Wednesday 22 May 2024

Inclusive Language in Perinatal and Postnatal Care

In this post, Kathleen interviews Matthew Cull (University of Edinburgh), Jules Holroyd (University of Sheffield), and Fiona Woollard (University of Southampton) on their funded exchange project 'Inclusive Language in Perinatal and Postnatal Care'. 

Poster from

Hello! Can you tell us a little bit about your recent project?

The project is a knowledge exchange project, about how to make language gender inclusive in perinatal and postnatal care. We’ve recently written a paper, which we’re nearly ready to submit for publication, about how standard approaches to inclusive language tend to be ‘monistic’: they aim to use one strategy, either making language gender-neutral (e.g. replacing ‘pregnant women’ with ‘pregnant people’) or gender additive (e.g. writing ‘pregnant women, trans men and nonbinary people’).

Working through a number of case studies, we find that no single strategy can meet the moral and communicative goals in all contexts. And, in fact, when attempts at using inclusive language are not done as well as they might be, this can fuel backlash and resistance to inclusion. Instead, a ‘pluralistic’ approach, which uses a range of linguistic devices, is needed. This means that reforms have to be done on a case by case basis, with careful eye on those goals in the particular context. But this is quite labour and time intensive, and there are a lot of potential cases! So we applied for knowledge exchange funds to support work with particular practitioners and policy makers on how to improve inclusive language.

How did the members of your group become interested in these issues?

My (Jules) experiences of pregnancy and childbirth were fraught with discomfort at the highly gendered aspects of it (e.g. being called ‘mum’ at every midwife appointment, having to sign up to taking ‘maternity’ leave). Shortly after having my first child, I worked with Matthew on a paper that applied Dembroff and Wodak’s work on gender-neutral pronouns to parenting labels, and we argued that using gender-neutral parenting labels (‘parent’ rather than ‘mother’ or ‘father’; ‘parental’ rather than ‘maternal’ or ‘paternal’) were both supported by Dembroff & Wodak’s arguments, and easily implementable in (e.g.) higher education parental leave policies. (The paper is forthcoming here. We’re still working on persuading our institutions to make those changes though!!).

Matthew themselves came to these issues through trans philosophy, and especially thinking about how we can use language to reshape our social practices to make the world a better place to be transgender. Whilst their book (What Gender Should Be, available in all good bookshops next year) focused mainly on engineering our concepts of gender, they have recently been getting more and more annoyed with how trans healthcare is run.

Meanwhile, Fiona had argued that our expectations of mothers are over-demanding in a way that harms parents, causing guilt, shame and feelings of being judged and required to justify their parenting decisions partly around hot button topics like infant feeding. She had originally spoken about harm to mothers, because these expectations did seem to be specifically around motherhood. However, she met parents who were treated as mothers - and so directly affected by overdemanding expectations of mothers - but did not see themselves as mothers. 

She began exploring what makes a parent count as a mother, and how gender impacts our experiences of parental duties. Fiona became aware that arguments against inclusive language seemed to be influencing policy makers and activists in infant feeding, and thought that a philosophical response was needed, so got in touch. We started writing a response paper, and over the course of doing so, we came to the conclusion that none of the existing approaches to inclusion alone were adequate, and formulated our own pluralistic approach, as described above. Our project poster gives a snapshot of the approach we take.

What is important about the topic and what do you hope it will contribute to ongoing work/debates?

We think the heavily gendered language in and around perinatal care alienates a lot of people: lesbian, bisexual and gay couples, surrogate families, and even cisgender heterosexual people who dislike the connotations of being called ‘mums and dads’. However, we’re especially concerned with the effects of this kind of exclusive language on trans people who might want to access perinatal care. Over 1% of births in England are to people whose gender does not match that which they were assigned at birth (CQC Maternity Survey 2022, see also Pearce et al 2023). 

Recent reports on the experiences of trans and non-binary people accessing perinatal care indicate that “28% of trans and non-binary respondents [to a survey about perinatal care] said they were not treated with dignity and respect during labour and birth” (LGBT Foundation, 2022, 9). Interviewees in the report describe their experiences of exclusion, and the harms experienced as a result:

“I felt there was no framework of language that was inclusive of people who do not identify within the gender binary so it was consistently a triggering experience” (2022, 22).

Yet, the NHS handbooks commit to values of respect, equality, and dignity. Moreover, their style guide explicitly makes a commitment to using inclusive language where possible. Clearly, there is a gap between aspiration and reality. And, we acknowledge, using inclusive language can be hard and sometimes involves carefully navigating competing goals. It is worth making the time to have discussions about inclusive formulations, and how to balance those competing values.

As a bunch of philosophers with (collective) expertise in pregnancy and parenthood and trans philosophy, and with a range of relevant experiences in this area, it felt like we could really say something useful about it, with the hope of improving things! The aim is to equip people writing public facing documents with a ‘conceptual toolkit’ to approach future writings. Since language is evolving, no one phrasing will be adequate forever, but feeling comfortable with the competing goals and challenges can better equip people to communicate in an inclusive way.

What are the future plans for the project?

The aim is to run a couple of workshops over the course of the project. We’d like these to have a ‘troubleshooting’ style format, where people bring resources they’d like to make (more) inclusive, and that we can work through together with a ‘conceptual toolkit’ on hand. It is very much a knowledge exchange project, as the different examples people bring help us to formulate and finesse our understanding of what inclusive language involves. For example, in our paper, we work through 6 different examples, from different sources (e.g. NHS public facing materials, government advice pages), about care in a range of contexts - tests available if you’re pregnant; risks of covid vaccinations for those who are pregnant; support during childbirth; post-natal checks offered; support for infant feeding, and cervical screening. Each example we considered posed a different set of challenges that required careful thought: simply pressing Ctrl-F and replacing all instances of ‘women’ with ‘people’ doesn’t always cut it!

So we’d love to have as many conversations, about as many different perinatal and postnatal care contexts as possible. And our overarching hope is that collaborative work helps to make care more inclusive in future.

If you’d like to participate in the project - either through ongoing conversations or the upcoming workshops (scheduled for Spring & Summer 2024), please do get in touch with us! You can fill out this form to express interest in participation, or email us directly.