“We want you to find yourself on that form.”

June 15, 2016 1:16 PM

Inside Planned Parenthood’s Push For Gender-Neutral Language: From their new Spot On Period Tracker to educational programs and intake forms, Planned Parenthood's national and affiliate offices have been overseeing an evolution of language and terms regarding the biology, gender, and identities of their clients.

The app discusses body symptoms and birth control, which may include “sore breasts” and reminders like “take your pill,” but doesn’t assume that the person with the breasts or the pills is a woman. Instead, it speaks directly to the user as “you.” There are no pink flowers and there is no gendered language. (There is, however, a dinosaur. On the moon.)

Although the national office of Planned Parenthood doesn't set official language policies for its affiliate offices, it does make recommendations and is working to develop a written resource to address how and when to use gendered language vs. transgender-inclusive language vs. gender-neutral language.

“The language we’re using today reflects the fact that gender is a spectrum and not a simple system, a binary system of male and female,” says Porsch. “We really talk about having sexual and reproductive health services [for everyone including] women who have penises, men who have vaginas, and there are people with all different types of anatomy that may not identify with a binary gender at all,” she says.

posted by The Wrong Kind of Cheese (37 comments total)

I love it. Meanwhile, my local LGBT center had three options for gender on its sign in sheet: Male, Female, or Transgender. I got an HIV test at Pride and since I marked "female" for "biological sex [sic] at birth," they wouldn't let me check "male" for gender. I had some words with both organizations.
posted by AFABulous at 1:34 PM on June 15, 2016 [15 favorites]

By the way, a lot of people don't know this, but some Planned Parenthood offices offer hormone therapy for transgender and GNC people. Including, improbably, Billings Montana.
posted by AFABulous at 1:36 PM on June 15, 2016 [8 favorites]

Sweet!
posted by rtha at 1:44 PM on June 15, 2016

I just downloaded this app. It is refreshingly free of pink flowery bullshit.
posted by little mouth at 1:47 PM on June 15, 2016 [1 favorite]

I love this whole thing, but this part especially:

The change in language was sparked by the Tumblr community, she says.

“The Tumblr audience is smart. They understand feminism. They understand that sex ed isn’t one-size-fits-all—even though that’s what they were taught in school,” says Perugini. “And they know that words matter. They didn’t see themselves reflected in the language we were using on our social media pages or our website, and they let us know.”


For all its faults, there is a lot of Real Good Shit getting spread in what is considered youth culture, and I like to see it getting called out when it deserves it.
posted by MCMikeNamara at 1:48 PM on June 15, 2016 [54 favorites]

Pretty sure that PP clinics offering hormone therapy in "improbable" places is far from coincidence.

LGBT health services are incredibly hard to come by outside of the coasts. It makes a lot of sense for PP to pick up that mantle, and I'm glad that they're doing it.

I'm not sure if the situation has improved recently, but a few years ago, there were a few *states* that didn't have any physicians who were adequately qualified to treat HIV or prescribe PrEP.
posted by schmod at 3:43 PM on June 15, 2016 [4 favorites]

And, as a Montanan, Billings is probably the most likely place in this part of the country to host services like that.
posted by traveler_ at 5:36 PM on June 15, 2016 [6 favorites]

Pretty sure that PP clinics offering hormone therapy in "improbable" places is far from coincidence.

AFAIK, it's not an actual Planned Parenthood initiative and is only not a coincidence in the sense that doctors who work at Planned Parenthood are more likely than the average to care about access to healthcare, which in turn makes them more likely to be the only doctor in X miles willing to learn about hormones.
posted by hoyland at 6:51 PM on June 15, 2016 [1 favorite]

The hospital I work at does not use inclusive language. It drives me bonkers. Somedays I want to go in a yell at people that people aren't always what they look!

And use proper pronouns in documentation!

My charting doesn't allow for me to put a preferred pronoun somewhere easily accessible and I have so many clients or is hard to keep track of.
posted by AlexiaSky at 7:08 PM on June 15, 2016

I love it. Meanwhile, my local LGBT center had three options for gender on its sign in sheet: Male, Female, or Transgender. I got an HIV test at Pride and since I marked "female" for "biological sex [sic] at birth," they wouldn't let me check "male" for gender. I had some words with both organizations.

