Minnesota Women’s Health Report Card: Glossary of Inclusive Language in MCH for Public Health Practice

(November 2022) By: Jenna Kacheroski, Dr. Zobeida Bonilla, Sara Benning, and Maternal and Child Health students from 2021 and 2022 PubH 6630 Foundations of Leadership in Maternal and Child Health course.

PURPOSE

This glossary intends to provide a reference guide when reading the Minnesota Women’s Health Report Card (MN-WHRC). This glossary reflects the current understanding of what the Center for Leadership Education in Maternal and  Child Public Health considers promising language practices in maternal and child health (MCH) and related work. 
This publication was inspired and guided by the MCH graduate students at the University of Minnesota School of Public Health, who challenged the normative language used in publications and prior report cards and encouraged alternatives for including more Minnesotans.

ROOM FOR GROWTH

There are challenges with using the socially constructed, binary categories of gender in the data sources that inform the MN-WHRC. There are limitations in the way current data collection is categorized, with noticeable gaps in the way some populations–like our transgender and non-binary communities– are not often represented in the data. 

Unless otherwise indicated, all data in the MN-WHRC capture women aged 18 years or older. The sample sizes also differ in each data reporting system. It is important to show data by race, ethnicity, zip code, and other characteristics, for focusing resources and interventions for populations in need. 

The terms “female” and “woman/women” are used interchangeably throughout the MN-WHRC based on the data collection methods and reporting of the data sources. As we can only report on the data that we have, we acknowledge that the data and language that is used in the MN-WHRC can resonate with some while making others feel uncomfortable, alone, or excluded.  We recognize that these terms are not inclusive of all gender identities and that multiple identities may have been present, but not properly captured, in the sampling

It is important to address the current limitations of language within research and in the MN-WHRC. Both written and spoken language have power, and affirming language can save lives.  As language also plays a central role in public health advocacy, we are committed to building inclusion by using gender-neutral language and welcoming all identities. Using gender-neutral, or desexed, language is most common in the English-speaking West, however, it can be disconcerting to some individuals and cultures1

RECOMMENDATIONS

Public health professionals have an obligation to become advocates for all people who utilize and need MCH services by being inclusive with their language in writing and practice. We recommend that future research and data reporting address the language used in alignment with the populations with whom they are working.

We invite you to be mindful of the setting and context you are working in to determine which terminology to use. Additionally, when deciding which terms, including pronouns, to use, ask the person what language feels best to them. Consider using “liberating language” [Britt Hawthorne] and gender-neutral alternatives when you are unsure what terms affirm an individual1

Please use the following glossary (page 2) and see the suggested terminology (page 3) for reference while reading the MN-WHRC and for use in practice. This glossary is not comprehensive; it will be continued to be updated annually by MCH students enrolled in PUBH 6630 at the University Minnesota School of Public Health.

Glossary

Affirming Care

Refers to care that supports a patient’s gender identity and must include inclusive terminology, practices, insurance coverage, and knowledgeable providers, and using the chosen name and pronouns chosen by individuals. Some people in the LGBTQ+ community may have changed their name and gender, informally or legally, to those that affirm their true gender identity1,14

Birthing person

Someone who gives birth, regardless of their gender identity, which may be female, male, nonbinary, or other6.

Chestfeeding

 A chest that may not be able to produce milk can still nurture babies through the benefits of skin-to-skin contact. People who don’t produce breast milk can still provide human milk through donor milk and bottle feeding. Transgender men and gender-nonconforming parents and caregivers may still breastfeed safely if they choose to, and may prefer the term chestfeeding over breastfeeding because it respects their identity7.

Cisgender

 A cisgender person’s gender identity matches the sex they were assigned at birth. For example, a person considered female when born and continues to identify as a woman is cisgender10

 Gender Expression

A person’s outward presentation of their gender through physical traits, clothing, makeup, hairstyle, nail polish, etc. which may or may not conform to socially typical characteristics or behaviors that are associated with masculinity or femininity12.

