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To reach #UHC2030, we need every idea on the table for transforming health systems and markets to advance people-centered primary health care—including #selfcare. Join @PATHtweets @EngenderHealth & @SFHNigeria to learn more on 3 Aug!➡️https://discoverselfcare.community.tc/t/2021/events/self-care-and-uhc-how-self-care-can-help-leave-no-one-behind-rwe9s8x3s9m1Pno9QcDUa8

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April 26, 2021

Lessons Learned in Language Evolution

By Amy Agarwal, Principal Writer and Editor

Calls to action to fight the pervasive and systemic racial injustices in the US collided with the global COVID-19 pandemic last summer. This merger magnified the intersection of racism and public health and the highlighted impact on marginalized communities worldwide. Moreover, we recognize that there are a host of other social prejudices and discriminatory beliefs and practices that compound these issues. As an international health organization, these issues directly affect our work, our people, our partners, and our impact populations in numerous ways, and it is our responsibility to ethically address these issues as best we can.

One of the many immediate challenges we faced was determining how to communicate about these and similar complex and controversial topics that are at the crux of our work in a manner that aligns with our vision of a gender-equal world where all people achieve their sexual and reproductive health and rights. While internal discussions around language had been sporadically surfacing for months, current events offered us an opportunity to prioritize addressing these issues in a more strategic manner than ever before. After discerning our initial direction—envisioning potential approaches and outcomes and identifying resources willing and able to undertake this important initiative, we have worked in earnest to produce three issue-specific resources, which we are calling language guides. In addition to the language guides, we have developed an introductory tool that provides overarching guidance on how we as an organization aspire to think about and use language in our work. As the international health and development community endeavors to undertake similar efforts to improve the language we use, I would like to share a selection of lessons learned from my experience.

Challenges in Crafting Language Guidance

Progress not Perfection

My fellow writers and editors, I feel confident, will relate to this struggle. We want to craft the ideal. We want to follow rules (hello, Oxford comma!) and ensure precision and perfection, sometimes to the point of pedantry. But how do we adhere to aspirations? How do we align with endlessly evolving ideologies? For example, while “decolonizing development” seems to have become de rigueur in 2020, the modern postcolonial intellectual discourse in international development in reality emerged decades ago with the writings of Edward Said and his contemporaries. So, what has changed and what will continue to change? Similarly, concurrent with continuing learning and dialogues around development theory that inform our approaches and operations, advancements and innovations in healthcare that shape program design and implementation are also constantly progressing, even as we publish this piece. And, all of these shifts must simultaneously be reflected in the language we use to communicate with each other, our partners, our impact populations, and the broader global health community. As a result, we must recognize that anything we develop today is likely to require revisions much sooner than we would like. Therefore, accepting that the objective of this undertaking is to develop what are necessarily works in progress—rather than perfect, unalterable pieces of art—is a critical challenge that must be recognized from the start and continuously contended throughout the entire process.

Becoming Comfortable with Being Uncomfortable

Now that we have accepted that we will be aspiring to ongoing advancement rather than a solitary end-achievement, the next critical challenge that we must embrace is becoming comfortable with being uncomfortable. We began our introductory Principles of Language explaining that “language both conveys and shapes our thinking.” Underlying this statement is the recognition that that despite our best efforts, our communication is infrequently neutral and that the language we use almost always builds upon historic sociocultural norms that have influenced each and every one of us as individuals. Therefore, confronting the personal privileges that have colored the language we use is critically necessary—and necessarily disconcerting. Allow me to model this for a moment by sharing two of my personal truths that have shaped my own beliefs, words, and actions. First, I am a woman of color, an immigrant from a developing country that was previously colonized. Second, I was raised by parents who each earned graduate degrees from one of the most prestigious universities in the US and who transferred their esteem for education to me and contributed to my ability to pursue my own degrees—degrees which enabled me to attain scholarships and accolades, explore unpaid internships, and foster networks and relationships that established a foundation for professional success. Marrying my personal history and privilege with my aspirations to be a strong ally to other marginalized populations—including by improving the language I and others use—has required continuous reflection. Furthermore, throughout this process, I was forced to relive personal experiences, including both workplace microaggressions and more general overt attacks, which are leveled at minorities every day, while simultaneously replaying insensitive comments I have made in the past that I now know were born of a mixture of ignorance and privilege. The process has been humbling, to say the least. The mental energy and investments of time required for this work is eclipsed by the emotional energy required, and those endeavoring to undertake similar process should plan accordingly. Are you ready to become uncomfortable?