AFABulous, so sorry that you had to deal with that, and thank you for doing the emotional labor of speaking up about it.
posted by une_heure_pleine at 8:48 PM on June 15, 2016

Meanwhile, my local LGBT center had three options for gender on its sign in sheet: Male, Female, or Transgender. I got an HIV test at Pride and since I marked "female" for "biological sex [sic] at birth," they wouldn't let me check "male" for gender. I had some words with both organizations.

My 21-year-old trans kid had a bad experience with a physician assistant at our doctor's office. I wrote a letter, and the doctor in charge replied with a letter saying that they always want to give their patients the best possible care, and talking about what they were doing to educate themselves about trans stuff. Next time I saw him, he talked to me about the conversation he'd had with a clinic that specializes in treating trans people.

We were so impressed and pleased, and relieved that we weren't going to have to go looking for a new doctor.
posted by not that girl at 4:58 AM on June 16, 2016 [10 favorites]

Oh wow, I think "Planned Parenthood’s Digital Products Lab" is the coolest tech shop I have heard of this year. And the Tumblr shout-out is a great reminder of thoughtful discourse that happens there -- an important reminder for me, as I have in the past been dismissive of "Tumblr feminism".

Chuck Tingle is either from, in, or otherwise interested in Billings, Montana and encourages his readers to donate to the Billings Public Library Foundation. This has now become the primary fact about Billings that pops up in my head when I hear someone mention Billings, displacing its previous prominent presence as "an important city in The Trumpet Of The Swan".
posted by brainwane at 7:02 AM on June 16, 2016 [2 favorites]

biological sex [sic] at birth

What's the preferred term for the idea this phrase is trying to convey?
posted by shponglespore at 8:33 AM on June 16, 2016

shponglespore - A better phrase would have been "assigned gender at birth."

Basically, a doctor looked at my genitals, said "yep, it's a girl," even though there is no biological basis for that. Genitalia and gender are not the same thing, although they line up for most people. Same with chromosomes and other things we consider "biological sex." There's no way to know whether a baby is going to grow up as a certain gender. We just basically give it our best guess when they're born, thus "assigned."
posted by AFABulous at 9:59 AM on June 16, 2016 [9 favorites]

Also, if a baby's genitalia is ambiguous (usually referred to as "intersex"), surgery is often performed to make the genitalia look like a vulva/vagina, (because it's easier to create that than a penis), and the baby is raised as female. Often with disastrous results, either because the genitalia doesn't function as most people's do, or because the child is not actually female, or is female, but does not go through typical female puberty. It's complicated and that's about the limit of my knowledge; you can google for more, or perhaps one of the intersex folks on mefi will jump in. (Though this may also be a derail.)
posted by AFABulous at 10:05 AM on June 16, 2016 [2 favorites]

Wow, this is really pushing/expanding my understanding, so I apologize if this comes across rudely.

In healthcare, why isn't birth gender assignment (incl. an intersex option) useful? Isn't it an extremely relevant basis for considering a patient's healthcare needs (from whether you need a PAP smear to birth control to prostate exams)? Of course, I'm assuming that a doctor would also take other characteristics related to physical sex (hormones, presence/absence of sex-specific body parts, etc.) into consideration whether connected to gender identity or anything else.
posted by R a c h e l at 12:05 PM on June 16, 2016

True, I should have specified that's the one I prefer. And like odinsdream said, it's rarely relevant. I can only think of a couple cases - blood and other tests where "normal" ranges are different for men vs. women and higher/lower results might be an indicator of disease, and medical emergencies that involve your reproductive organs or urological system. I don't understand how assigned gender at birth would affect the results of an HIV test. My guess is that they're collecting data on how many transgender people have HIV (which is shockingly high among trans women according to the CDC).
posted by AFABulous at 12:09 PM on June 16, 2016

In healthcare, why isn't birth gender assignment (incl. an intersex option) useful? Isn't it an extremely relevant basis for considering a patient's healthcare needs (from whether you need a PAP smear to birth control to prostate exams)?

None of which needs to happen while an infant is in the hospital immediately following childbirth. There's plenty of time for a patient to come terms with gender before those things become relevant.
posted by Etrigan at 12:15 PM on June 16, 2016 [1 favorite]

In healthcare, why isn't birth gender assignment (incl. an intersex option) useful?

