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Reconsidering “inclusive language:” Consequences for healthcare and equitableness of a growing linguistic movement to address gender identity with a path forward
Including women in research and collecting and disaggregating data on sex is an ethical imperative. However, increasingly gender identity is being prioritised over sex in data collection and language which has ethical implications. In this paper, the authors share their experiences as study participants; a health consumer advocate, patient research advisor, and lay researcher; and academic researchers of engaging with researchers, Human Research Ethics Committees (HRECs), university ethics offices, and editors and reviewers of journals regarding data collection and communication on sex and gender identity. We argue that HRECs, researchers, and publishers must carefully consider the implications of omitting data collection on sex, mandatory and universalising gender identity questions and use of desexed language. We also propose that reduced data collection and disaggregation by sex, universal imposition of gender identity, and use of desexed language in research is decreasing data quality, reducing the willingness of some to participate in research and is culturally imperialistic. Recommendations for HRECs are made and research needs in relation to sex and gender identity are outlined. Respect for women in the conduct of research requires their sex-related experiences and needs are considered and therefore that data on sex is appropriately collected and reported upon.
Effective communication in relation to pregnancy and birth is crucial to quality care. A recent focus in reproductive healthcare on “sexed language” reflects an ideology of unchangeable sex binary and fear of erasure, from both cisgender women and the profession of midwifery. In this paper, we highlight how privileging sexed language causes harm to all who birth—including pregnant trans, gender diverse, and non‐binary people—and is, therefore, unethical and incompatible with the principles of midwifery. We show how this argument, which conflates midwifery with essentialist thinking, is unstable, and perpetuates and misappropriates midwifery's marginalized status. We also explore how sex and gender essentialism can be understood as colonialist, heteropatriarchal, and universalist, and therefore, reinforcing of these harmful principles. Midwifery has both the opportunity and duty to uphold reproductive justice. Midwifery can be a leader in the decolonization of childbirth and in defending the rights of all childbearing people, the majority of whom are cisgender women. As the systemwide use of inclusive language is central to this commitment, we offer guidance in relation to how inclusive language in perinatal and midwifery services may be realized.
Objectives
To quantify the change in proportion of young people and adults identified as transgender in UK primary care records and to explore whether rates differ by age and socioeconomic deprivation.
Design
Retrospective, dynamic, cohort study.
Setting
IQVIA Medical Research Data, a database of electronic primary care records capturing data from 649 primary care practices in the UK between 1 January 2000 and 31 December 2018.
Participants
7 064 829 individuals aged 10-99 years, in all four UK countries.
Main outcome measures
Diagnostic codes indicative of transgender identity were used. Sex assigned at birth was estimated by use of masculinising or feminising medication and procedural/diagnostic codes.
Results
2462 (0.03%) individuals had a record code indicating a transgender identity. Direction of transition could be estimated for 1340 (54%) people, of which 923 were assigned male at birth, and 417 were assigned female at birth. Rates of recording in age groups diverged substantially after 2010. Rates of the first recording of codes were highest in ages 16-17 years (between 2010 and 2018: 24.51/100 000 person years (95% confidence interval 20.95 to 28.50)). Transgender codes were associated with deprivation: the rate of the first recording was 1.59 (95% confidence interval 1.31 to 1.92) in the most deprived group in comparison with the least deprived group. Additionally, the rate ratio of the proportion of people who identified as transgender was 2.45 (95% confidence interval 2.28 to 2.65) in the most deprived group compared with the least deprived group. Substantial increases were noted in newly recorded transgender codes over time in all age groups (1.45/100 000 person years in 2000 (95% confidence interval 0.96 to 2.10) to 7.81/100 000 person years in 2018 (6.57 to 9.22)). In 2018, the proportion of people with transgender identity codes was highest in the age groups 16-17 years (16.23 per 10 000 (95% confidence interval 12.60 to 20.57)) and 18-29 years (12.42 per 10 000 (11.06 to 13.90)).
Conclusion
The rate of transgender identity recorded in primary care records has increased fivefold from 2000 to 2018 and is highest in the 16-17 and 18-29 age groups. Transgender diagnostic coding is associated with socioeconomic deprivation and further work should investigate this association. Primary and specialist care should be commissioned accordingly to provide for the gender specific and general health needs of transgender people.
