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22 February 2021

Why gender-neutral healthcare language is not a threat to women – or anyone else

Terms such as “chest-feeding” might sound strange to some, but surely our health system should make every effort to reach vulnerable groups?

By Alona Ferber

Looking at the news recently, you would be forgiven for thinking that a certain NHS trust had told midwives never again to utter the words mother, breastfeeding, or breast milk.   

Last Monday, Brighton and Sussex University Hospitals NHS Trust announced “the UK’s first clinical and language guidelines supporting trans and non-binary birthing people”. From now on, the trust would use “gender-additive language” in its birth services – maternal and parental, rather than maternal; breastfeeding and chestfeeding, rather than breastfeeding. Maternity services would now be called perinatal services.    

The story was exhibit one million in Britain’s seemingly never-ending trans rights culture war. Media coverage did not attempt to avoid the fanning of these now-familiar flames. “Breastfeeding is now chestfeeding, Brighton’s trans-friendly midwives are told” said the Times. The Telegraph ran with “Midwives told to stop using terms such as ‘breastfeeding’ and ‘breastmilk’.” The Mail Online described the policy as a “radical overhaul” that had “unveiled a blizzard of ‘gender inclusive’ phrases”.    

On first seeing this story, my initial reaction was visceral: immediate rejection. Could they really be banning the word “breastfeeding”? What did that have to do with trans rights?  

But then I read more about the policy. As with everything, the devil was in the details. The trust’s guidance states that midwives should in general use terms like “human milk” or “chest milk” alongside “breast milk”, “co-parent” alongside “father”, rather than dropping the original phrases entirely. The language used one-on-one depends on the ­­individual accessing the service.   

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“The vast majority of midwifery service users are women and we already have language in place they are comfortable with,” the policy document explains. “This is not changing and we will continue to call them pregnant women and talk about breastfeeding. Adding to the language we use, and that people are comfortable with, ensures we are providing individual care for every person.”    

I tried to understand my initial response. I am pregnant with my second child, and plan to breastfeed her in a few months’ time. When my first daughter was born, the midwife placed her on my chest, still white with vernix, and one of the first things she did in her little life was to breastfeed. Breastfeeding can seem animal and strange until it’s you that’s doing it. Then it can feel like the most natural thing in the world. Some resent it, some find it unbearable, some aren’t able to make it work for them, for some it might trigger dysphoria – and some, like me, love the hard-to-describe closeness of it.  

Did seeing that headline make me feel like my ownership of this experience was somehow under threat, and if so, why?

I had been caught in the familiar cycle of outrage that is a common feature of divisive public debates, like the bitter discourse over trans rights. In this instance, the wrath was epitomised by none other than Piers Morgan, who denounced the policy on Good Morning Britain. “This kind of PC nonsense with the language, it has the opposite effect to what you think it does,” he said. “It annoys people, it doesn’t bring them any inclusivity. It becomes exclusive and alienates people.”   

This NHS trust is not the first organisation to think about the words it uses with trans or non-binary parents. Its policy cites examples from Canada and the US. Last year, the British branch of La Leche League, the breastfeeding group founded in the 1950s by seven Catholic mothers, sparked comparable anger when it published its own guidance. The Mail quoted one Mumsnet user as saying at the time that breastfeeding “is a particular female experience and it is not up for grabs”.   

Gendered language is contested ground in other areas of healthcare, too. There was a similar story last year when new guidance from the American Cancer Society, recommending that “individuals with a cervix” should begin cervical screening from the age of 25, rather than 21, set off similar responses. 

One argument against such steps is that trans people are a tiny minority, and that initiatives to make language more inclusive are “luxury beliefs”, thought up by the privileged with little discernable real-life benefit, as our columnist Louise Perry wrote. But trans and non-binary people do exist, and, even if in small numbers, they face barriers to accessing certain health services. It is important that our health system is accessible to anyone who might need it, that it makes every effort to reach even the tiniest vulnerable group.  

In our 24/7 news and social media ecosystem, we watch reactions to societal shifts in real time. The amount of detail we are exposed to is overwhelming and claustrophobic, giving us little space to think things through for ourselves. When stories of policies designed to better include marginalised groups are served up with inflammatory headlines such as those seen in the Telegraph and Times, they only perpetuate the addictive rage cycle, provoking visceral responses and cementing divisions.  

In both the maternity care and cervix screening examples, guidelines intended to widen access to services were the subject of public opprobrium. And in both cases, two things can be true at once: a change can be a vital step in the care of some, and it can shake the confidence of others about the extent to which they will be seen, and cared for.   

With both these things being true, the best outcome is still that, while those watching society’s clunky moves towards change have the space they need to think and fear, a vulnerable minority receives equitable and respectful treatment. And, in this case, healthcare.