Midwives Advocate For 'And-And' Approach To Pregnancy Language

Tuesday, 15 April 2025, 6:04 pm
Article: RNZ

Anneke Smith, Political reporter

The College of Midwives says Health New Zealand can keep saying "pregnant women" without excluding trans and non-binary people.

Associate Health Minister Casey Costello has directed the agency to say "women" instead of "pregnant people" in its communications about health issues.

Costello pointed to inequities and bias in the health system, as well as conditions like endometriosis, as reasons why she thought it was necessary Health NZ used "sex-specific language".

"It is important that we have clarity about the people we are referring to when talking about women's health. Sex-specific language ensures that women know what health services they are entitled to and can access these easily, especially for those women with English as a second language."

Costello's move has drawn criticism from Victoria University's Dr George Parker, who said there was no evidence the use of inclusive language negatively affects cisgender (those who are not trans or non-binary) people.

But the New Zealand College of Midwives chief executive Alison Eddy said the organisation had heard of examples where inclusive language had caused confusion.

"I think we don't really know the impact of what happens if we change language at a policy level without being thoughtful about how we do it," Eddy said.

"There's some work to do to really understand the impact of these changes and I think there's ways that we can address this issue, in a more nuanced way."

Eddy said the college acknowledged not everyone who gave birth identified as a woman, and expected midwives to be "absolutely respectful" of that.

"We're being very thoughtful as the profession about how we address this issue of inclusively at a population or policy level and we're really mindful that words such as 'woman' or 'mother' [have] deeply embedded cultural meanings in every language around the world," Eddy said.

"As a profession, we've spent years advocating for language around pregnancy and birth to be really humanistic and to centre the woman or those giving birth and not sort of describe them in a demeaning way by body parts.

"Some of the examples that have been reported this morning, 'people with a cervix' for example rather than women, could be potentially confusing for people that have English as a second language or lower health literacy. And it's also potentially very dehumanising for women to be described in that way."

She said it was possible to use inclusive language in healthcare without ditching the word "women".

"For example, you can talk about 'women and gender diverse' people at the same time so that you're using the words that describe the entire population and not eliminating women, who are the vast majority of people giving birth."

Don't pit sides against each other - academic

University of Waikato senior lecturer in psychology Jaimie Veale, who is also the director of the Transgender Health Research Lab, said the minister's directive was disappointing.

It was a movement away from having inclusive language to cover not only women as the majority of child-bearers but also men and non-binary people.

It was better not to pit sides against each other when it came to choosing accurate and inclusive language, she said.

"Generally, my preference would be for this not to be something politicians decide on. It would be great if our health experts and people looking at the evidence make those kinds of decisions.

"I think it is a bit concerning that we're seeing some of the 'quote divisive politics' coming out of potentially other parts of the world starting to be brought in here in Aotearoa."

Veale told Midday Report the risk was some would see information about the services being provided as not applying to them, so therefore barriers were being created to accessing care.

As well, some communities felt they were being "singled out and targeted".

"Hopefully we can come to some sort of resolution with this," Veale said.

'Wouldn't be my first priority' - Labour leader

Speaking on Morning Report, opposition leader Chris Hipkins said changing terminology around gender shouldn't be so high on the minister's agenda.

"I'm surprised the minister's giving this her time when there are many, many more important things I would have thought that she should be worrying about.

"This is a minister who's got delegations for women's health, delegations for smoke-free, delegations for a variety of things where I think there are some pretty pressing issues and I'm surprised that this is what she's giving her time to."

Asked if his party would overturn the directive, Hipkins said decisions like that should be left to health professionals, not politicians.

"I think ultimately you leave the clinicians to make decisions based on what's best clinically for the people that they're dealing with. And I think they should aim to be as inclusive as possible.

"The directive from us would be the health system should be inclusive. You should respect all of the people who you're dealing with, and we'll leave it to your professional judgment as to how best to do that.

"I think they should use evidence-based research to justify their decisions, and I think when ministers start cutting across that, you get into pretty dangerous territory."

Asked about his personal views on saying "pregnant women" or "pregnant people", Hipkins said both could be appropriate in different settings.

"It depends on the context. It depends on the group of people who you're dealing with. If you're dealing with a group of transgender people, then no, it isn't. But if you're dealing with a group of women who would prefer to be called women, then I'm quite happy with that as well.

"Ultimately, this is what the whole system deals with on a day-to-day basis. No two people have the same need. And so you deal with each person individually, based on their need."

But Prime Minister Christopher Luxon argued the government wanted clear and appropriate language.

"What's important is just to have clear language and I think, common sense language," he said.

"I think most New Zealanders would actually say 'pregnant people' are women and that's quite acceptable to say so."

Costello declined to appear on Morning Report.

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