Women’s¹ lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women’s reproductive biology is closely linked to their social roles and situation, including regarding economic disadvantage and disproportionate unpaid work. Recognizing, as well as reducing and redistributing women’s care and domestic work (known as the ‘Three Rs’), is an established framework for addressing women’s inequitable unpaid care work. However, the care work of breastfeeding presents a dilemma, and is even a divisive issue, for advocates of women’s empowerment, because reducing breastfeeding and replacing it with commercial milk formula risks harming women’s and children’s health. It is therefore necessary for the interaction between women’s reproductive biology and infant care role to be recognized in order to support women’s human rights and enable governments to implement economic, employment and other policies to empower women. In this paper, we argue that breastfeeding–like childbirth–is reproductive work that should not be reduced and cannot sensibly be directly redistributed to fathers or others. Rather, we contend that the Three Rs agenda should be reconceptualized to isolate breastfeeding as ‘sexed’ care work that should be supported rather than reduced with action taken to avoid undermining breastfeeding. This means that initiatives toward gender equality should be assessed against their impact on women’s ability to breastfeed. With this reconceptualization, adjustments are also needed to key global economic institutions and national statistical systems to appropriately recognize the value of this work. Additional structural supports such as maternity protection and childcare are needed to ensure that childbearing and breastfeeding do not disadvantage women amidst efforts to reduce gender pay gaps and gender economic inequality. Distinct policy interventions are also required to facilitate fathers’ engagement in enabling and supporting breastfeeding through sharing the other unpaid care work associated with parents’ time-consuming care responsibilities, for both infants and young children and related household work.
Biomedical and social scientists are increasingly calling the biological sex into question, arguing that sex is a graded spectrum rather than a binary trait. Leading science journals have been adopting this relativist view, thereby opposing fundamental biological facts. While we fully endorse efforts to create a more inclusive environment for gender‐diverse people, this does not require denying biological sex. On the contrary, the rejection of biological sex seems to be based on a lack of knowledge about evolution and it champions species chauvinism, inasmuch as it imposes human identity notions on millions of other species. We argue that the biological definition of the sexes remains central to recognising the diversity of life. Humans with their unique combination of biological sex and gender are different from non‐human animals and plants in this respect. Denying the concept of biological sex, for whatever cause, ultimately erodes scientific progress and may open the flood gates to “alternative truths.” Leading science journals increasingly adopt a view considering sex as a graded spectrum rather than binary. Thereby, they confuse operational definitions of sex, sexual differentiation, and variable sex roles with biological sex, which simply distinguishes two reproductive strategies, a female one producing large gametes, and a male one producing small gametes.
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8.
Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment.
Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings.
Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health.
Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
Recent advances have made it possible to precisely measure the extent to which any two words are used in similar contexts. In turn, this measure of similarity in linguistic context also captures the extent to which the concepts being denoted are similar. When extracted from massive corpora of text written by millions of individuals, this measure of linguistic similarity can provide insight into the collective concepts of a linguistic community, concepts that both reflect and reinforce widespread ways of thinking. Using this approach, we investigated the collective concept PERSON/PEOPLE, which forms the basis for nearly all societal decision-and policy-making. In three studies and three preregistered replications with similarity metrics extracted from a corpus of over 630 billion English words, we found that the collective concept PERSON/PEOPLE is not gender-neutral but rather prioritizes men over women-a fundamental bias in our species' collective view of itself. 2 One-Sentence Summary: Based on billions of words on the internet, the concept of a PERSON is not gender-neutral but instead prioritizes men. 3
The importance of literacy to the personal development of an individual and existence of any nation cannot be overemphasized. Literacy is the foundation for meaningful development of any nation. It is not a single entity but an interconnection of several fields―education, health, agriculture, and more. For example, a literate individual can have access to information relating to her career or business. However, not every individual in the society is literate enough to contribute to national development. Thus, strong literacy skills are necessary to function in today’s contemporary society. This research examines literacy across African countries with a view of determining countries with high literacy rates. Countries in sub-Saharan Africa have low literacy rates with gender and regional disparity. Therefore, sub-Saharan Africa national governments need to develop strong literacy skills in their countries to participate effectively in the globalized society.
Background
Transgender/ gender non-binary (TGNB) people are an understudied population that appears to have undergone changes in both its size and demographic composition; however, population-level data on the magnitude of these changes are sparse.
Methods
Electronic health records from Kaiser Permanente health plans in Georgia and Northern and Southern California were used to identify TGNB individuals who sought care from January 2006 through December 2014, and the data were analyzed by year, site and age, and by sex assigned at birth.
