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Abstract

Some midwives and related professionals agree with concerns expressed in the popular media about the removal of the “sexed terms” woman and mother from reproductive healthcare discourse. They contend that while gender may be chosen and diverse, biological or reproductive sex is immutable and anatomically based. It follows, they claim, that while we may affirm people’s gender choices, binary sex ought to be the identifying factor in reproductive healthcare, research, and advocacy. Sex-based language advocates also make the unexamined metaphysical assumption that reality is material and natural and that sex is on this unshakable, grounding level. In contrast, I argue that they ignore the true complexity and diversity of sex/gender differentiation and are motivated by their own situated, politicized gender identity. These beliefs result in measurable reproductive harm to trans, nonbinary, and other gender diverse individuals.

Keywords

trans reproductive rights healthcare sex-based language gender reproductive justice

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References

Abdullah

Afi

Assoumana

Camacho-Hübner

Homer

Hughes

Breen Kamkong

(2021). The state of the world’s midwifery report. United Nations population fund.

Ainsworth

(2015). Sex redefined. Nature, 518(February 19), 288–291. https://doi.org/10.1038/518288a

Bauer

G. R.

Hammond

Travers

Kaay

Hohenadel

K. M.

Boyce

(2009). “I don’t think this is theoretical; this is our lives”: How erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care, 20(5), 348–361. https://doi.org/10.1016/j.jana.2009.07.004

Beatie

(2009). Labor of love: The story of one man’s extraordinary pregnancy: Seal Press.

Beauvoir

S. D.

(2011). The Second Sex. [Trans Constance Borde and Shelia Malvonay-Chevallier]. Vintage.

Beckman

E. N.

Susan

(1985). Endometriosis of the prostate. The American Journal of Surgical Pathology, 9(5), 374–379. https://doi.org/10.1097/00000478-198505000-00008

Betran

A. P.

Moller

A.-B.

Souza

J. P.

Zhang

(2021). Trends and projections of caesarean section rates: Global and regional estimates. BMJ, 6, e005671. https://doi.org/10.1136/bmjgh-2021-005671

Briggs

George

B. R.

(2019). Words for every body. In Aeon Why trans-inclusive language is no threat to cis women | Aeon Essays. Aeon.com.

Burke

Seltz

(2018). Mothers’ nature: Feminisms, environmentalism, and childbirth in the 1970s. Project MUSE, 30(2), 63–87. https://doi.org/10.1353/jowh.2018.0014

10.

Burkett

(2015). What makes a woman? The New York Times. https://www.nytimes.com/2015/06/07/opinion/sunday/what-makes-a-woman.html

11.

Butler

(1993). Bodies that matter: On the discursive limits of “sex”. Routledge.

12.

Carolan

Kruger

(2011). Undertaking midwifery studies: Commencing students’ views. Elsevier BV, 27(5), 642–647. https://doi.org/10.1016/j.midw.2009.10.002

13.

Coleman

Radix

A. E.

Bouman

W. P.

Brown

G. R.

De Vries

A. L. C.

Deutsch

M. B.

Ettner

Fraser

Goodman

Green

Hancock

A. B.

Johnson

T. W.

Karasic

D. H.

Knudson

G. A.

Leibowitz

S. F.

Meyer-Bahlburg

H. F. L.

Monstrey

S. J.

Motmans

Nahata

Arcelus

(2022). Standards of care for the health of transgender and gender diverse people, version 8. Informa UK Limited, 23(1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644

14.

Currah

(2022). Sex is as sex does: Governing transgender identity. New York University Press.

15.

Dahlen

(2021a). Do We Need the Word ‘woman’ in Healthcare? Oxford University Press. https://doi.org/10.1136/postgradmedj-2021-140193

16.

Dahlen

(2021b). De-Sexing the Medical Record? an Examination of Sex Versus Gender Identity in the General Medical Council’s Trans Healthcare Ethical Advice, Informa UK Limited, 26(1), 38–52. https://doi.org/10.1080/20502877.2020.1720429

17.