Countering Conservative Sociocultural Norms

EngenderHealth is an international sexual and reproductive health and rights organization, first and foremost. From my position in the organization’s DC-based global support office, the breadth of my internal clients are technical experts and program leaders working around the world in vastly different cultural contexts. All of these colleagues bring their own individual experiences and perspectives, which may or may not be quite different from my own, and many speak English as a second or third language. Hence, for any guidance we develop to resonate, overcoming these inherent differences was an imperative consideration at all times. Moreover, as unpacking complex and potentially controversial topics—such as adolescent sexual behaviors and access to abortion—is at the crux of this initiative, this task necessitated creativity as well as sensitivity to the fact that we are not dealing in simple semantics. And, as many of the topics we needed to address are both highly politicized and deeply personal, uncomfortable conversations with colleagues, albeit uncommon, did occur. These conversations forced us at times to reexamine our organizational beliefs (e.g., should we mirror language used by a donor that we feel is regressive for fear of risking new funding opportunities?) and challenge one another’s unconscious biases in the process. Negotiating these difficult discussions was a necessary evil to ensure our end-products incorporated inclusive, respectful language that colleagues across the organization could understand and apply while working in a diversity of cultural, social, and political environments.

Elements of Success

Divide and Overcome

The list of issues which one might address is as endless as the approaches an organization might use to complete this work. One of the reasons our effort started so slowly was because I had a hard time conceiving of how we could address all of the issues that I knew were important in a meaningful way. With everyone already overextended, adjusting to the new dynamics required by remote work and travel restrictions, how could I ask colleagues, who I knew would be assets to this effort, to contribute their time and energy to this initiative without a well-planned strategy? After a series of emails and video calls with a few different technical teams, I drafted a detailed proposal outlining potential approaches, resources required, tentative topics and timelines, and suggested end products. This proposal was met with a mix of apprehension and enthusiasm, which in the end informed our strategy of starting with a single issue, piloting initial approaches to collaboration and preliminary structures, and using learning to inform the process for future action. Demonstrating the success of this approach, while we spent approximately three months debating content and format for the first language guide, we were able to produce a second in a mere couple of weeks.

Culture of Collaboration and Learning

As alluded to in the previous paragraph, this was and continues to be a group effort, for several important reasons. First, while I think I know a fair amount about language and editorial style and am passionate about promoting inclusivity and advancing equality, I know definitively that I am not an expert on the multitude of topics that we must address. Thankfully, I have a number of equally enthusiastic colleagues with subject matter expertise willing to commit themselves to this cause. This supports one of our overarching principles, which is “everyone plays a role.” A second and related element of our approach ties to our commitment to being a learning organization. This initiative was new for all of us and, as noted in the discussion around progress, we are all continually gathering new ideas and information relevant to this effort. Establishing a common understanding—that this was in some ways a learning exercise for us all—allowed us to operate with an assumption of good faith and offer each other grace throughout the process, knowing that in the end we all share a similar objective.

Supportive Leadership

Last but not least, anyone who has ever heard Traci L. Baird speak, read anything she’s written, or simply had a conversation with her will likely agree that she is seemingly effortlessly able to convey a sense of compassion that many of us can only aspire to. For example, in one article she authored for Forbes last spring, Traci wrote that “staff must know that leadership—the board, CEO, leadership team, and their own supervisors—care about them.” I have had the privilege of watching how she manifests this care and compassion in practice while learning from and being inspired by her for the past two-plus years that she has served as our President and CEO. Therefore, while I was admittedly overwhelmingly anxious when she first requested my department lead this important initiative—a result of both wanting to match the exceptional standards she has set and feeling inadequately prepared for assuming such responsibility—I am enormously grateful to have benefited from her guidance at pivotal points throughout the process. She made time for and devoted her attention to reviewing drafts, providing meaningful comments, and offering thoughtful solutions, when necessary. Her involvement in the process and endorsement of the “final” products also demonstrates the importance of language and the validity of these resources to and for staff across the organization. All of this to simply say: supportive leadership—at the highest levels—is critical to surmounting the varying aforementioned obstacles and will hopefully likewise affirm the importance of implementing these guidelines and principles moving forward.

View the Principles of Language Use and Language Guides on Abortion; Adolescent and Youth Sexual and Reproductive Health and Rights; and Gender, Sex, and Sexuality in the Language Guidance section of our Publications and Resources Page.

Amy Agarwal is an experienced writer and editor, an avid reader, and an amateur designer. With a master of arts in international development, she has visited nearly 50 countries for work and/or pleasure and has documented her travels in the photographs that adorn her home in Alexandria, VA.

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