Results
In 2006 the number of TGNB people (and corresponding 95% confidence intervals) per 100,000 population were 3.5 (1.9, 6.3) in Georgia, 5.5 (4.8, 6.4) in Southern California and 17 (16, 19) in Northern California. In 2014, these frequencies increased to 38 (32, 45), 44 (42, 46) and 75 (72, 78) per 100,000 population, respectively. When analyzed by age, the most rapid increase was observed among persons 18 to 25 years old, and this increase accelerated after 2010. The ratio of transmasculine to transfeminine persons also changed from 1:1.7 in 2006 to 1:1 in 2014 overall, and from 1:1 in 2006 to 1.8:1 in 2014 among persons under the age of 18 years.
Conclusions
This analysis confirms previous observations that the proportion of TGNB people is growing especially among young adults. The composition of TGNB population is also changing from predominantly transfeminine to roughly 1:1 overall, and predominantly transmasculine in children and adolescents.
It is unclear whether transgender and gender-diverse individuals have elevated rates of autism diagnosis or traits related to autism compared to cisgender individuals in large non-clinic-based cohorts. To investigate this, we use five independently recruited cross-sectional datasets consisting of 641,860 individuals who completed information on gender, neurodevelopmental and psychiatric diagnoses including autism, and measures of traits related to autism (self-report measures of autistic traits, empathy, systemizing, and sensory sensitivity). Compared to cisgender individuals, transgender and gender-diverse individuals have, on average, higher rates of autism, other neurodevelopmental and psychiatric diagnoses. For both autistic and non-autistic individuals, transgender and gender-diverse individuals score, on average, higher on self-report measures of autistic traits, systemizing, and sensory sensitivity, and, on average, lower on self-report measures of empathy. The results may have clinical implications for improving access to mental health care and tailoring adequate support for transgender and gender-diverse individuals. It is unclear if rates of autism and other neurodevelopmental and psychiatric diagnoses are elevated in transgender and gender-diverse individuals compared to cisgender individuals. Here, the authors use data from five different large-scale datasets to identify elevated rates of autism diagnoses, diagnoses of other neurodevelopmental and psychiatric conditions, and elevated traits related to autism in transgender and gender-diverse individuals, compared to cisgender individuals.
Aboriginal and Torres Strait Islander (collectively, Indigenous Australian) women experience a higher burden of cervical cancer than other women. The National Cervical Screening Program (NCSP) is failing to meet the needs of Indigenous Australian women, resulting in many women not regularly participating in cervical screening. However, one third of Indigenous Australian women do participate in cervical screening. The reasons that some women in this population commence and continue to screen remain unheard but could provide insights to support women who currently do not participate. We aimed to describe Indigenous Australian women’s experiences and views of participation in cervical screening by yarning (a culturally-appropriate interview technique) with 50 Indigenous Australian women aged 25–70 years who had completed cervical screening in the past five years, recruited via Primary Health Care Centres (PHCCs) from three jurisdictions. Aboriginal or Torres Strait Islander women researchers conducted the interviews. Thematic analysis identified six themes: screening as a means of staying strong and in control; overcoming fears, shame, and negative experiences of screening; needing to talk openly about screening; the value of trusting relationships with screening providers; logistical barriers; and overcoming privacy concerns for women employed at PHCCs. Despite describing screening as shameful, invasive, and uncomfortable, women perceived it as a way of staying healthy and exerting control over their health. This ultimately supported their participation and a sense of empowerment. Women valued open discussion about screening and strong relationships with health providers. We identified logistical barriers and specific barriers faced by women employed at PHCCs. This study is strengthened by a research approach that centred Indigenous Australian women’s voices. Understanding the experiences of Indigenous Australian women who participate in screening will help screening providers support women to start and continue to screen regularly. Recommendations for practice are provided.
Estimates of high-risk human papillomavirus (HPV) infection and susceptibility to HPV-related cancer in transgender men (TM) are comparable to prevalence rates found in cisgender women. Regular and thorough screening for cervical cancer is equally as crucial for TM as for cisgender women; however, despite continued risk for cervical cancer in TM and associated recommendations for screening, studies indicate disparities in rates of cervical cancer screening (CCS) in TM compared to cisgender women. The current scoping review explores TM’s knowledge and experiences of CCS and barriers to screening uptake in this population. A range of barriers were identified including the need for health-care services to provide care for TM within the context of a nonbinary approach to gender identity and health. Findings synthesized from relevant research studies ( n = 15; published 2008–2019) are presented, and recommendations are drawn from these findings to inform primary health-care providers’ clinical practice and care of TM.
