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The good and important intention behind these changes is sensitivity to, and acknowledgment of, the needs of people who are biologically female and yet do not consider themselves to be women because of their gender identity 1. However, these changes are often not deliberated regarding their impact on accuracy or potential for other unintended consequences. In this paper we present some background to this issue, describe various observed impacts, consider a number of potentially deleterious consequences, and suggest a way forward.
Sex a reproductive category , gender a societal role , and gender identity an inner sense of self are not synonymous 2 , 3. Sex is salient to reproduction, as there are only two gametes and pubertal pathways to adulthood and gamete production, and only one gamete producing body type that becomes pregnant 2. As a general principle of communication it is well established that the sex of individuals should be made visible when it is relevant and should not be invoked when it is not 4 — 9.
This facilitates avoidance of sex stereotyping while ensuring that sex-based needs and issues are not overlooked 4 — 9. Yet, this usage has been challenged in response to rising numbers and visibility of people who have a gender identity which means they do not wish to be referred to as such 10 , As described below, we should address individuals as they wish 12 , but more broadly there are risks to desexing language when describing female reproduction.
The discussion here is presented with an explicitly global audience in mind. While people who do not conform to the social expectations of their sex are ubiquitous throughout the world, the response to such individuals is influenced by culture in which they reside. This includes in the level of acceptance or marginalization they experience, the ways in which they are accommodated and the ways in which their non-conformity is conceptualized It should be recognized that the penalty for non-conformity with gender roles can be high Where the concept of gender identity is salient, desexing the language of female reproduction has emerged as an accommodation to remedy marginalization 10 , However, it needs to be kept in mind that pregnant and birthing women and new mothers and their infants have unique vulnerabilities and also require protection.
