One of the most common topics that comes up in our conversations with organizations, families, and communities is the difference between sex and gender. As a quick refresher, we typically assign a newborn’s sex as either male or female based on the baby’s genitals. Once a sex is assigned, we presume the child’s gender, which may or may not correspond with their sex. A person’s gender is the complex interrelationship between three dimensions: body, identity and social.
- Body: Our body, our experience of our own body, how society genders bodies, and how others interact with us based on our body
- Identity: The name we use to convey our gender based on our internal sense of self
- Social: How we present our gender in the world (including clothing, hairstyles, mannerisms) and how individuals, society, culture, and community perceive, interact with, and try to shape our gender
Sex and gender are often conflated or misrepresented, and without this fundamental understanding of their key differences (and to what degree they are connected), a nuanced understanding of gender’s impact on our lives is difficult.
The American Medical Association’s (AMA) recent proposal to remove sex designation from birth certificates serves as a good step towards bridging this gap in understanding, and helps broader sets of the population see sex and gender as distinct. The AMA’s proposal also stands out as an example of an institutional level change that can help address gender discrimination against everyone, especially gender diverse people.
Despite this good faith effort, some of the AMA’s proposal still references sex and gender in confusing ways:
“If sex designation is removed from the public portion of the birth certificate, there are concerns that transgender individuals may not have government documentation confirming their gender identity. However, in most states, a person can change the gender marker on their driver’s license, though the process varies by jurisdiction”
In this case, the use of “sex designation” is used almost interchangeably with “gender identity” which can lead to readers conflating the two concepts despite them being different. That said, we at Reimagine Gender understand the good intentions behind the proposal: to protect the personal information which can lead to discrimination, especially for gender diverse people.
Birth certificates 101: where we are today
To understand the importance of the AMA’s proposal, we must first understand the social context that informed their decision and how birth certificates have evolved over time.
Unknown to most, there are two documents created at the time of birth, containing different information and used for different purposes: the U.S. Standard Certificate of Live Birth form, and the more commonly known birth certificate. The Standard Certificate of Live Birth form spans 58 questions gathering data including the child’s sex designated at birth, and key information on the child’s parents, with this information later submitted to the state for record keeping and helping state governments track the prevalence of disease, life expectancy, teenage pregnancy, and infant mortality, among other key public health indicators.
Birth certificates, on the other hand, are used to prove citizenship, age and identity, and are issued to parents shortly after the birth of their child. They contain much less information on the child including child/parent name(s), birth date, birth place, city of birth and sex, however, information reflected varies by state. Birth certificates are also widely used to prove identity and get access to other vital goods/services including obtaining passports and driver’s licenses, registering for school, adoption, securing employment, marriage, and accessing other private records. These are situations where knowing a person’s sex is irrelevant.
As the Standard Certificate of Live Birth form captures sensitive information, including sex, that state governments may need for population and health tracking purposes, including this information on birth certificates is simply unnecessary. Keeping sex designation on birth certificates leaves room for countless ways in which people are forced to unnecessarily disclose private information about their sex and/or gender identity to access essential goods and services.
Not only that, but having sex designations on public birth certificates adds unnecessary complexity and challenges both for the state and individuals. Because of the societal tendency to conflate sex and gender, individuals who want to align their birth certificate with their gender need to modify their birth certificate. To date, 48 states and the District of Columbia allow people to amend their sex designation on their birth certificate, and 10 states allow for a sex-neutral designation (typically “X”) on the birth certificate which parents can denote at the time of birth, or the child can choose to update later in life. Tennessee and Ohio do not allow for any changes to one’s sex designation on birth certificates. Of note, while one’s sex can be altered (e.g. genitalia), it cannot be completely changed (e.g. chromosomes ), whereas one’s gender identity can evolve and grow alongside them. In fact, in a global study done by Irregular Labs not long ago, 23% of GenZ respondents said they expect to change their gender identity at least once in their lifetime. However, because of society’s interchangeable use of the terms sex and gender, some people choose to alter the sex on their birth certificate to be more closely aligned with their gender identity, even though they are two different aspects of self.
Why is the AMA proposal so vital for today?
Despite growing evidence that populations are thinking of and relating to gender differently, birth certificates still lag behind in accommodating shifting views of sex and gender identity.
The AMA’s proposal to remove sex designation on public birth certificates can potentially curb some of the gender and sex-based discrimination, violence, and erasure gender diverse and intersex people face. Birth certificates disclosing sex designation can lead to:
- The dismissal of intersex children - Including sex on birth certificates enforces a binary understanding of sex, and forces families and doctors in many states to choose between male and female designations when an intersex child is born; this may also lead to invasive surgeries before the child can provide consent. Furthermore, sex designation based on a child’s genitalia is still a doctor’s best guess at a child’s sex designation. Current research indicates approximately 1% of humans have an intersex trait, many of which are not identified at birth.
- Discrimination against trans, non-binary, and other gender diverse people - Those whose gender identity or expression do not fit someone else’s expectations relative to their sex assigned at birth may face discrimination in the workplace, be denied housing, or be subject to invasive medical examinations to prove their gender identity. The National Center for Transgender Equality reports more than one in four transgender people have lost a job due to bias, and more than three-fourths have experienced some form of workplace discrimination. By removing sex designations on birth certificates, we can potentially reduce instances of discrimination for gender diverse people.
The AMA’s proposal is by no means a new idea — there is already a precedent for removing personal information on birth certificates that is known to promote discrimination. Parents’ race is no longer included on birth certificates as that information has been used to discriminate and otherwise promote racial hierarchies, and has since been removed. By removing sex on this public document, we can continue to remove unnecessary information that may lead to discrimination.
Steps you can take if you want to support the AMA’s proposal
The AMA does not have the power to enforce this proposal across states, as birth certificates are state-governed vital records, but there are still ways to support!
- Connect with your local representatives + state medical association - Even with a majority of states allowing residents to change their sex designation on birth certificates, having any sex or gender designation on these documents creates opportunities for gender and sex-based discrimination, especially for gender diverse and intersex people, respectively. Get familiar with your own state’s policies, identify your local representatives, and request their support of the AMA’s proposal. Additionally, you can reach out to your local state medical association to understand where they stand on this topic and request their support in lobbying local congress members to remove sex designation on birth certificates.
- Facilitate conversations in your personal life - In spaces where you feel safe, bring up the distinctions between sex and gender and see where others are in terms of their journey with understanding gender and where you can be a support system for them. Bringing up this AMA proposal can be a good starting point to understand their ideas of gender.