Objective
This study examines cohort differences in attitudes toward women's roles within marriage in Japan.
Background
Japan has undergone dramatic sociocultural shifts in the 20th century that have shaped childhood experiences differently by cohort. Sociodemographic perspectives predict cohort effects, which suggest the lasting impact of experiences during the formative years on attitudes.
Method
This study employs a hierarchical age‐period‐cohort analysis and uses repeated cross‐sectional data from the 2000 to 2012 Japanese General Social Survey (N = 31,912), a nationwide probability survey.
Results
Among cohorts born before 1960, for both sexes, attitudes toward wife's employment and a gender‐based division of labor were significantly less traditional for later born cohorts. However, younger cohorts born in 1960 and after were not significantly different in their attitudes from the cohort born in the 1950s.
Conclusion
This study suggests the strong impact of ideological shifts and mothers' homemaking role (experienced in one's formative years) on gender role attitudes. It points to the important and lasting influence of structural contexts on attitudes and hence cohort effects.
Implications
This study contributes to our understanding of attitudinal change (and stagnation) toward gender roles and has policy implications for Japan and other countries characterized by low marriage and fertility rates.
The newborn infant with atypical genitalia presents a challenging clinical scenario and requires expert input. There have been appreciable advances in our knowledge of the underlying causes that may lead to a mere difference or a more serious disorder of sex development (DSD), the natural history of conditions, as well as the short and long-term complications of these conditions themselves, together with the clinical interventions that are associated with these conditions. With this information, the DSD expert can be more confident when discussing options with the parents of the newborn infant. By working within a multidisciplinary team, the expert should be able to support the family whilst individualising the management plan so that it is also cognizant of the shifts in societal attitudes and expectations around concepts of diversity and openness. It is, therefore, likely that the practice of assigning sex, especially in those cases where sex assignment is unclear on expert assessment, will continue to show temporal, social and geographical variations. It is imperative that clinical data for rare conditions such as these are collected in a standardized format and shared through a common registry so that any evidence that is used for future shifts in practice has a stronger foundation than that which is currently available.
This paper addresses one of the most controversial issues in cultural anthropology: the conceptual foundations of kinship and the apparent inevitability of ethnocentrism in kinship studies. The field of kinship studies has been in turmoil over the past few decades, repeatedly pronounced dead and then again rising from the ashes and being declared central to human affairs. As this paper argues, the conceptual confusion surrounding ‘kinship’ is to a large extent due to the lack of a clear and rigorous methodology for discovering how speakers of the world’s different languages actually navigate their kinship systems. Building on the author’s earlier work on kinship but taking the analysis much further, this paper seeks to demonstrate that such a methodology can be found in natural semantic metalanguage theory (developed by the author and colleagues), which relies on 65 universal semantic primes and on a small number of universal “semantic molecules,” including ‘mother’ and ‘father’. The paper offers a new model for the interpretation of kinship terminologies and opens new perspectives for the investigation of kinship systems across languages and cultures. © 2016 by The Wenner-Gren Foundation for Anthropological Research. All rights reserved.
Background
Transmasculine individuals are people who were assigned as female at birth, but identify on the male side of the gender spectrum. They might choose to use and engage their bodies to be pregnant, birth a baby, and chestfeed. This study asked an open research question, “What are the experiences of transmasculine individuals with pregnancy, birthing, and feeding their newborns?” Methods
Participants who self-identified as transmasculine and had experienced or were experiencing pregnancy, birth, and infant feeding were recruited through the internet and interviewed. Interviews were transcribed verbatim. We used interpretive description methodology to analyze the data. Our analysis was guided by our awareness of concepts and history important to the transgender community. ResultsOut of 22 participants, 16 chose to chestfeed for some period of time, four participants did not attempt chestfeeding, and two had not reached the point of infant feeding (i.e., were still pregnant or had a miscarriage). Nine of the 22 study participants had chest masculinization surgery before conceiving their babies. Six participants had the surgery after their children were born, five desired the surgery in the future, and two did not want it at all.Chest care, lactation, and chestfeeding in the context of being a transgender person are reported in this paper. The participants’ experiences of gender dysphoria, chest masculinization surgery before pregnancy or after weaning, accessing lactation care as a transmasculine person, and the question of restarting testosterone emerged as data. We present the participants’ experiences in a chronological pattern with the categories of before pregnancy, pregnancy, postpartum (6 weeks post birth), and later stage (beyond 6 weeks). Conclusions
The majority of participants chose to chestfeed while some did not due to physical or mental health reasons. Care providers should communicate an understanding of gender dysphoria and transgender identities in order to build patient trust and provide competent care. Further, health care providers need to be knowledgeable about lactation and chest care following chest masculinization surgery and during binding, regardless of the chosen feeding method and through all stages: before pregnancy, during pregnancy, postpartum, and afterward.
