The case for saying ‘pregnant people’ and other gender-inclusive phrases

The use of phrases such as “pregnant people” or “penis owners” in cultural or political discourse is sometimes met with confusion, or even anger.

Why use these terms when, as some people ask, “only women can get pregnant” or when “only men have penises?”

Those people and institutions using gender-neutral language aim to be cognizant of the fact that sex doesn’t always align with gender identity, said psychiatrist Dr. Jack Drescher, past president of the Group for Advancement of Psychiatry and clinical professor of psychiatry at Columbia University in New York City. And it’s the most inclusive, streamlined way to refer to everyone who, regardless of their gender identity, has certain anatomy or biological abilities.

“We need to be doing a better job of educating people and realizing that sex and gender are a bit of a spectrum … and that they’re not the same,” said Keygan Miller, director of public training at The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ+ youth.

READ MORE: Gender identity: The difference between gender, sex and other need-to-knows

Here’s what experts have to say about these linguistic changes and concerns that have been raised.

What is sex versus gender?

A person’s sex is what they were assigned at birth based on biological characteristics of maleness or femaleness as indicated by chromosomes, gonads, hormones and genitals.

Gender, however, is a social construct and social identity marked by certain attitudes, feelings and behaviors a culture associates with someone’s biological sex, according to the American Psychological Association.

There are at least more than 1.6 million adults and youth — ages 13 to 17 — who identify as transgender in the United States, or 0.6% of people ages 13 and older, according to the University of California, Los Angeles’ Williams Institute, a UCLA Law center for research on sexual orientation and gender identity law and public policy.

Gender identity is an aspect of gender that describes a person’s psychological sense of their gender, which may or may not align with one’s sex, according to the American Psychological Association. Someone whose gender identity conforms with what has been culturally associated with the sex they were assigned at birth is known as cisgender, while those whose identities don’t align may be transgender or a nonbinary gender (someone who doesn’t exclusively identify as either of the binary genders).

Pinpointing the beginning of these linguistic shifts away from centering only cisgender people is difficult, but they have amped up over the last two decades, and especially in the last five years or so, said Miller and Dr. Dennis Baron, professor emeritus of English and linguistics at the University of Illinois at Urbana-Champaign.

“As our understanding of gender has evolved, and our understanding of inclusion has evolved, we’re starting to see more and more of these terms being used,” Miller added.

Why gender inclusivity matters at the doctor’s office

In addition to acknowledging the difference between gender and sex, using phrases like “pregnant people,” for example, also recognizes intersex people (who have reproductive anatomy or genes that don’t fit into a male-female binary, which is often discovered at birth) and the various ways gender-diverse people affirm their gender identity, Miller said.

Some people may think a trans man can’t get pregnant based on assumptions he has undergone surgical gender-affirming care that would remove, add or alter the appearance of some sex characteristics such as a vagina or breasts. But every trans or nonbinary person is different in terms of what care they want, if any, Miller said — so a trans man who hasn’t received this care can still get pregnant. And sometimes this happens even when a trans man has been taking testosterone.

In the context of health care, “it’s not just a matter of (being) inclusive or polite, it’s a matter of medical accuracy,” Baron said.

That applies to various medical scenarios, including something as simple as the prescription of antibiotics, which can diminish the effectiveness of birth control. If someone who was assigned female at birth, yet presents as a man, is on birth control and hormones and is given antibiotics because the doctor assumed the patient has a penis based on their appearance and identity, the patient could unwillingly end up pregnant.

Labeling people by what anatomy or biological functions they have allows medical professionals to “be more inclusive and consider those clinical impacts,” Miller added.

In addition to the American Psychological Association, several other medical associations have recognized the difference between gender and sex and support the use of gender-neutral terms — including the American Medical Association, the American Psychiatric Association and the National Institutes of Health.

“Presumably, it makes the patient feel like they’re being seen, that they’re being paid attention to appropriately,” said Baron, author of “What’s Your Pronoun?: Beyond He and She.”

Whether this openness exists in medical professions can affect whether a gender-diverse person seeks care, Drescher said.

Are cisgender people being erased?

A common critique of gender-inclusive language is that it “erases women.” But there are parallel euphemisms for the genitalia or biological functions of those assigned male at birth, too — it’s just that phrases such as “pregnant people” or “people with uteruses” have been amplified in public discourse due to constant political discussions around reproductive rights, experts said.  

Given the fact that there are “so many ciswomen and cismen and that they actually are a very large majority, language is not going to erase them,” Drescher said.

These experts also aren’t saying the issues facing certain groups of people are unimportant, they said — broader language is just a way to include people who haven’t been included before.

“You can’t just wave it away and say, ‘Oh, these are made up terms so they’re no good,’” Baron said. “All language is made up, and it’s made up because we have a need to say things.”

And contrary to what some may think, saying things like “only women can get pregnant” excludes more than just intersex people or those in the LGBTQ community, Miller said — that’s because such statements can also convey that a ciswoman who can’t get pregnant is no longer fully a woman.

Gender-inclusive language may seem to be just words, but research has shown that acceptance can be lifesaving for transgender and nonbinary people, Miller said, both for medical and psychological reasons.

“Verbalizing,” Baron added, “is an act of important recognition that then gives people a sense that, ‘Yeah, I’m here and I can talk about this. And other people can talk about me and to me and with me in ways that maybe weren’t so easy before or were impossible before.’”

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