The Cissexist Language of Midwifery Care and Reproductive Justice.

I started trying to write a post on the way my pro-choice views on abortion intersect positively with my midwifery practice, but I realised that first I needed to address the way that the language of midwifery care and reproductive justice is cissexist. Lauren Rankin spells it out when she says

We must acknowledge and come to terms with the implicit cissexism in assuming that only women have abortions. Trans men have abortions. People who do not identify as women have abortions. They deserve to be represented in our advocacy and activist framework. Honestly, I am guilty of perpetuating that harmful myth, both in my rhetoric and framing. I often frame abortion restrictions as misogynistic attacks meant to control women’s reproductive lives, and that is true. But abortion restrictions also affect the lives of people who aren’t women, and they hinder trans men and gender-non-conforming people and others who were Designated Female at Birth (DFAB) from accessing abortion care, as well.

Lauren Rankin, Not Everyone Who Has an Abortion Is a Woman – How to Frame the Abortion Rights Issue

I went to a training day on abortion activism (run by Abortion Rights) last year, attended by feminists and anarchists involved or interested in grassroots activism and campaigning. And it was refreshing to talk about “people wanting/needing abortions” without the discussion stalling when the other people in the conversation couldn’t understand why we weren’t saying women, or worse refuting the fact that it’s not only women getting pregnant (radfems, I’m looking at you again). And yet even though the space we made challenged the cissexism of typical reproductive justice dialogue, the cissexist language was still was inescapable. The news clips we watched, the stats on how many abortions are performed in the UK each year all talk about women and women only. The statistics we have for UK abortion rates take into account every registered abortion, but they do not record the person’s gender because it is assumed they are women. These statistics we quote, that “1 in 3 women will have an abortion by the time they are 45 years old”… these statistics implicitly misgender all those people who are not women who have abortions.

The same happens in midwifery. Language misgenders, both implicitly and explicitly. Because, on both an individual and systematic level, the possibility of trans men and non binary people becoming pregnant is either not considered or wilfully ignored; all language is inherently cissexist.  As midwives we talk constantly about “the woman” (or worse, “the lady”) as though it had not even occurred to us that not everyone who is pregnant is a woman, or that these people do not exist, or that they are such a small minority that it is ok for our language to erase them.

It is not ok. But everyone does it. I am even finding myself doing it.

A couple of weeks into my training I started to realise I wasn’t imagining it, midwifery lecturers were constantly talking about “the woman” and as students we were picking it up too. I queried it, explaining that I realised we said “the woman” rather than  “the patient”, because midwifery is about providing care through a normal physiological event (pregnancy and birth) rather than treating illness. But what about those people who aren’t women who are pregnant..? After clarifying that I didn’t mean cis men who have a developing embryo implanted in their abdominal cavity(!), the lecturer told me there hadn’t been any non binary people or trans men who had accessed midwifery care in our city and this seemed to suggest my point was moot. I didn’t believe her (because I imagine there must have been people who were not women, but were read as such by staff who didn’t feel safe/comfortable/have the energy to come out) but the discussion moved on.

Aside from the obvious problem of potentially misgendering (implicitly or explicitly) individuals accessing maternity care by talking only about women, there is the further problem that the language we use shapes the way we think and the way we see the world. By talking only about women, we are conditioning ourselves to think only in terms of women, to assume womanhood of everyone in our care. It is both habit-forming and world-shaping. When I started my training I always said “pregnant person” but everything I read, everything I am taught is saying “women”, and I am starting to slip up, to give up, and it’s not good enough.

I want people of all genders to be able to access midwifery care if they need it, without worry that they will be misgendered. I want NHS midwifery staff to have awareness raising sessions so they understand what is meant by trans, non binary, cissexist, misgendering. I want to rid policies and guidelines of their cissexist language. I want space on the paperwork we fill in at initial midwifery booking appointments to have space to ask about the person’s gender so we don’t simply assume they are all women.

In the same way that there seems to be a slow but sure shift away from heteronormative language in midwifery care (as both policies and practitioners start to talk about “partners” rather than “husbands/fathers”) I want to see a shift away from cissexist language. A lot of the times when we are talking generally and we say women, we can instead more accurately say “people who menstruate”, “people with uteruses”, “people who are pregnant”, “people needing abortions”. Instead of saying “she” we can say “they”. We can find new ways to convey meaning.

And don’t tell me it’s too hard – it can’t be any harder than having to navigate a maternity service designed for women when you are not a woman – which is what we are essentially asking of some people unless we sort this out.

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