Readers React: Neutral language has adverse effects

To the editors:

In their guest editorial “Inclusion is not erasure,” Frances Grimstad, MD, MS; Elizabeth Boskey, PHD, MPH, MSSW; and Jessica Kremen, MD, conclude that “talking about transgender and gender-diverse individuals’ reproductive health care needs allow us to recognize the full scope of patients whose lives and bodies are at risk when abortion is outlawed and the importance of fighting for the well-being of all.”¹ I could not agree more. The authors propose that one important strategy is to use inclusive language.

Unfortunately, they never lay out clearly what they mean by inclusion or why such proposals can raise concerns, instead allowing one deeply problematic opinion piece by a journalist to stand in for any of the more nuanced discussions available.

Some versions of inclusive language use diverse terms to describe our patients. The authors of the editorial do exactly this, referring to cisgender women, transgendered individuals, and gender-diverse people over the course of the article. Others, however, entirely decouple gender from the discussion of abortion or pregnancy care.

For instance, language such as “persons with the capacity for pregnancy” or “pregnant people” is often prescribed as “inclusive.” It can more accurately be considered neutral because it does not specifically identify anyone by gender: not transmasculine people, not gender-diverse people, not men, not women. Neutral language can have adverse effects.

A few analogies make the problem clear. Without specifically naming and considering the experiences of transgender individuals—as the authors do throughout their editorial—we cannot understand the harms perpetuated by transphobia. While Black Lives Matter asks us all to uncover and eradicate the many ways that racism harms Black people; to respond to it with “all lives matter” may seem inclusive.² It is not; it is erasure.

Gender remains an extraordinarily powerful social category with profound health effects.³ One cannot analyze the impact of sexism, patriarchy, or misogyny without it. It is important not only to name women but to consider how and why women are treated as women; without doing so, we risk failing to understand the workings of any of these forces.^4,5

Language is just one small piece, but it’s an important piece. Instead of using solely neutral language and calling it “inclusive,” I suggest that we use specifics—and that we make every effort to keep the specifics diverse. When welcoming patients to our clinics, we should use the language that each of them prefers that is both accurate and respectful.

In our policy advocacy, when we talk about abortion, let’s talk about the women, and the transgender men, and the nonbinary individuals who seek it. Although this language strategy may be as cumbersome as the LGBTQIA acronyms many of us also use, it is not erasing. In our research, let’s analyze the specific ways that sexism and racism, patriarchy and white supremacy, transphobia, and heteronormativity interlock to violate human rights and endanger human lives. These kinds of analyses are not easy, but they are critical to high-quality reproductive care and to equitable public health.⁶

Specific language does not prevent anyone from “fighting for the well-being of all” or from building coalitions. The authors are correct that women’s rights and the rights of gender-minority individuals are not in opposition.

The powerful enforcement of the gender binary evident in recent judicial and legislative actions threatens both and threatens the well-being of our patients and their families.⁷ Avoiding the word “woman” as we work for abortion rights is not the way forward. Refusing to use only that word is.

Referencese

1.Grimstad F, Boskey E, Kremen J. Inclusion is not erasure. Contemporary OB/GYN®. 2022;67(9):7-9. Accessed September 25, 2022. https://cdn.sanity.io/files/0vv8moc6/contobgyn/17fa76640766ecf41e49805139bbb5d05178d286.pdf/OBGYN0922_Editorial.pdf

2.West K, Greenland K, van Laar C. Implicit racism, colour blindness, and narrow definitions of discrimination: why some White people prefer ‘All Lives Matter’ to ‘Black Lives Matter.’ Br J Soc Psychol. 2021;60(4):1136-1153. doi:10.1111/bjso.12458

3. Heise L, Greene ME, Opper N, et al; Gender Equality, Norms, and Health Steering Committee. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet. 2019;393(10189):2440-2454. doi:10.1016/S0140-6736(19)30652-X

4.Homan P. Structural sexism and health in the United States: a new perspective on health inequality and the gender system. Am Sociol Rev. 2019;84(3):486-516. doi:10.1177/0003122419848723

5.Manne K. Down Girl: The Logic of Misogyny. Oxford University Press; 2018.

6.Krieger N. Measures of racism, sexism, heterosexism, and gender binarism for health equity research: from structural injustice to embodied harm-an ecosocial analysis. Annu Rev Public Health. 2020;41:37-62. doi:10.1146/annurev-publhealth-040119-094017

7.Everett BG, Limburg A, Homan P, Philbin MM. Structural heteropatriarchy and birth outcomes in the United States. Demography. 2022;59(1):89-110. doi:10.1215/00703370-9606030