English medicine and the new gender neutral inclusive language
Individuals with a cervix. Pregnant people. Chestfeeding gestational parent. Bodies with vaginas.
If you’ve not encountered these phrases before, you might think they belong in a science fiction novel.
In fact, they are now used in British medicine as so-called gender neutral inclusive language.
The idea is to make healthcare more welcoming and accessible to those who don’t fit the standard model of being male or female.
"Inclusive language" isn’t only meant for gender non-conforming people – ‘co-parent’ may replace ‘father’ for same-sex couples.
And just last week, The Lancet, one of the world’s most influential medical journals, tweeted an image of the cover of its latest issue, which displayed a sentence that, in effect, replaced the word ‘women’ with ‘bodies with vaginas’.
The line was from a review of an exhibition on menstrual health at the Vagina Museum in London. It read: ‘Historically, the anatomy and physiology of bodies with vaginas have been neglected.’
Many women, quite understandably, were furious. Editor Richard Horton was accused of ‘dehumanisation’ and ‘erasing’ women from a conversation that primarily concerns... women.
The use of inclusive language isn’t new. In 2016, the British Medical Association recommended its staff use ‘pregnant people’ instead of pregnant women.
For anyone who thought that wouldn’t catch on, it’s a phrase that you’ll hear widely used in maternity care now.
Then, in February last year, midwives at Brighton and Sussex University Hospitals Trust were told to start using terms such as ‘chest milk’ instead of breast milk.
And yet, medically speaking, of course, men have breasts. You don’t call male breast cancer ‘chest cancer’.
‘Breast’ is already a gender- neutral term. In medicine, the chest usually refers to the thorax, which houses the lungs and heart, among other things.
Dr Alison Berner, a cancer specialist who also works in gender identity at the Tavistock and Portman NHS Foundation Trust, said the idea was to assume nothing, perhaps use a neutral term as a starting point, and if in doubt, ask.
She said a ‘cisgender’ man – one who was assigned male at birth and still identifies as a man – may be fine with the term breast cancer, but added: ‘There might be someone who experiences extreme distress from that term. It’s about checking with each individual person what’s all right for them.’
What about ‘bodies with vaginas’ – surely no one wants to be called that?
But Dr Berner said: ‘I am a cisgender woman and I have a body with a vagina.
'When I see a term like that I know it’s applicable to me and applicable to my trans male friends, if they have a vagina. It’s an anatomically accurate term.’
In healthcare, misunderstandings can lead to serious consequences.
Many people already struggle to understand vital health information.
An NHS report estimates that 43 to 61 per cent of adults have literacy and numeracy levels that mean simple messages in NHS leaflets can baffle them, and 43 per cent struggle to grasp instructions on a paracetamol packet.
Women who don’t have an adequate grasp of health messages are less likely to attend screenings for breast and cervical cancer, less likely to attend follow-up appointments after an abnormal result and are more likely to have unplanned, complicated pregnancies.
‘Terms like uterus and vagina may not be totally understandable by the general population,’ says Joyce Harper, an IVF doctor and Professor of Reproductive Science at the Institute for Women’s Health.
‘It’s much more important to use language that people understand.’
Guidance from Imperial College London and the Institute of Global Health offered evidence-based instructions for health messages to improve the take-up of treatment.
It stated: ‘Make it simple. Use language, visuals and ideas that are easy to process quickly. People need to be able to understand what you are asking them to do and why it matters, and... act accordingly.’
Will ‘bodies with vaginas’ do this? I don’t think so. By trying to include one vanishingly small minority it may exclude larger numbers already facing struggles.