17 February 2021

Why using gender-neutral language risks excluding one minority group to include another

The costs of confusing public health messaging are suffered more by some groups – such as those who speak little or no English – than by others.

By Louise Perry

The hospital at which I’ll be giving birth in a few months’ time currently allows partners to accompany pregnant women to three events: the first scan, the second scan and the birth itself. To lower the risk of coronavirus transmission, partners are also required to wait outside the maternity unit before the appointment. Arriving at my first scan, husband in tow, the receptionist took one look at the pair of us and, despite the fact I wasn’t yet showing, knew exactly who to boot out into the cold. “You, out!” she said, pointing at the male, who meekly sloped off to wait in the car park.

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

This change will be applied to the language used in official NHS literature. Yet, even in uber-progressive Brighton, I think it highly unlikely that a significant number of health professionals will actually start using the term “chest-feeding” (along with “breastfeeding”) when speaking to patients, given its clunkiness, and given that, at least in my experience, people who work in maternity services can often be rather candid about biological reality. No one bothered to ask my husband if he might be the “birthing person” when he showed up at our maternity unit, and rightly so.

After all, the number of people who will benefit from this move is truly tiny: specifically, we are concerned here with trans or non-binary people, who are biologically female, and able to bear a child following any surgical or hormonal interventions undergone as part of sex reassignment, and decide to do so, and care about squabbles over vocabulary. The NHS does not currently keep a record of how many trans people give birth every year in the UK, but in Australia the figure is in the dozens. Unfortunately, there is another group – and a much larger one – who might be alienated by efforts to make medical vocabulary more trans-inclusive and therefore also (if inadvertently) more obscure. The 2011 census records that 1.3 per cent of the population of England and Wales cannot speak English well, and 0.3 per cent cannot speak English at all, and the majority of these people are women. The problem is particularly acute among British Muslims, with almost a quarter of Muslim women reporting that they either do not speak English or do not speak it well.

My hospital happens to cover an area with a large Muslim population, and it’s not uncommon to see women in the maternity unit struggling to make themselves understood by staff. The problem has been made worse during the pandemic, as friends and relatives have been banned from waiting rooms and so cannot act as translators. There are phone translation services available, but – as I witnessed from the other side, when I was (briefly) a medical student – they’re not always straightforward to use. And even if some leaflets might be translated into other languages, the posters and signs on the wall are all in English.

I was told by one midwife that the first maternity appointment – which includes crucial assessments of health, genetic background and risk of domestic violence – typically takes twice as long for those patients who struggle with English. Now try adding terms such as “chest-feeding” and “birthing person” to the official forms.

Or, rather than ask that “women” present themselves for a smear test, NHS letters and poster campaigns might use gender-neutral language and direct the appeal instead to “individuals with a cervix”, the phrase used by the American Cancer Society. This kind of language is feted as “more inclusive”, but the question we should be asking is, inclusive of whom?

Attendance at cervical screenings is at a ten-year low, and late diagnosis hugely increases mortality risk. But, unfortunately, less than 50 per cent of UK women know where the cervix is, and those who do are disproportionately likely to have more educational qualifications and be native English speakers. The costs of confusing public health messaging are suffered more by some groups than by others, but this can all too easily be forgotten by progressive elites in the rush to signal inclusiveness.

The psychologist Rob Henderson has coined the term “luxury beliefs” to describe, as he puts it, “ideas and opinions that confer status on the rich at very little cost, while taking a toll on the lower class”. For instance, a member of the bourgeoisie can elevate his status by proposing to “defund the police” with little fear of negative consequences for himself if this policy were ever enacted, since those most affected by crime are poor people who can’t afford to move away from dangerous areas.

Similarly, rich people in the modern West can experiment with alternative relationship arrangements, such as having multiple partners, in the knowledge they can always fall back on their financial and social capital if it doesn’t work out. But not everyone has the luxury of rewriting relationship norms. A poor woman with several children by several different men, for example, is placed in an intolerably precarious situation if she finds herself suddenly single. For the rich, luxury beliefs are about gain with little pain.

The elaborate dance involved in avoiding using words such as “mother” and “breast” offers those at the cutting edge of political discourse the opportunity to demonstrate their status at no cost to themselves. That does not, however, mean there is no cost to be borne by anyone else.