Eder

Roomaney

(2023). Transgender and non-binary people’s perception of their healthcare in relation to endometriosis. International Journal of Transgender Health, 25(4), 911–925. https://doi.org/10.1080/26895269.2023.2286268

18.

Ellis

S. A.

Wojnar

D. M.

Pettinato

(2014). Conception, pregnancy, and birth experiences of male and gender variant gestational parents: it’s how we could have a family. Wiley, 60(1), 62–69. https://doi.org/10.1111/jmwh.12213

19.

Evenden

(2000). The midwives of seventeenth-century London. Cambridge University Press.

20.

Flores

A. R.

Herman

J. L.

Gates

G. J.

Brown

T. N. T.

(2016). How many adults identify as transgender in the United States? https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-asTransgender-in-the-United-States://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-asTransgender-in-the-United-States.pdf (Accessed November 8, 2016).

21.

Gaskin

I. M.

(1978). Spiritual midwifery on the farm in summertown, Tennessee. Birth, 5(2), 102–104. https://doi.org/10.1111/j.1523-536X.1978.tb01258.x

22.

Goodman

Adams

Corneil

Kreukels

Motmans

Coleman

(2019). Size and distribution of transgender and gender nonconforming populations: A narrative review. Elsevier BV, 48(2), 303–321. https://doi.org/10.1016/j.ecl.2019.01.001

23.

Grant

Mottet

L. A.

Tanis

Herman

J. L.

Harrison

Keisling

(2010). National transgender discrimination survey report on health and healthcare.

24.

Greenfield

Darwin

(2023). LGBTQ+ new and expectant parents’ experiences of perinatal services during the UK’s first covid-19 lockdown. Birth, 5(1), 134–143. https://doi.org/10.1111/birt.12780

25.

Greenlees

Bryder

(Eds.), (2013). Western maternity and medicine, 1880–1990. Pickering and Chatto.

26.

Gribble

K. D.

Bewley

Bartick

M. C.

Mathisen

Walker

Gamble

Bergman

N. J.

Gupta

Hocking

J. J.

Dahlen

H. G.

(2022). Effective communication about pregnancy, birth, lactation, breastfeeding and Newborn care: The importance of Sexed Language. Frontiers Media SA, 3(3), 818856. https://doi.org/10.3389/fgwh.2022.818856

27.

Herman

J. L.

Flores

A. R.

O’Neill

K. K.

(2022). How many adults and youth identify as transgender in the United States? The Williams Institute.

28.

Heyes

(2003). Feminist solidarity after queer theory: The case of transgender. Signs: Journal of Women in Culture and Society, 28(4), 1093–1120. https://doi.org/10.1086/343132

29.

Hoffkling

Obedin-Maliver

Sevelius

(2017). From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy and Childbirth 17(Suppl 2):332, 8-20. DOI 10.1186/s12884-017-1491-5

30.

House of Lords . (2021). Ministerial and other maternity allowances bill: volume 810: debated on Monday 22 February 2021. Hansard. https://hansard.parliament.uk/lords/2021-02-22/debates/EF8A7974-0A9C-4F17-B9DC-B7D26E52D52F/MinisterialAndOtherMaternityAllowancesBill

31.

Hunte

(2021). Brighton NHS trust introduces new trans-friendly terms. BBC News. https://www.bbc.com/news/uk-england-sussex-56007728

32.

International Confederation of Midwives . (2014). International code of ethics for midwives. https://www.internationalmidwives.org/our-work/policy-and-practice/international-code-of-ethics-for-midwives.html

33.

James

S. E.

Herman

J. L.

Rankin

Keisling

Mottet

Anafi

(2016). The report of the 2015 U.S. Transgender survey. National Center for Transgender Equality.

34.

Jones

Carroll

Parker

Steers

Ormandy

Filoche

(2024). Developing a transgender and non-binary inclusive obstetrics and genaecology undergraduate medical curriculum in Aotearoa/New Zealand: Where are we at, and where do we need to be? The Australian and New Zealand Journal of Obstetrics and Gynaecology, 64(1), 15–18. https://doi.org/10.1111/ajo.13746

35.

