From the article linked in my previous post:
Desexing the language of female reproduction has been done with a view to being sensitive to individual needs and as beneficial, kind, and inclusive. Yet, this kindness has delivered unintended consequences that have serious implications for women and children. These include: decreasing overall inclusivity; dehumanizing; including people who should be excluded; being imprecise, inaccurate or misleading; and disembodying and undermining breastfeeding. In addition, avoidance of the term “mother” in its sexed sense, risks reducing recognition and the right to protection of the mother-infant dyad.
Decreases Overall Inclusivity
Avoiding sexed terminology in relation to female reproduction works against the plain language principle of health communication and risks reducing inclusivity for vulnerable groups by making communications more difficult to understand (57). Those who are young, with low literacy or education, with an intellectual disability, from conservative religious backgrounds, or being communicated to in their non-native language are at increased risk of misunderstanding desexed language (58–62). However, even women with high levels of education may not be familiar with female reproductive processes and terms of female anatomy and physiology and so may not understand some desexed terms (63–65). They may not know, for example, that “a person with a cervix” is a woman and refers to them (59). Translating desexed text into other languages may also be more difficult particularly when there is no direct equivalent to the English sex-neutral “parent” (e.g. Spanish which has only “padre”) (66).
Dehumanizes
Numerous alternative terms for “women” and “mothers” involve references to body parts or physiological processes. Referring to individuals in this reduced, mechanistic way is commonly perceived as “othering” and dehumanizing (67). For example, the term “pregnant woman” identifies the subject as a person experiencing a physiological state, whereas “gestational carrier” or “birther” marginalizes their humanity. Efforts to eliminate dehumanizing language in medical care are longstanding (68), including in relation to women during pregnancy, birth, and new motherhood (67, 69–71). Using language that respects childbearing women is imperative given the prevalence of obstetric violence (18, 72, 73). Considering women in relation to males as “non-men” or “non-males”, treats the male body as standard (8) and hearkens back to the sexist Aristotelian conceptualization of women as failed men (74).
Includes People Who Should Be Excluded
Terms such as “parents” and “families” as replacements for “mothers” can inappropriately include fathers and other family members, thus diminishing and invisibilising women (75). Use of “people” and “families” as replacements for “women” can similarly inappropriately include males and other family members. Women have unique experiences, needs and rights in relation to pregnancy, birth, and breastfeeding that are not shared with others (18, 76–79). It cannot be assumed that a woman's interests will align with those of her husband or partner. This is most clearly illustrated by the issue of domestic violence which often commences or increases during pregnancy and for which the worldwide prevalence ranges from 5 to 63% (80). Women, even when pregnant, do not lose their individual human rights, and should be supported to make autonomous decisions throughout pregnancy, birth, and breastfeeding. This includes for example, their companion of choice during birth (81) who may or may not be the father of their child. However, text referring to “birthing families” can suggest other family members have rights regarding a woman's decision making during birth. Similarly, text referring to supporting “parents” or “families” to make infant feeding decisions (82) suggests people other than the mother should make decisions regarding breastfeeding (75). This overlooks that partners and family members may directly or indirectly undermine breastfeeding (75, 83). It also obscures the positionality of women as rights-holders and family members as duty-bearers in relation to breastfeeding (76). Terminology that includes others can thus impede the provision of appropriate care and erode the rights of mothers and their infants.
The intent of “additive language” is to encapsulate pregnant and birthing females or female parents as a group but to do so in a way that avoids offense to those who do not wish to be named as women or mothers. However, the addition of terms like “birthing people” or “breastfeeding parents” changes the meanings of “women” and “mothers” from sexed terms that include all female people and all female parents, to gendered terms that may be confusing or inappropriately inclusive. For example, what does the phrase “women and birthing people” actually mean? This construction could be interpreted in a literal way as meaning that “women” are not people. Another interpretation occurs if “women” is meant or read in a gendered sense so including males with the gender identity of “woman” who cannot be pregnant or give birth. It is not always clear from the context. The change in meaning of “women” from a sexed term to a gender identity can also mean that those women who do not have a belief in gender identity as a concept do not see themselves reflected in the gendered use of “women.” Consequently, they may feel objectified by terms referring to processes like “birthing people” [e.g. (84)]. Thus, although sprinkling some “additive language” is often presented as a simple solution, it has its own risks, particularly when there is a need to be specific, to refer only to female people or female parents and to exclude male people or male parents.
Introduces Inaccuracy, Precludes Precision, and
Creates Confusion
Replacing a word with another of different meaning as if they are synonyms makes communications inaccurate or confusing. For example, in a growing number of papers, the severity of COVID-19 disease in pregnant women is being misrepresented by comparing “pregnant people” to “non-pregnant people” (40, 85–92) when the comparator in the research in question is “non-pregnant females.” Given the greater severity of COVID-19 disease in males (93), this misrepresentation means readers may under-estimate disease severity in pregnant women. Highly regarded organizations like the United States Centers for Disease Control and Prevention (40) and the Australian Department of Health (85) have made this error, and research containing this error has been published in the eminent New England Journal of Medicine (86). In the Australian Department of Health case, the mistake appeared when a previously published document was updated and a seemingly simple and innocuous “find and replace” undertaken with the word “women” switched with “people.” This change made the statistics on disease severity incorrect (see Supplementary Material 1 for further details). Carelessness may partly explain such errors, but there appears to be no easy way to straightforwardly communicate scientific information about female reproduction without using sexed terms. The misrepresentation of research and health communication during a pandemic ought to raise serious concern about how inappropriately desexing language can undermine public health.