Because people vary, especially intersex people. I was assigned female at birth so I got all the nagging reminders about pap smears, got automatic pregnancy tests every time I went for surgery, got asked when my last period was, etc. It'd be more useful and correct to say "Uterus? Yes/No" "Cervix? Yes/No" "Mammogram required? Yes/No"
posted by AFABulous at 12:15 PM on June 16, 2016 [2 favorites]

Of course now that my legal gender is male, I get asked when my last prostate exam was.
posted by AFABulous at 12:16 PM on June 16, 2016 [2 favorites]

It'd be more useful and correct to say "Uterus? Yes/No" "Cervix? Yes/No" "Mammogram required? Yes/No"

Realizing sadly we'd have to have much better anatomy/sex education before we started using this. Or at least have an "unsure" option.
posted by MCMikeNamara at 1:07 PM on June 16, 2016

I work in a LGBTQ-centered health clinic and so we are constantly thinking about these issues. We have worked pretty hard to be as inclusive as possible on forms but sometimes it's not possible due to the need to interface with other systems.

For instance, our current policy is to have electronic medical records reflect a person's legal gender, because otherwise we can run into problems with billing/insurance. We do note people's preferred gender pronouns whenever possible in their charts, and regularly ask them which pronouns they use, since sometimes people decide to change them!

Often insurance companies have gender exclusions which make it hard for trans people to get the care appropriate for their bodies. For instance, if a person who was assigned female gender at birth and who has breasts goes through the process of changing their legal gender to male, the insurance may not be willing to pay for mammograms since their records show the person as 'male', which is how they do identify.

And of course gender reassignment surgery is often not covered by insurance, and even when it is often there are no specialists available since insurance won't pay enough. So people have to do a complex dance with the surgeon, the insurance and whatever hoops and prior authorizations the insurance company is requiring.... I think that New York and California are a bit more progressive in terms of their coverage requirements, but in the vast majority of the US these surgeries are basically seen as cosmetic-level, almost vanity projects, instead of medically necessary treatments.

It's heartbreaking to see how many patients, particularly trans folks, come to our center from other states, sometimes hundreds of miles away, because they don't have any other access to medical care that meets their needs and is sensitive to issues of sexual orientation and gender identity.

Safe space. It's hard to find, especially this week.
posted by tivalasvegas at 8:25 AM on June 17, 2016 [1 favorite]

I work in a LGBTQ-centered health clinic and so we are constantly thinking about these issues. We have worked pretty hard to be as inclusive as possible on forms but sometimes it's not possible due to the need to interface with other systems.

We're having similar issues, and I keep arguing (and not being heard, apparently) that the requirement that our database have the client's information that matches their insurance information is not the same as requiring that information to be displayed. And we sure as hell don't need little man or woman avatars at the top of each client's chart (which of course are auto-generated to match the client's legal gender and piss me off every time I see them, even if they match the client's gender identity, because why? Why do we need little gendered avatars on every single client's electronic chart? Argh).
posted by lazuli at 8:31 AM on June 17, 2016 [2 favorites]

Positive note on this: It's no longer permissible under the Final Rule of Section 1557 of the ACA to have such exclusions.

Yeah, we'll see. I'm cautiously optimistic.

Here is an excellent analysis from the National Health Law Program. Summary.
posted by tivalasvegas at 8:41 AM on June 17, 2016 [1 favorite]

Summary of the section relating directly to trans issues:

"The rule prohibits denying or limiting coverage or a claim or imposing additional cost-sharing or other limitations or restrictions for any health services that are ordinarily or exclusively available to individuals of one sex to a transgender individual based on the fact that the individual’s sex assigned at birth, gender identity or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available. Further, the rule prohibits having or implementing a categorical coverage exclusion or limitation for all services related to gender transition; and otherwise denying or limiting coverage or coverage of a claim or imposing additional cost-sharing or other limitation or restrictions on coverage for specific health services related to gender transition if the denial, limitation or restriction results in discrimination against a transgender individual.

"The provision was finalized with mostly technical revisions for clarity. One change clarifies that the final rule broadly prohibits having or implementing a categorical exclusion or limitation of coverage. The change was to clarify HHS’ intent as prohibiting categorical exclusions or limitations in both benefit design and administration.
posted by tivalasvegas at 8:54 AM on June 17, 2016

I work in a LGBTQ-centered health clinic and so we are constantly thinking about these issues. We have worked pretty hard to be as inclusive as possible on forms but sometimes it's not possible due to the need to interface with other systems.