Background:
The Australian National Cervical Screening Program, introduced more than 20 years ago, does not record the Indigenous status of screening participants. This article reports the first population-based estimates of participation in cervical screening for Indigenous and non-Indigenous Australian women.
Methods:
This was a retrospective, population-based study of 1,334,795 female Queensland residents, aged 20 to 69 years, who participated in cervical screening from 2000 to 2011; 26,829 were identified as Indigenous through linkage to hospitalization records. Participation rates were calculated as the number of women screened divided by the average estimated resident population, with adjustments made for hysterectomies, for each 2-, 3-, and 5-year screening period. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), which were adjusted for age group, place of residence, and socioeconomic disadvantage.
Results:
In 2010-2011, the 2-year participation rate was 55.7% (95% CI, 55.6%-55.9%) for non-Indigenous women and 33.5% (95% CI, 32.9%-34.1%) for Indigenous women; this represented a decrease from 2000-2001 (57.7% [95% CI, 57.6%-57.9%] and 35.3% [95% CI, 34.5%-36.1%], respectively). The difference between Indigenous and non-Indigenous women was greatest for those aged 45 to 49 years. The 3- and 5-year participation rates were higher within both groups, and the absolute differences between the 2 groups were larger. Significant interactions between the Indigenous status and the place of residence and socioeconomic disadvantage highlight that the Indigenous/non-Indigenous differential was evident in all places of residence except for very remote areas (OR, 0.99; 95% CI, 0.95-1.02) and was greatest in the most affluent areas (OR, 0.26; 95% CI, 0.24-0.27).
Conclusions:
Indigenous Australian women participate less than non-Indigenous women, and this gap has not closed. These results provide important benchmarks for the new Australian cervical screening program commencing in 2017, which will provide opportunities to reduce inequities for Indigenous women and address longstanding data deficiencies in the collection of the Indigenous status. Cancer 2016;122:1560-9. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations.
The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews.
The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model.
Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.
© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association.
Background: During emergencies, including natural disasters and armed conflict, breastfeeding is critically important. Breastfeeding provides reliable nutrition and protection against infectious diseases, without the need for clean water, feeding implements, electricity, or external supplies. Key Information: Protection, promotion, and support of breastfeeding should be an integral part of all emergency preparedness plans. Breastfeeding specialists should be part of plan development. Emergency protocols should include breastfeeding specialists among emergency relief personnel, provide culturally sensitive environments for breastfeeding, and prioritize caregivers of infants in food/water distribution. Emergency relief personnel should be aware that dehydration and missed feedings can impact milk production, but stress alone does not. Emergency support should focus on keeping mothers and infants together and providing private and/or protected spaces for mothers to breastfeed or express milk. Emergency support should also focus on rapidly identifying mothers with breastfeeding difficulties and breastfeeding mothers and infants who are separated, so their needs can be prioritized. Breastfeeding support should be available to all women experiencing difficulties, including those needing reassurance. Nonbreastfed infants should be identified as a priority group requiring support. Relactation, wet-nursing, and donor milk should be considered for nonbreastfed infants. No donations of commercial milk formula (CMF), feeding bottles or teats, or breast pumps should be accepted in emergencies. The distribution of CMF must be highly controlled, provided only when infants cannot be breastfed and accompanied by a comprehensive package of support. Recommendations: Protecting, promoting, and supporting breastfeeding should be included in all emergency preparedness planning and in training of personnel.