Kachen

Pharr

J. R.

(2020). Healthcare access and utilization by transgender populations: A United States transgender survey study. Transgender Health, 5(3), 141–148. https://doi.org/10.1089/trgh.2020.0017

36.

Kaplan

Rogers

(2010). Gene worship. Penguin House.

37.

Kariyawasam

Rai

Sharma

(2025). Beyond inclusion politics: A critical discourse analysis of sex and gender in medical education. Medical Education, 59(3), 302–308. https://doi.org/10.1111/medu.15532

38.

Ker

Shaw

R. M.

(2024). Trans reproductive imaginaries: Access and barriers to fertility preservation and family creation. LGBTQ+ Family: An Interdisciplinary Journal, 20(2), 140–150. https://doi.org/10.1080/27703371.2024.2304747

39.

Kukura

(2022). Reconceiving reproductive health systems: Caring for trans, nonbinary, and gender- expansive people during pregnancy and childbirth. Journal of the American Society of Law, Medicine & Ethics, 50(3), 471–488. https://doi.org/10.1017/jme.2022.88

40.

Legato

M. J.

(2018). Untangling the gordian knot of human sexuality. Gender and the Genome, 2(2), 62–67. https://doi.org/10.1177/2470289718803639

41.

Lewis

(2021). Why I’ll keep saying 'pregnant women. In The Atlantic (Vol. 26). Atlantic Media Company. https://www.theatlantic.com/ideas/archive/2021/10/pregnant-women-people-feminism-language/620468/

42.

LGBT Foundation . (2022). LGBT foundation 2022 report.

43.

Mander

Murphy-Lawless

(2013). The politics of maternity. Routledge.

44.

Mason

(2011). Two kinds of unknowing. Hypatia, 26(2), 294–307. https://doi.org/10.1111/j.1527-2001.2011.01175.x

45.

McIntosh

(2012). A social history of maternity and childbirth: Key themes in maternity care. Routledge.

46.

Meerwijk

E. L.

Sevelius

J. M.

(2017). Transgender population size in the United States: A meta-regression of population-based probability samples. American Public Health Association, 107(2), e1–e8. https://doi.org/10.2105/ajph.2016.303578

47.

Midwives Alliance of North America . (2023a). Dignity birth campaign. https://mana.org/healthcare-policy/dignity-birth-campaign (Accessed 8/30/2023).

48.

Midwives Alliance of North America . (2023b). Normal physiologic birth. https://mana.org/research/normal-physiologic-birth-2 (Accessed 8/30/2023).

49.

Muldoon

O. T.

Reilly

(2003). Career choice in nursing students: Gendered constructs as psychological barriers. Journal of Advanced Nursing, 43(1), 93–100. https://doi.org/10.1046/j.1365-2648.2003.02676.x

50.

National Association of Certified Professional Midwives . (2008). Midwives model of care. https://www.nacpm.org/midwives-model-of-care (Accessed 3 2 2014).

51.

Nove

Friberg

I. K.

De Bernis

Mcconville

Moran

A. C.

Najjemba

Ten Hoope-Bender

Tracy

Homer

C. S. E.

(2021). Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: A lives saved tool modelling study. Elsevier BV, 9(1), e24–e32. https://doi.org/10.1016/s2214-109x(20)30397-1

52.

Parker

Kelly

Miller

Van Wagner

Handa

Baddock

Griffiths

Kelsey

Neely

Wilson-Mitchell

(2023). Taking up the challenge of trans and nonbinary inclusion in midwifery education: Reflections from educators in Aotearoa and Ontario Canada. Midwifery, 118, 1–8. https://doi.org/10.1016/j.midw.2023.103605

53.

Parker

Kelsey

Miller

S. C.

Griffiths

Ker

Baddock

S. A.

(2025). Embedding LGBTQIA+ health equity in midwifery education: A holistic whole-of-programme approach. Women and Birth: Journal of the Australian College of Midwives, 38, 1–6. https://doi.org/10.1016/j.wombi.2024.101850

54.

