternity services can often be quite honest about the biological reality. No one bothered to ask my husband if he might be the person giving birth when he showed up at our maternity ward, and rightly so.

After all, the number of people who will benefit from this move is really small: specifically, here we are concerned about trans or non-binary people, who are biologically female, i able to give birth to a child after any surgical or hormonal interventions performed as part of a sex change, i decide to do it, i worrying about quarrels over vocabulary. The NHS does not currently keep records of how many trans people a year give birth in the UK, but in Australia that number is in the tens. Unfortunately, there is another group – and a much larger one – that could be alienated by efforts to make the medical vocabulary more translusive, and therefore (if inadvertently) vague. The 2011 census records that 1.3 percent of the population of England and Wales do not speak English well, and 0.3 percent do not speak English at all, and most of these people are women. The problem is particularly acute among British Muslims, as almost a quarter of Muslim women report that they either do not speak English or do not speak it well.

Coincidentally, my hospital covers an area with a large Muslim population and it is not uncommon to see women in the maternity ward trying to be understood by the staff. The problem worsened during the pandemic, because friends and relatives were forbidden to wait, so they could not be interpreters. Telephone translation services are available, but – as I testified on the other hand, while I was (briefly) a medical student – they are not always easy to use. And even if some leaflets could be translated into other languages, the posters and signs on the wall were written in English.

[see also: Why should CNN tweet about “individuals with a cervix”?]

One midwife told me that the first appointment for a childbirth child – which includes key health assessments, genetic background and risk of domestic violence – usually takes twice as long for those patients who struggle with English. Now try adding terms such as “breastfeeding” and “birth” to official forms.

Or, instead of asking for “women” to be smeared, NHS letters and campaign posters can use gender-neutral language and appeal to “cervical people,” a phrase used by the American Cancer Society. This type of language is considered “more comprehensive”, but the question we should ask is, since when?

Attendance at cervical examinations is at ten years, and late diagnosis greatly increases the risk of mortality. But unfortunately, less than 50 per cent of women in the UK know where the cervix is, and those who do have it are undeniably likely to have more educational qualifications and be native English speakers. The costs of confusing public health messages are borne by some groups more than others, but progressive elites in a hurry to signal inclusiveness can easily forget this.

Psychologist Rob Henderson coined the term “luxury beliefs” to describe, as he puts it, “ideas and opinions that give status to the rich at a very low cost, while taking a toll on the lower class”. For example, a member of the bourgeoisie can raise his status by proposing to “break up the police” with little fear of negative consequences in itself if this policy is ever passed, because the most affected by crime are poor people who cannot afford to stay away from hazardous areas.

Similarly, wealthy people in the modern West can experiment with alternative relationship arrangements, such as multiple partners, in the knowledge that they can always return to their financial and social capital if that fails. But not everyone has the luxury of rewriting the norms of relationships. For example, a poor woman with several children of several different men is brought into an unbearably uncertain situation if she suddenly finds herself alone. For the rich, luxury beliefs are a profit with little pain.

The complex dance that involves avoiding the use of words such as “mother” and “breast” offers those on the fringes of political discourse the opportunity to show their status to themselves at no cost. However, that does not mean that no one bears the costs.

[see also: Judith Butler on the culture wars, JK Rowling and living in “anti-intellectual times”]