The 2021 Census of England and Wales was one of the first in the world to ascertain the gender identity of an entire population. This article argues that its results are implausible with regard to geography, language, education, ethnicity, and religion. The results contradict data on referrals to gender clinics and signatures on a pro-transgender petition. The results are also internally inconsistent when the various categories of gender identity are correlated across localities, and when compared with sexual orientation. The spurious results were produced by a flawed question, which originated with a transgender campaigning organization. The question evidently confused a substantial number of respondents who erroneously declared their gender identity to differ from their natal sex. Confusion is manifested in the overrepresentation of people lacking English proficiency in the most suspect gender categories. These findings demonstrate how a faulty question can distort our apprehension of the social world.
Background:
Recent calls-to-action have recommended the use of gender-inclusive language in the field of human lactation research and clinical care. However, little empirical evidence about parental acceptance and understanding of this new terminology exists.
Research aim:
To assess understanding and acceptance of an inclusive language revision of the Breastfeeding Attrition Prediction Tool (BAPT).
Methods:
This was a prospective qualitative study consisting of two phases, a survey followed by cognitive interview. Pregnant people (N = 16) were recruited from the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children, which uses the BAPT as a standard of care. The study team revised the BAPT (e.g., changed terms like "breast milk" to "human milk"). Study participants completed the Revised BAPT and then participated in a cognitive interview by phone to assess their understanding and acceptance of revised, inclusive language.
Results:
Most inclusive language was well understood and accepted by participants. Proposed revisions to the survey to replace terms like "breastfeeding" with other terms like "chestfeeding" or "bodyfeeding" were more difficult for participants to understand and were not well accepted.
Conclusions:
While it is clear that language in human lactation research and clinical practice should be revised to be more gender inclusive, specific inclusive terms elicit different levels of understanding and acceptance. Inclusive language options should be tested with target populations and more research is needed in this area.
What gender are you? And in virtue of what? These are questions of gender categorization. Such questions are increasingly at the core of many contemporary debates about gender, both within philosophy and in public discourse.
Growing efforts are being made to highlight the importance of gender identity to gender categorization. Philosophical theories of gender have traditionally focused on gender role—the social norms, obligations, and positions that others impose on you based on perceived gender. But the experiences of trans, non-binary, and gender nonconforming people have shown that an exclusive focus on gender role is inadequate for theorizing gender. We also need to consider a person’s relationship to gender categories and gender norms. Two people might both be perceived by others as women, but while one thinks of herself as a woman the other thinks of themself as genderqueer. And this difference in gender self-identification is not merely a difference in personal feeling. A gender nonconforming woman and a genderqueer person—even if they are treated similarly by others—will often experience and navigate gender norms and roles quite differently, and this difference matters to a full understanding of gender.
Since the introduction of systematic population-based cervical cancer screening in Australia in 1991, age-standardized incidence of cervical cancer has halved. Given recent advances in human papillomavirus (HPV) vaccination and screening, cervical cancer may be eliminated nationally within 20 years. However, immigrant women are not equitably reached by screening efforts. This study systematically reviewed evidence on cervical cancer screening practices among immigrant women in Australia. A systematic search of MEDLINE, Embase, PubMed, CINAHL, and PsycINFO and gray literature for English language studies published till March 1, 2019, was conducted. Observational and qualitative studies evaluating cervical cancer screening awareness and participation of immigrant women were screened. Of 125 potentially relevant studies, 25 were eligible: 16 quantitative (4 cohort, 12 cross-sectional), 6 qualitative, and 3 mixed-methods studies. Quantitative studies indicated 1% to 16% lower screening rates among migrant women compared with Australian-born women, with participation of South Asian women being significantly lower (odds ratio = 0.54, 95% confidence interval = 0.48-0.61). Qualitative studies illustrated factors affecting women’s willingness to participate in screening, including insufficient knowledge, low-risk perception, and unavailability of a female health professionals being key barriers. Future studies should focus on South Asian women, due to recent increase in their immigration.
Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.
Background:
Over the past decade, the number of people referred to gender identity clinics has rapidly increased. This raises several questions, especially concerning the frequency of performing gender-affirming treatments with irreversible effects and regret from such interventions.
Aim:
To study the current prevalence of gender dysphoria, how frequently gender-affirming treatments are performed, and the number of people experiencing regret of this treatment.
Methods:
The medical files of all people who attended our gender identity clinic from 1972 to 2015 were reviewed retrospectively.
Outcomes:
The number of (and change in) people who applied for transgender health care, the percentage of people starting with gender-affirming hormonal treatment (HT), the estimated prevalence of transgender people receiving gender-affirming treatment, the percentage of people who underwent gonadectomy, and the percentage of people who regretted gonadectomy, specified separately for each year.
