Neutral language has adverse effects

To the editors:

In her guest editorial “Inclusion Is Not Erasure,” Frances Grimstad, MD, MS; Elizabeth Boskey, PHD, MPH, MSSW; and Jessica Kremen, MD, conclude that “talking about the reproductive health care needs of transgender and gender diverse people allows us to recognize the full range of patients whose lives and bodies are at risk when abortion is prohibited and the importance to fight for the good-being of all.”1 I could not agree more. The authors propose that an important strategy is to use inclusive language.

Unfortunately, they never make clear what they mean by inclusion or why such proposals might raise concerns, instead allowing a deeply problematic op-ed by a journalist to stand in for any of the more nuanced discussions available.

Some versions of inclusive language use various terms to describe our patients. The authors of the editorial do just that, referring to cisgender women, transgender people, and gender diverse people throughout the article. Others, however, completely decouple gender from the discussion of abortion or pregnancy care.

For example, language such as “persons of childbearing potential” or “pregnant persons” is often prescribed as “inclusive”. It can be considered more accurately neutral because it does not specifically identify anyone by gender: neither transmasculine people, nor gender-diverse people, nor men, nor women. Neutral language can have adverse effects.

Some analogies clarify the problem. Without specifically naming and considering the experiences of transgender people, as the authors do throughout their editorial, we cannot understand the harms perpetuated by transphobia. While Black Lives Matter asks all of us to uncover and eradicate the many ways that racism harms Black people; responding with “all lives matter” can seem inclusive.two It is not; it is erased.

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Gender remains an extraordinarily powerful social category with profound effects on health.3 You can’t analyze the impact of sexism, patriarchy, or misogyny without it. It is important not only to name women, but also to consider how and why women are treated. like women; Without doing so, we run the risk of not understanding the operation of any of these forces.4.5

Language is just a small piece, but it is an important piece. Instead of just using neutral language and calling it “inclusive,” I suggest we use details and do our best to keep the details diverse. When welcoming patients to our clinics, we must use the language that each of them prefers, which is both precise and respectful.

In our policy advocacy, when we talk about abortion, let’s talk about women, transgender men, and non-binary people seeking it. Although this language strategy can be as cumbersome as the LGBTQIA acronym that many of us also use, it is not erasing. In our investigation, we explore the specific ways in which sexism and racism, patriarchy and white supremacy, transphobia and heteronormativity intertwine to violate human rights and endanger human lives. This type of analysis is not easy, but it is essential for high-quality reproductive care and equitable public health.6

Specific language does not prevent anyone from “fighting for the good of all” or forming coalitions. The authors are correct that the rights of women and the rights of persons belonging to gender minorities are not in opposition.

The powerful application of the gender binary evident in recent legal and legislative actions threatens both and threatens the well-being of our patients and their families.7 Avoiding the word “woman” while working for abortion rights is not the way to go. Refusing to use just that word is.

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1.Grimstad F, Boskey E, Kremen J. Inclusion is not deletion. Contemporary obstetrics/gynecology®. 2022;67(9):7-9. Accessed September 25, 2022.

2. West K, Greenland K, van Laar C. Implicit Racism, Color 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; Steering Committee for Gender Equality, Standards and Health. 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. Anu 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