The Need for Gender Inclusive Reproductive Health
Society loves to use language and ideas to sort and put people into specific categories. Due to this if someone doesn’t fit within the set parameters of a category they are viewed as abnormal and there is a push for them to change or conform to the set parameters. If this doesn’t happen, the person will find themselves further pushed either to conform or they are discarded in the form of erasure of their identity. This has been seen with the push against transgender, non-binary, gender non-conforming, and intersex people in Western society.
As these groups push for inclusion and recognition the groups that have for most of Western society’s history are pushing back to keep themselves as the ones who fit into the available categories instead of working to expand or even create new categories to allow inclusion. In the field of healthcare there is a push for inclusivity in regards to menstruation and pregnancy, two areas what have for decades been viewed as “female only” and therefore off limits to men and those who do not fit into the binarist view of gender. This push is not without issue, but the only way to include and provide accurate medical care and provide education is to ensure that the healthcare is gender inclusive regardless of the attempts to enforce the erasure of anyone outside of the currently strict confines of reproductive healthcare.
For the purposes of this paper, instead of writing out cisgender women, trans masculine, and non-binary I will be using the term AFAB (Assigned Female At Birth) to refer to the collective group. There are certain intersex conditions that also allow for menstruation and pregnancy, though in many cases intersex children have their gonads removed leaving them sterile. Because of this they will be included in this paper along with AFAB non-intersexed individuals.
The main barrier to gender inclusive healthcare is our society’s use of gendered language. The vulva, vagina, uterus, ovaries, etc are viewed as “female” anatomy, which is why those born with those parts are deemed to be female upon birth even if it turns out later that they are intersex or have a gender other than female. The idea that certain body parts, aspects, and ideals are connected to a certain gender is rooted in what is known as cissexism or cisnormativity which is the idea that anything that is cisgender is normal or natural and anything else is abnormal, unnatural, or bad. Lal Zimman pointed out in their article, Transgender language reform: some challenges and strategies for promoting trans-affirming, gender-inclusive language that using certain words such as man or woman to interchangeably refer to a person’s physiology, childhood socialization, perceived gender, or gender identity is just one of the many ways that our use of language helps to enforce cissexism. In gendering these body parts AFAB people who are not cisgender are being excluded from discussions about reproductive healthcare in many areas as was seen when the company Rubycup had to issue an apology letter due to excluding trans masculine people during a survey regarding the satisfaction of their product. Their survey only allowed one to complete it if they marked that they were female, sending anyone who marked male to the end. By assigning menstruation to a specific gender they wound up in essence telling anyone who wasn’t a cis woman that their opinion didn’t matter.
While it may feel odd or even cumbersome to say “people who menstruate” or “menstrual care product” in the beginning it is important to remember that language and by extension education is ever evolving and expanding. Through repetition and practice gender neutral or gender inclusive terms will become “normal” and any push back seen against the terminology will become the minority rather than commonplace. Simple actions such as using gender neutral terms for menstruation and products used during menstruation aim to include all AFAB and menstruating intersex persons in not only medical care but education as well. Instead of referring to products as “feminine hygiene products” one can simply refer to them as “hygiene products” or “menstrual care products.”
The same can be done for pregnancy, though as was seen in the open letter to the Midwives Alliance of North America, there is a hard push against gender inclusive language. People such as Michelle Peixinho Smith and Mary Lou Singleton (supposedly on behalf of the Women’s Liberation Front) stated that by using gender the gender inclusive language of “pregnant individual” and “birthing parent” that it was “harmful to female adult humans” and that these actions were erasing the long and hard fight that (cis) women have had in being recognized as autonomous beings (“Open Letter to MANA”, 2015). The response to the open letter from the medical community has shown that these claims are inaccurate and harmful to AFAB persons who do not identify as female. The group Birth for Every Body refuted the open letter, stating that by using gender inclusive language they are upholding the rights of bodily autonomy and self-determination for all people, and that through gendering body parts such as the uterus one rejects said autonomy and self-determination (Caffrey, Carter, Darlin, et al, 2015).
Because there are currently no studies to document just how many AFAB people who don’t identify as cisgender woman have experienced pregnancy the main focus has been on menstruation, as almost all AFAB individuals experience menstruation unless they lack a functioning uterus due to either being born without one, were born with a non-functioning one, or have a medical condition that prevents their uterus from functioning properly. As demonstrated in the article Transgender men and pregnancy, there is a very real need for medical professionals to incorporate inclusive policies and to work on educating not only themselves in caring for and assisting AFAB and intersex persons when dealing with matters of pregnancy and postnatal care, but also for medical care in general for AFAB persons. The authors bring to note that many health professionals are left unprepared to care for these people, often having to either refer their patients to someone else or struggling to provide quality care if their patient isn’t cisgender. Questions such as when a how to determine when breast cancer screening protocols should be implemented, or the effects of cross-sex hormones on reproductive cycles (and pregnancies) are difficult to answer due to the lack of scientific studies available, especially in regards to trans masculine persons.
The need for gender inclusive reproductive healthcare is apparent, yet due to the lack of education, resources, and the push back from groups seeking to invalidate those who do not conform to a cissexist view of gender and sex make it difficult for those most in need of said care to get what they need. The use of gendered language and socialization of certain aspects being associated to a specific gender, such as menstruation and pregnancy being deemed women’s issues, add to the hurdles needed to be overcome as medical professionals and patients alike strive towards comprehensive and accurate healthcare for all AFAB and intersex persons. By pushing back against those seeking to erase non-cisgender AFAB persons through education and evolution of Western society’s terminology regarding pregnancy and menstruation the path to inclusive healthcare begins to form. Studies and better access to current data and resources will assist providers and patients in ensuring accurate medical care, and by using gender neutral or gender inclusive language when discussing topics dealt with by non-cisgender AFAB and intersex persons, those who have for decades been excluded from care can finally begin to experience the same levels of care that cisgender women have experienced.
Caffrey, A., Carter, A., Darlin, J., & MacDonald, T. (n.d.). Response to the Open Letter to MANA. Retrieved from http://www.birthforeverybody.org/response-to-open-letter
Obedin-Maliver, J., & Makadon, H. J. (2015). Transgender men and pregnancy. Obstetric Medicine,9(1), 4–8. doi:10.1177/1753495x15612658
“Open Letter to MANA”. (2015, August 20). Retrieved from https://womancenteredmidwifery.wordpress.com/take-action/
Sayer, L. (2017, August 04). We need to apologize, dear Transgender Community. Retrieved from https://rubycup.com/blog/on-transgender-periods/
Zimman, L. (2017). Transgender language reform: Some challenges and strategies for promoting trans-affirming, gender-inclusive language. Journal of Language and Discrimination, 1(1). doi:10.1558/jld.33139