Gender Identity

A person’s own, internal sense of their gender, which does not necessarily match the sex assigned at birth or gender expression of an individual. It is subjective, and can not always be outwardly known or apparent1,9,11.

Non-binary/Gender Non-conforming (GNC)

Not limited to the gender of male or female. Some non-binary people have one gender identity which is neither male nor female. Some identify as more than one gender. Others do not identify with a gender. Some non-binary people move between genders or have changing gender identities10.

Reproductive Justice

A framework for thinking about the experience of reproduction that incorporates reproductive rights and social justice to achieve reproductive justice–which demands sexual autonomy and gender freedom for all. 

In addition, the three primary principles that all humans have are as follows:

1. the right not to have a child;

2. the right to have a child; and 

3. the right to parent children in safe and healthy environments2.

Transgender (Trans)

Is a broad term for people whose gender identity or expression (masculine, feminine, other) is different from their sex (male, female) at birth8. Trans people may or may not wish to modify their bodies to varying degrees by taking hormones or having surgery to affirm their gender identity and gender expression9.

Woman, Female 

“1. An adult female person.

 2.  of, relating to, or being the sex that typically has the capacity to bear young or produce eggs

3. having a gender identity that is the opposite of male”13.

Table 1: Terminology Recommendations

TerminologyDescription
Pregnant women; mothers-to-be; expectant mothers; expectant parent(s)When writing for communities, use terms that are inclusive of all gender identities: Pregnant people; parents-to-be; expectant parents5; Combinations of terms can be used for inclusivity and clarity, like Expectant mothers and expectant parents1
Mother, father, birth mother, birthing person, parent, gestational parent In practice, combinations may be used for clarity, such as “mothers and gestational parents”. A “mother” implies a family connection and the complex relationships embodied therein, but a “lactating person” does not imply family connections, and could be a person who is producing milk for donation or sale1
Breastfeeding, human milk feedingAn encompassing term that includes the production and giving of the milk to the infant and the bidirectional nurturing interaction between the mother and infant4
Chestfeeding, human milk feeding, nursingSame experience as breastfeeding, but chestfeeding and nursing are terms typically more affirming for transgender men4
Lactating, expressing, pumping Refers to the physiological process by which a person produces milk and “lets down” the milk so that it is available to the infant4
Breast milk, human milk, mother’s milk, expressed milk, parent’s milk, father’s milk1“Breast milk” may be preferred by some when discussing a mother’s milk, because a family connection may be implied, whereas “human milk” may be preferred for milk that is donated or sold, as no family connection is implied.1
2SLGBTQIA+ (or LGBTQIA or LGBTQ+); two spirit, lesbian; gay; bisexual; queer; pansexual; intersex, asexualNote: Use 2SLGBTQIA+ community (and not, e.g., gay community) to reflect the diversity of the community unless a specific subgroup is meant to be referenced. Avoid the use of Homosexual and MSM (men who have sex with men).5   Instead, consider using MLM (men loving men) and WLW (women loving women)15 . The “+” symbol represents any other queer identity not listed.
Transgender; assigned male/female at birth (AMAB, AFAB); designated male/female at birth; gender non-conforming; non-binary; genderqueerOutdated and inaccurate terminology to avoid include: Transgenders; transgendered;transsexual; biologically male/female;genetically male/female5
The table (above) is modeled after the CDC’s Health Equity Style Guide for the COVID-19 Response: Principles and Preferred Terms for Non-Stigmatizing, Bias-Free Language, a 2021 Academy of Breastfeeding Medicine position statement, and a 2019 article, “Affirming language use when providing health care for and writing about childbearing families who identify as LGBTQI+”, by Duckett, & Ruud. Note, that this table is not comprehensive. 

