Why Our Words Matter—And Five Approaches to Intentionally Employing Inclusive, Respectful Language

The words we choose and the language we use have the power to affect the people and the world around us. Our words represent our beliefs, morals, prejudices, and principles—sometimes in ways we may not mean—and can shape an audience’s perceptions of us as well as the issues about which we speak and write. And, our failure or refusal to speak or write certain words—intentional or not—sends similar messages. For instance, when the previous administration ostensibly prohibited the U.S. Centers for Disease Control and Prevention from using such terms as diversity, entitlement, evidence-based, fetus, science-based, transgender, and vulnerable, the intent was obvious to stakeholders across the public health sector and beyond—to minimize the importance and legitimacy of the concepts and individuals associated with those terms.

At EngenderHealth, we understand that our language and how we frame our messages can dramatically impact the thoughts and feelings of those with whom we work—including our partners, supporters, and impact populations. Last spring, we published a series of Language Guides reflecting our values of inclusion, integrity, reflection, respect, and transformation; and, this fall we have added one more. After publishing the original guides and sharing our experience in creating these materials, colleagues at other international health and development organizations and friends working in other fields completely have connected with me to discuss these topics and our process, demonstrating a desire to likewise improve their own language and support those around them in doing the same. Below, I am sharing a few approaches that I try to employ to ensure the language we use is as inclusive and respectful as possible.

Say What You Mean, Mean What You Say

In a world where everyday conversations are commonly reduced to emoji-filled texts or SMS messages (short message service—emphasis on the “short”) and character-limited tweets, it is perhaps unsurprising that our language more broadly has become imprecise and even pedestrian at times. Additionally, our brains are wired to categorize essentially everything and, in an effort to accomplish as much as possible as quickly as possible, it is easy to rely on generalizations and oversimplifications. I do not want to be completely dismissive, however. There are many relatively inoffensive categorizations, some of which even aid in our survival, for example: citruses—including lemons, limes, and clementines—are edible fruits. However, social characterizations, which may extend from inaccurate to discriminatory and/or exclusionary, can reduce people to dangerous stereotypes and can create or exacerbate biases and stigmas. This includes gender binaries that delegitimize trans and other nonbinary populations as well as racial constructs that equate whiteness as “normal” and categorize all others collectively as “nonwhite” or “diverse.”

You can avoid perpetuating such stereotypes by pausing to carefully consider what you mean and being as specific as appropriate. We have sought to overcome this type of counterfeit communication by emphasizing the importance of consistently using current, accurate terminology in all of our language guides and by providing explanations for key terms and recommended language, which we hope will enable us to communicate correctly and respectfully. For instance, we intentionally use the term “sexual orientation” rather than “sexual preference,” as we recognize that a person’s emotional, physical, and romantic attraction to other people is not a choice. And, we differentiate between early and later adolescents (ages 10 to 14 and 15 to 19, respectively) because we know that their needs for sexual and reproductive health information and services change over time in important ways; for example, early adolescents more commonly need support in dealing with puberty issues, such as the onset of menses, whereas later adolescents may require more assistance navigating their sexual debuts and forming enduring emotional and physical relationships.

Know Your Audience, Respect Your Audience

Communicating effectively requires an understanding and appreciation of audience. Only after identifying audience can we frame our words and messaging with care and intentionality. A couple of key tenets connected to our work—that we likewise aim to employ in our language to respect our audiences—relate to an understanding of intersectionality and an appreciation for individual agency. This is why we apply a gender, youth, and social inclusion framework to program design, implementation, and monitoring and why we constantly highlight the importance of free, full, informed choice when promoting contraceptive care. We produce materials for a breadth of diverse audiences. This includes clinical curricula and counseling resources that we use to train healthcare providers; information, education, and communication materials that aim to increase awareness among clients and patients; technical and research briefs that we share with others in our sector to advance the global evidence base; programmatic and financial reports for our funding partners; and social media content that we share with general audiences with varying levels of familiarity with our sector. The needs of these audiences therefore varies, and so must our approach to communicating with them.

In our maternal and obstetric care programs, to respect the agency of pregnant people and to assist them in making the best decisions possible for themselves, we encourage providers to offer guidance in terms that can be readily understood, rather than using coded language (medical abbreviations and jargon) that can confuse patients, employing condescending language that can shame them, or issuing directives that diminish their autonomy. For instance, we aim to retire terms like “normal birth,” which implies that those who undergo caesarean delivery are “abnormal.” Similarly, in our adolescent- and youth-focused programs, we recognize young people as experts in their own lives, capable of making informed decisions, and we understand that they are not a monolith. We know that youth who do not identify as cisgender and heterosexual (cis-het) experience increased risks related to sexual behaviors and health outcomes compared to their peers. Additionally, we recognize that comprehensive sexuality education (where it exists) is frequently limited to heteronormative content and discourse, thereby failing to provide LGBTQ+ (lesbian, gay, bi, trans, queer/questioning, and/or other) adolescents with the information they need to make educated, healthy choices and perpetuating dangerous stigmas that further prevent them from exercising their rights. Therefore, we promote the idea that all people have the right to explore and engage in consensual, healthy, respectful sexual activity—for emotional, mental, social, and physical pleasure as well as for reproduction—and we encourage the use of gender-neutral language, such as “partner” or “significant other” instead of “boyfriend” and “girlfriend,” to ensure all adolescents feel included and can access the information they need.

