Voices: Inclusive, gender-neutral language helps us all – it doesn’t take away ‘woman-ness’

The main NHS web pages on womb, 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’s move towards using more inclusive language has been met with criticism and even fear.

There was a similar response last year when Brighton and Sussex University Hospitals NHS Trust announced that it would be using “gender-additive” language in its birth services, with words like “chestfeeding” as well as “breastfeeding”.

Some people felt that cisgender women may be further invalidated or silenced in their experiences within a system that already does this in myriad (I wrote a whole book about it) ways. This fear is understandable.

When bitter debates around gender and trans rights saturate our timelines, it is only human to see these stories and think, “This seems important. What’s my take?”

It is only human to align with, or form, strong opinions based on the information we receive, along with painful experiences we might have had. But on the matter of inclusive language – who deserves it; who should use it; who might get left behind – in a public system like the NHS, ostensibly for everyone, it feels particularly important to pause and think about nuance.

One way is to look beyond polemics and read the policies in question. The Brighton and Sussex University Hospitals NHS Trust policy document, for instance, said: “The vast majority of midwifery service users are women and we already have language in place they are comfortable with. This is not changing and we will continue to call them pregnant women and talk about breastfeeding.”

Expanding their language was not about excluding anyone at all: it was about bringing more people in.

Another way would be to think about 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 1970s anti-racist movement. The term evolved to become “Bame” (incorporating “Asian”) to reflect other minority ethnic groups as well as Black.

For some people within the community, the term is a powerful signifier of inclusion. For others, “Bame” is a problematic, catch-all phrase that masks individual identities and experiences. We must respect any individual’s right to use terminology they’re comfortable with. Expanding language gives people more options to choose from – or indeed reject, if they want to.

In healthcare settings, careless use of language can make people feel dismissed. This could be true for a woman who might feel, for whatever reason, that she can’t say “woman” and could be true for a trans man who might feel invalidated by the blanket use of the term in certain services.

As I have argued before, much responsibility for whipping up rage in both directions lies within certain areas of the media. It does strike me as unfair, though, to ignore that LGBT+ people experience disproportionately worse health outcomes and often have a difficult time using health services. Language is a key part of the story.

If I identify as part of a minority community, assumptions from healthcare providers about my personal characteristics may make me feel shamed, embarrassed or anxious. This creates an active health risk, if a problem is missed because I am afraid of asking for help again. I know LGBT+ people who have been afraid. As a lesbian with, shall we say, a “complex” gynecological history, I haven’t. But I have felt shame and disappointment.

I have endometriosis and was offered embryo-freezing on the NHS as a result of fallopian tube scarring that would make conceiving “naturally” more difficult. I have had two surgeries to remove adhesions (scar tissue) that cause me significant pain. In more interactions than I could possibly count, I have had to correct the baseline assumption that I am straight.

Doing this once or twice is fine. Having to come out over and over again is boring and demoralising. The emotional labour becomes mine, when I am in a vulnerable position – literally, with my legs spread. The idea of a trans man or non-binary person with pelvic pain (which could point to something serious) trying to get that pain taken seriously, while navigating language that might make them feel dysphoric, makes me very sad.

Personally, I don’t judge the (likely overworked) individual who makes assumptions about my sexuality. But I do judge a state system that doesn’t train its employees to work on the basis of individual difference. To me, recent additions to the NHS’s website – a massive public interface – that speak to those differences, like guidance on becoming pregnant as an LGBT+ person, make the whole system feel kinder and safer.

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On the matter of safety, a lead author of a recent review on sexed language in birth and childcare said: “I think the changes to desex language are well-intentioned, but we are seeing that they are making communications less clear…”

Some campaigners argue that those with lower literacy, or without English as a first language, might miss certain health messages that apply to them. The risk that already-low cervical screening uptake rates may be further affected by desexed language has been discussed, too. All these fears are valid. They also speak to the importance of working harder to reach everyone.

We need an awareness of individual variation among the people that certain words describe. The NHS is not asking anyone to pick one “proper” term, but is trying, admirably, to have a more inclusive public interface. To say words are important is like saying we need oxygen to survive; we use them to codify ourselves in the world.

So, it is vital to keep talking about vaginas and wombs, and to use the word “woman” as much or as little as we want. We can still do this and find ways to include people who, although belonging to a small minority, deserve to receive equitable treatment for something that binds us all: health.

Eleanor Morgan is a journalist, author and trainee psychotherapist