Pezaro

Pendleton

van der Waal

LaChance Adams

Santos

M. J. D. S.

Bainbridge

Istha

Maeder

Gilmore

Webster

Lai-Boyd

Brennan

A. M.

Newnham

(2024). Gender-inclusive language in midwifery and perinatal services: A guide and argument for justice. Birth, 00, 1–13. https://doi.org/10.1111/birt.12844

55.

Powell

(2022). A vanishing word in abortion debate: ‘Women’. The New York Times. https://www.nytimes.com/2022/06/08/us/women-gender-aclu-abortion.html

56.

Rei

Williams

Feloney

(2018). Endometriosis in a man as a rare source of abdominal pain: A case report and review of the literature. Case Reports in Obstetrics and Gynecology, 31, Article 2083121. https://doi.org/10.1155/2018/2083121

57.

Renata

(2022). Toward a nonbinary model of gender/sex traits. Hypatia, 37(2), 402–421. https://doi.org/10.1017/hyp.2022.10

58.

Renfrew

(2020). Scaling up care by midwives must now be a global priority. The Lancet Global Health, 9(1), e2. https://doi.org/10.1016 S2214-109X(20)30478-2

59.

Riggs

Fischer

A. S.

Lotfy

H. A.

(2016). In Reilly

A. O. ’

(Ed.), Trans parenting in maternal theory. Demeter Press.

60.

Rizk

Fischer

A. S.

Lotfy

H. A.

Turki

Zahed

H. A.

Malik

Holliday

C. P.

Glass

Fishel

Soliman

M. Y.

Herrera

(2014). Recurrence of endometriosis after hysterectomy. Facts, views & vision in ObGyn, 6(4), 219–227.

61.

Rock

J. A.

Markham

S. M.

(1992). Pathogenesis of endometriosis. Lancet, 340(8830), 1264–1267. https://doi.org/10.1016/0140-6736(92)92959-J

62.

Rogers

L. J.

(2001). Sexing the brain. Columbia University Press.

63.

Romboy

(2021). What ann Romney, a mother of 5, thinks about the term ‘birthing person. Deseret News. https://www.deseret.com/utah/2021/6/14/22533379/ann-romney-mother-of-five-comment-birthing-person-mitt-romney-federal-budget

64.

Ross

L. J.

Solinger

(2017). Reproductive Justice: An Introduction. University of California Press.

65.

Stroumsa

J. P.

(2018). Welcoming transgender and nonbinary patients: expanding the language of “women’s health”. Elsevier, 219(6), 585.e1–585.e5. https://doi.org/10.1016/j.ajog.2018.09.018

66.

Ulrich

(2009). Applicants to a nurse-midwifery education program disclose factors that influence their career choice. Journal of Midwifery & Women’s Health, 54(2), 127–132. https://doi.org/10.1016/j.jmwh.2008.09.002

67.

United Kingdom Council of Deans of Health . (2025). Council 2025 strategy. https://www.councilofdeans.org.uk/wp-content/uploads/2021/10/Strategy.2025_v3.pdf

68.

United Kingdom Network of Professors of Midwifery and Maternal and Newborn Health . (2023). Position Statement: Use of sexed language in relation to women’s reproductive health. https://www.councilofdeans.org.uk/wp-content/uploads/2024/02/Position-Statement-Use-of-sexed-language-FINAL-May-2023.pdf

69.

Wilson

(1995). The making of man-midwifery: Childbirth in england, 1660-1770. Harvard University Press.

70.

With Woman . (2022). Why we are with Woman. https://with-woman.org/2022/04/30/why-we-are-with-woman/ (Accessed 2/15/2023).

71.

Woman Centered

Midwifery.

(2015). Pregnancy and birth can never be “biologically neutral”. https://womancenteredmidwifery.wordpress.com/ (Accessed 2/15/2020).

72.

Woman Centered Midwifery Letter to MANA . (2023). https://womancenteredmidwifery.wordpress.com/take-action/ (Accessed 9/4/2023).

73.

Ziemińska

(2022). Toward a nonbinary model of gender/sex Traits . Hypatia, 37(2), 402–421.

Midwifery and the Politicized Logic of “Sex-Based” Childbirth Discourse

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