I've pushed our local genetic/medical/legal experts to devise a reporting language policy for situations where chromosomal status may not match other reported identities and does impact test orders or results interpretation (should the male filters be used for those who are biologically female but now identify as male? how should changes on the X chromosome be noted so that clinicians don't think we've made a nomenclature/interpretation error? how careful should the phrasing be? is the referring clinician aware of this? how about others who might see the report in the future?). Not surprisingly the difficulty plus the relative rarity of this means no policy has been developed means when the need does arise, the resolution is inconsistent.
posted by beaning at 9:06 AM on June 17, 2016

Interestingly, when I told my endocrinologist's office that my gender was now legally male, all of my prior test results were edited retroactively to display "normal male" ranges alongside the actual results.
posted by AFABulous at 9:23 AM on June 17, 2016

To clarify, the medical results I'm thinking of that are gender dependent are genetic studies like hemophilia, other X-linked genetic disorders, or select other genetic conditions wherein a change might lead to a symptoms in a male but females would not be expected to have symptoms or where the presentations might strongly vary between genders.

Also when a genetic result is inconsistent on the basis of gender, is this misreported gender or a swapped sample or other draw site/labelling/lab error?
posted by beaning at 9:49 AM on June 17, 2016

To clarify, the medical results I'm thinking of that are gender dependent are genetic studies like hemophilia, other X-linked genetic disorders, or select other genetic conditions wherein a change might lead to a symptoms in a male but females would not be expected to have symptoms or where the presentations might strongly vary between genders.

Just a thought: "select other genetic conditions wherein a change might lead to a symptoms in someone with XY chromosomes but people with XX chromosomes would not be expected to have symptoms".
posted by Etrigan at 10:22 AM on June 17, 2016 [2 favorites]

As long as it's medically the same, I think "single X chromosome" versus "two/multiple X chromosomes" would be better than XY/XX there, due to how XX and XY are used as synonyms for gender in popular discourse.
posted by vibratory manner of working at 10:44 AM on June 17, 2016

As long as it's medically the same, I think "single X chromosome" versus "two/multiple X chromosomes" would be better than XY/XX there

There are people who have a single X chromosome who are medically female, as well as people who have two/multiple X chromosomes who are medically male.

due to how XX and XY are used as synonyms for gender in popular discourse.

That was why I went with "someone with XX chromosomes" rather than "XX person" or the like.

Precision is probably for the best.
posted by Etrigan at 10:57 AM on June 17, 2016 [1 favorite]

I apologize for that phrasing. Is there a better way to refer to the presence of medical issues that are linked to the XY chromosomes (e.g., colorblindness, male pattern baldness) and the people who would therefore be more susceptible to them?
posted by Etrigan at 11:51 AM on June 17, 2016

Unfortunately current overarching opinion here is that something like "this CHANGE would cause THIS presentation is a person with THIS chromosome status and would cause THAT presentation in a person with THAT chromosome status" does not meet mandatory guidelines for a clear cut interpretation back to the clinician of "affected/not affected/at risk/not at risk" etc. however it could be used as template in other places in the report.

I don't want to sidetrack too far from the discussion of Planned Parenthood's excellent efforts so feel free to memail me if you want do discuss further...and I also apologize for my own poor use of male/female earlier.
posted by beaning at 11:55 AM on June 17, 2016

Also thanks for the discussion-MF has been a great boon to me in my understanding on these issues!
posted by beaning at 12:04 PM on June 17, 2016

Yeah, unless the patient has been karyotyped, you have no idea if they have 2 Xs and/or (at least) one Y. There are plenty of men with 2 Xs, for various reasons, and plenty of women with (at least) one Y, for various reasons.
posted by hydropsyche at 2:32 PM on June 17, 2016 [1 favorite]

Yes, that is what I said.
posted by Etrigan at 5:09 PM on June 17, 2016

I was having a similar conversation with a friend, and I realized I had done a 23andme genetic thingy, and saw that it seems to have provided me with info on my XX chromosome status. And I have fantasies of the company doing commercials like they do now, with "Oh, I thought I was Scottish, and it turned out I was German!" but with "Oh, I thought I was XY, but it turns out I was XX and intersex!" and it being treated as as much of a "OK, I'll just shift my thinking a bit and put on some lederhosen!" as the current ad campaigns.
posted by lazuli at 7:52 PM on June 17, 2016 [1 favorite]