There’s a new iteration of the bitter public debate in the UK over trans rights, and it all began with a single tweet by CNN. The American news broadcaster tweeted on Thursday evening (30 July) that new guidance by the American Cancer Society recommends that “individuals with a cervix” should begin cervical screening from the age of 25, rather than 21.
Do you mean women? https://t.co/IThpse7fST
— Piers Morgan (@piersmorgan) July 31, 2020
On Friday morning, it began to be picked up by prominent British commentators, including Piers Morgan and Iain Dale. “Do you mean women?” Morgan tweeted to his seven and a half million followers. The argument that CNN should have said “women” instead of “individuals with a cervix” ricocheted around the internet, and engendered a new controversy, as the Labour MP Rosie Duffield “liked” Morgan’s tweet in implicit agreement, and then doubled down on it when accused by other Labour supporters of being transphobic, replying: “I’m a ‘transphobe’ for knowing that only women have a cervix….?!” Her name spent most of the weekend trending on Twitter, and huge numbers of Labour activists are organising to report her for breaking party rules, while many others flock to praise her.
If you are sick of Twitter rows and “identity politics”, don’t give up on reading this article quite yet. The row isn’t just about language, but about public policy.
Duffield, who is chair of the Women’s Parliamentary Labour Party (PLP), the largest grouping of women in parliament, and who rose to prominence after delivering a powerful speech about her experience of domestic abuse in a parliamentary debate on the Domestic Abuse Bill, was challenged over this because trans men (for those who may be new to this, a trans man is someone born biologically female but identifies and lives as a man) do, also, have cervixes in many cases, and have a legal right (see the Gender Recognition Act of 2004) to be recognised as men. The cervical cancer screening guidance for trans men in the UK was shared with the MP, who replied: “Of course this applies to some people, they’ll know who they are and this advice is great. But the implication that one cannot describe oneself as a woman without inviting a pile-on is beyond ridiculous now. Almost 52% of the UK population are women….”
The Labour MP makes an argument that will strike many people as common-sense: why erase the word “women” from a report about a change that will, mainly, impact them? A concern around more complicated language and the erasure of women in what is broadly a women’s health issue with a major uptake problem is undoubtedly the more sensitive and sensible end of the objections to CNN’s wording, which also encompasses a large number of people whose main problem seems to be that this effort to accommodate trans people with more precise language is silly, laughable, “political correctness gone mad”; and by extension, that any effort to accommodate or acknowledge trans people in our public life or discourse is also silly, laughable, political correctness gone mad.
At this point, it is worth bringing in some of the facts. We know that there is a problem with women attending cervical screenings, with some shocking statistics from 2018 showing that one in three women in the UK don’t attend cervical screening because of “embarrassment”, and 31 per cent of women wouldn’t go to a screening if they hadn’t waxed or shaved their bikini area. This points to a deep shame around female biology that has serious public health consequences: awareness campaigns encouraging women to attend, and indeed, Theresa May’s own plea from the dispatch box in 2019 for people to attend their smear tests, are a concerted effort to address this problem, but it won’t be entirely fixed until the misogyny that informs this shame is also tackled.
But if there is a problem in encouraging women who have cervixes (it is worth noting at this point that many women, both trans women and women who may have had intimate surgery, do not have a cervix) to attend their cancer screening, that public health challenge also applies to trans men. There is a recognised problem with screening inequalities for trans men in the UK and a Public Health England effort to address it. In the US, the audience for CNN’s tweet, there is robust evidence to show that trans men are roughly half as likely to have had a pap test in the last year as cis (not trans) women and are believed to be at increased risk for cervical cancer due to underutilisation of cancer screening and delayed follow-up care.
This makes sense: if shame, embarrassment and fear of pain (along with the fear of a subsequent diagnosis) are factors preventing women from attending cervical screening, this will also be the case for trans men who in many cases relate uncomfortably or indeed traumatically to their bodies, who fear discrimination during the testing process, and who report a higher level of pain from smear tests because of testosterone therapies.
This is the context of CNN’s tweet and report, which both simply replicate the wording from the paper by the American Cancer Society, an organisation issuing new guidance for cervical cancer screening in a context where trans men are particularly in need of public health messaging that includes them, not for the sake of political correctness and mealy-mouthed wording, but to save lives.
Most public health messaging around cervical screening continues to explicitly address women, just as prostate cancer messaging tends to address men. Trans people don’t tend to complain about this. But when one tweet does use precise wording that includes them on public health grounds, it becomes a cause of uproar, concern and derision.
We have a woefully immature standard of public discussion around trans issues, which has yet to catch up with the legislative accommodations for trans people. But now at least you know why CNN’s tweet isn’t so silly and why this isn’t always just about political correctness.
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