Results:
6,793 people (4,432 birth-assigned male, 2,361 birth-assigned female) visited our gender identity clinic from 1972 through 2015. The number of people assessed per year increased 20-fold from 34 in 1980 to 686 in 2015. The estimated prevalence in the Netherlands in 2015 was 1:3,800 for men (transwomen) and 1:5,200 for women (transmen). The percentage of people who started HT within 5 years after the 1st visit decreased over time, with almost 90% in 1980 to 65% in 2010. The percentage of people who underwent gonadectomy within 5 years after starting HT remained stable over time (74.7% of transwomen and 83.8% of transmen). Only 0.6% of transwomen and 0.3% of transmen who underwent gonadectomy were identified as experiencing regret.
Clinical implications:
Because the transgender population is growing, a larger availability of transgender health care is needed. Other health care providers should familiarize themselves with transgender health care, because HT can influence diseases and interact with medication. Because not all people apply for the classic treatment approach, special attention should be given to those who choose less common forms of treatment.
Strengths and limitations:
This study was performed in the largest Dutch gender identity clinic, which treats more than 95% of the transgender population in the Netherlands. Because of the retrospective design, some data could be missing.
Conclusion:
The number of people with gender identity issues seeking professional help increased dramatically in recent decades. The percentage of people who regretted gonadectomy remained small and did not show a tendency to increase. Wiepjes CM, Nota NM, de Blok CJM, et al. The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. J Sex Med 2018;XX:XXX-XXX.
The behavior of women and men varies greatly depending on situations, cultures, and historical periods. This flexibility emerges as men and women tailor their division of labor to local ecological and socioeconomic demands. The resulting division is supported by childhood socialization practices that, in interaction with sex differences in child temperament, help boys and girls to develop psychologies suited to their likely adult activities. Although responsive to local conditions, the division of labor is constrained by women's childbearing and nursing of infants and men's size and strength. Because these biological characteristics influence the efficient performance of many activities in society, they underlie central tendencies in the division of labor as well as its variability across situations, cultures, and history. Gender roles-that is, shared beliefs about the traits of women and men-track the division of labor because people infer these traits from their observations of the sexes' behaviors. Social perceivers often essentialize these traits by regarding them as inherent in the biology or social experience of women and men. Gender role expectations, which tend to be consensual within cultures, influence behavior through proximal social psychological and biological processes, whereby (a) other people encourage gender-typical behavior and individuals conform to their own gender identities and (b) hormonal, reward, and cardiovascular mechanisms enable masculine and feminine behaviors.
Readers mentally simulate the objects and events described in narratives. One common assumption is that readers mentally embody an actor's perspective; alternatively, readers might mentally simulate events from an external "onlooker" perspective. Two experiments examined the role of pronouns in modulating a reader's adopted perspective when comprehending simple event sentences. Experiment 1 demonstrated that readers embody an actor's perspective when the pronoun you or I is used, but take an external perspective when he is used. Experiment 2, however, found that a short discourse context preceding the event sentence led readers to adopt an external perspective with the pronoun I. These experiments demonstrate that pronoun variation and discourse context mediate the degree of embodiment experienced during narrative comprehension: In all cases, readers mentally simulate objects and events, but they embody an actor's perspective only when directly addressed as the subject of a sentence.
The term "gender role" appeared in print first in 1955. The term "gender identity" was used in a press release, November 21, 1966, to announce the new clinic for transsexuals at The Johns Hopkins Hospital. It was disseminated in the media worldwide, and soon entered the vernacular. The definitions of gender and gender identity vary on a doctrinal basis. In popularized and scientifically debased usage, sex is what you are biologically; gender is what you become socially; gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine. Causality with respect to gender identity disorder is subdivisible into genetic, prenatal hormonal, postnatal social, and postpubertal hormonal determinants, but there is, as yet, no comprehensive and detailed theory of causality. Gender coding in the brain is bipolar. In gender identity disorder, there is discordancy between the natal sex of one's external genitalia and the brain coding of one's gender as masculine or feminine.
How many adults and youth identify as transgender in the United States? Los Angeles
- J L Herman
- A R Flores
- O Neill
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- K Stoliznow
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- J Ingram
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- Barnes
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- A Byrne
- C K Hooven
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- E Barnes
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