With Woman

Earlier this month, an Open Letter (read the full text of it here) from a collective of UK LGBTQ+ perinatal workers was published, as a ‘means to have a voice’ for inclusion.

This is our response. 

We too are a collective. We are feminist perinatal workers, mainly in the UK, with several international members. We view the influence of transgender ideology on the maternity services as harmful to women. 

We know everyone who is pregnant and everyone who gives birth is female, no matter what gender identity, or none, they may have. Denying the impact of shared biological sex on the experience of the maternity services undermines the work of the many healthcare professionals and others who understand these services exist in a sexist, patriarchal framework. 

We strongly agree with the Open Letter that everyone who needs the maternity services has the right to give birth ‘safely supported’ with care from people ‘who will protect [their] mental and physical health’. 

But beyond this, we reject much of the Open Letter’s content. 

The Open Letter claims people who hold a sexed understanding of humanity and language want to hurt LGBTQ+ people. We are told we would prefer them not to exist as parents. This misrepresents us personally, and the issues at play. 

We are critical thinking women. We frequently work with and support lesbian and bisexual mothers and gender non-conforming women. Many of us consider ourselves to be gender non-conforming, and that our work can be a powerful act of defiance against patriarchal norms. 

We are no allies of anyone who wants to ‘hurt’ any parents highlighted in the Open Letter, or who want them ‘not to exist’. 

Our issue is not with individuals but with the ideological claim that beliefs about gender must be prioritised, at the expense of the material reality of biological sex. 

We reject this ideology and its imposition on us, on mothers as a group, and as a general political analysis. Put simply, we don’t believe that gender identity is more important than sex, or that an understanding of sex can be replaced, or ignored, in favour of gender identity. 

Upholding the sexed use of language says nothing about any mother’s sexuality, identity, gender presentation, family format, preferences, beliefs or choices. Biological sex is the most inclusive category of all women across all nationalities, cultures and throughout human history.

Our specific counterpoints to the Open Letter are:

1. Why are the needs of lesbians in the maternity services bundled together with the needs of gay men, and indeed with the needs of transmen (women whose gender identity is male), who may or may not be lesbian? The needs of LGBT+ people are not homogenous and should not be treated as such.

2. The Open Letter’s claim that the ‘gender binary’ is a modern concept is ludicrous. Sex stereotypes and sex-limited or sex-defined roles are seen historically in almost every documented society.

In fact, the ‘gender binary’ is a collection of cultural, social stereotypes and expectations, imposed by often rigidly-enforced patriarchal pressures. 

The Open Letter references the idea that the ‘gender binary’ was not strict in ancient times with a link to the story of a female Egyptian pharaoh. That’s like suggesting Queen Elizabeth I (or Boudicca), reigned over a ‘gender-binary free’ England. We don’t think that is the case! 

We challenge sex stereotypes and the imposition of sex role expectations everywhere – but to do this, we have to accept, and acknowledge, biological sex.

3. Family composition is changing, and here we agree that health workers’ training should emphasise this, and that policies should enable easy accessibility for all. Documentation in the maternity services should of course be updated and made flexible, to include mothers who want to be recorded with a gender identity alongside their biological sex. Just as important is that partners, birth partners and next of kin are recorded according to the mother’s wishes.

In current UK law, a mother is always the person who gives birth to the baby and will be recorded as such on the birth certificate, which documents sex and not gender identity. The Open Letter calls for this to change – but the birth certificate belongs to the infant, who has a right to a factual and accurate account of his or her origins. 

4. We see little acknowledgement in the Open Letter of the crucial need for midwives and other birth workers to centre the mother, with the mother-baby dyad as the focus of care. 

5. As birth workers, we understand the long history of harm caused to women as a result of attitudes and processes developed without consultation. Many interventions originate from an expectation that women will comply with imposed practice. We believe that is wrong, and so we refuse to submit to fundamental changes in practice and communication without examining the implications for all women. 

Services which have removed sex-based language in favour of a gendered understanding of language have rightly been criticised and questioned – sometimes robustly. We reject the Open Letter’s description of this non-compliance as ‘attacks’ (though of course threats of violence are never justified). 

Women who wish to discuss the impact of privileging gender identity over sex have a right to express their view. We reject the claim that having this discussion denies trans people their existence or causes harm. The real harm is in the stifling of debate and bad faith representation of women as bigots.

6. We need to understand what ‘erasure’ and ‘exclusion’ mean, without acting as if anyone is under threat of extinction. 

Sexed language is certainly being erased in research, in policy documents, in guidelines to workers, in professional and volunteer settings. This is a serious error.

Within the worlds of women’s health, maternity and reproductive services, accurate and clear terminology is important. Changing this language conflates sex with gender identity, and leads to lack of clarity for sexed women throughout their lives, from menarche to maternity to menopause. Women whose first language is not English, women with literacy or language challenges and women who simply don’t want to be ‘birthing people’ may well have a view. No impact assessments have been made, as far as we can see. 

In addition, how can we value the powerful nature of women’s reproductive bodies, if we can’t name them as, indeed, distinctively women’s bodies? How can we retain the glory of pregnancy, birth and breastfeeding if we can no longer name them as sexed, female processes, that men cannot share? 

So-called ‘additive language’ – a suggested idea in the Open Letter – doesn’t help in any way. ‘Women and birthing people’ in a document sounds like there are two different sorts of people who give birth. It’s confusing, divisive and inaccurate….and still denies the impact of biological sex. We also know that in real life the result of additive language is that the words ‘woman’ and ‘mother’ disappear – often for practical reasons of space and time, and other times to deliberately omit the whole notion of   ‘women’ as a biological sex.

7. We believe, nevertheless, that individual conversations and individual care should centre that individual, and without question, use terms requested by that same individual. That’s part of normal, good care.

8. The Open Letter demands that LGBTQ + people are paid   – we really don’t understand this, beyond the normal remuneration anyone might have for their work. We’re told not being paid ‘re-traumatises’. It’s as if trauma can be resolved with a bank transfer. Hardly. 

We believe honest acknowledgement of biological reality in a sexist world allows us all to campaign for women and birth workers. We struggle with poor staffing, defensive practice, reduced resources…all limiting our ability to care properly for everyone who doesn’t fit ‘the norm’ .Woman-centred care is under threat across the whole professional and volunteer area. 

Maternity services weren’t designed for us either, in truth, but for those with ‘authoritative knowledge’ who followed, and follow, a medical model of care, which as we all agree, fails so many in our care. 

With Woman Collective