Sources

1Bartick, M., Stehel, E. K., Calhoun, S. L., Feldman-Winter, L., Zimmerman, D., Noble, L., Rosen-Carole, C., & Kair, L. R. (2021). Academy of Breastfeeding Medicine Position Statement and guideline: Infant feeding and lactation-related language and gender. Breastfeeding Medicine, 16(8), 587–590. https://doi.org/10.1089/bfm.2021.29188.abm  

2Ross, L. J., & Solinger, R. (2017). A Reproductive Justice History. In Reproductive Justice: An Introduction (1st ed., pp. 9–57). University of California Press. http://www.jstor.org/stable/10.1525/j.ctv1wxsth.4 

3Gribble, K. D., Bewley, S., Bartick, M. C., Mathisen, R., Walker, S., Gamble, J., Bergman, N. J., Gupta, A., Hocking, J. J., & Dahlen, H. G. (2022). Effective communication about pregnancy, birth, lactation, breastfeeding and newborn care: The importance of sexed language. Frontiers in Global Women’s Health, 3. https://doi.org/10.3389/fgwh.2022.818856  

4Duckett, L. J., & Ruud, M. (2019). Affirming language use when providing health care for and writing about childbearing families who identify as LGBTQI+. Journal of Human Lactation, 35(2), 227-232. doi:10.1177/0890334419830985  

5Health Equity Style Guide for the COVID-19 Response: Principles and Preferred Terms for Non-Stigmatizing, Bias-Free Language. Centers for Disease Control & Prevention. (2020, August 11). Retrieved April 11, 2022, from https://ehe.jhu.edu/DEI/Health_Equity_Style_Guide_CDC_Reducing_Stigma.pdf 

6Brooks, H. (2021, June 29). Exploring a nonbinary approach to health. NICHQ. Retrieved May 24, 2022, from https://www.nichq.org/insight/exploring-nonbinary-approach-health

7Winter, L. F. (2019, December 4). Breastfeeding priorities: Safe sleep, bias, gender-equitable norms, and  paid leave. NICHQ. Retrieved May 24, 2022, from 

https://www.nichq.org/insight/breastfeeding-2019-safe-sleep-bias-gender-equitable-norms-and-paid-leave

8Centers for Disease Control and Prevention. (2021, June 9). Transgender Persons. Centers for Disease Control and Prevention. Retrieved May 24, 2022, from https://www.cdc.gov/lgbthealth/transgender.htm  

9McDonald, T. (2021). Transgender/transsexual/genderfluid Tip Sheet – General Information. La Leche League Canada. Retrieved May 24, 2022, from https://www.lllc.ca/sites/default/files/REVISED-Trans-Nursing_Tip-Sheet.pdf   

10K (know) W (want) L (learned) . Minnesota Department of Health- Health Curriculum for English Learners. (n.d.) Retrieved May 24, 2022, from https://www.health.state.mn.us/communities/rih/ell/lesson13.pdf   

11Meyer, E (2016) “Designing Women: The Definition of “Woman” in the Convention on the Elimination of All Forms of Discrimination Against Women,” Chicago Journal of International Law: Vol. 16: No. 2, Article 7. https://chicagounbound.uchicago.edu/cjil/vol16/iss2/7 

12HRC Foundation. (2016). Sexual Orientation and Gender Identity Definitions. Human Rights Campaign. Retrieved from 

https://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions

13Merriam-Webster. (n.d.). Woman definition & meaning. Merriam-Webster. Retrieved May 24, 2022,  from https://www.merriam-webster.com/dictionary/woman

14Ferri, R. L., Rosen-Carole, C. B., Jackson, J., Carreno-Rijo, E., & Greenberg, K. B. (2020). ABM Clinical Protocol #33: Lactation care for lesbian, gay, bisexual, transgender, queer, questioning, plus patients. Breastfeeding Medicine, 15(5). https://doi.org/10.1016/b978-0-323-68013-4.00077-8 

15Barbour, C. (2022, June 17). #tuesdayterms: MLM and WLW. Center for Positive Sexuality. Retrieved November 21, 2022, from  https://positivesexuality.org/tuesdayterms-mlm-and-wlw/