Learn to Live in the Grey Areas

As much as I love consistency, syntax, and incontrovertible grammar rules, when it comes to language and semantics, things are necessarily more complicated. This became abundantly apparent as we were developing our Language Guide for Gender, Sex, and Sexuality, which required thoughtfulness around the fact that there are not always simple right and wrong choices when it comes to our words. As an organization dedicated gender equality in and through sexual and reproductive health and rights programming, much of our work centers on improving the status of women and girls as the historically marginalized sex. We know that girls and women are frequently the primary recipients of contraceptive methods as well as maternal and obstetric care and we believe in and work hard to facilitate their agency in sexual and reproductive activities and decision-making. We also know that where we work, cis-het norms often prevail. However, we recognize and value individuals who are intersex, transgender, nonbinary, genderqueer, or similar as well as those who do not conform to heteronormativity, and we believe these populations—which are often ignored, excluded, and discriminated against—have the same rights and similar needs as their cis-het counterparts, particularly when it comes to sexual and reproductive health.

Where does language fit in here? We recognize the power in naming these populations as the first step to providing inclusive services and we are committed to ensuring our language reflects a diversity of sexual and gender identities and respects a variety of relationship and family constructs, which we can do by employing gender-neutral terms, such as “pregnant person” and “parent.” However, we also acknowledge that many of the individuals we work with and support are more familiar with and in some cases prefer traditional, gender-specific terms such as “wife” and “mother.” In many ways this links with the previous tip around knowing your audience; and, this is why some of our language guides include “Additional Considerations” that extend beyond the simple “say this, not that” guidance. By asking readers to wade into these grey areas by considering using gender-neutral and audience-appropriate language, we hope to advance thinking among those who write and speak these words and those who hear them in small but meaningful ways.

Do a Little Research

When I first started working on our language refresh initiative, I was a bit ambivalent. I concurrently felt like I was starting from scratch and yet also believed that there were so many issues, and so many opinions on those issues, that I’d never be able to comprehensively understand everything well enough to create acceptable and appropriate guidance for my colleagues. After a little exploration, I discovered, in a way, I was right in both thoughts. In select areas, there was a wealth of information—albeit some consistent and some contradictory—and in other areas I found opportunities to think creatively and propose new ideas. While I was able to draw guidance from other respected international health organizations for some topics, I also found myself drawn to and reflecting upon literature from fields outside of sexual and reproductive health—including education, mental health, and justice reform. For example, in reading about autism, I found interesting conversations about the terms “person with autism” and “autistic person,” with some individuals preferring to be referred to as the former (person first, autism second), while others felt that autism was so intrinsic to them that they preferred the latter. Reflecting upon earlier discussions around agency, audience, and grey areas, this also serves as an opportunity to think about how we define people in other ways—and how we can support people as they define themselves.

In the end, because of this research, all of our language guides include at least a couple of references to additional sources where readers can learn more. Further, I hope, these guides may also serve as a resource for others working on similar guidance for their own organizations. So, grab a cup of tea (or other beverage of choice) and see where a little Googling takes you. What’s the worst that can happen—you learn something new?

When in Doubt, Ask (Politely)

Finally, sometimes you just need to phone a friend. Or email a colleague. If you are authentically interested in learning and are courteous in your pursuit, you may find showing a little interest in an area can foster fascinating conversations and facilitate learning for all involved. Our language guides were not developed in isolation. I consulted literature, queried colleagues and friends, and learned a lot in the process. I have also had the opportunity to continue learning through conversations that I have had with friends and colleagues who have enquired about our guides and my experience developing them. And, as noted in the aforementioned discussions on audiences and grey areas, I encourage readers of our guides to ask themselves and those around them to consider what is appropriate in different contexts.

Respect is critical, however, and carefully considering who you are asking and why you are asking is paramount. I’ll conclude this with a personal anecdote. I am frequently asked “where are you from?” or some similar variation—simply because of the color of my skin. Often the insinuation is othering, and I am left feeling…not great. There have likewise been times where I have identified myself as “Asian American” (the standard checkbox on so many forms), but because I am South Asian, people (in the US) often respond with additional questions essentially to the effect of “Asian means East and Southeast Asian, and that’s not you.” There are times, however, when I am asked the question and the intention is unmistakably the opposite—it is meant to forge a connection. Before you ask someone this question, or any question, I encourage you to consider what your intentions are as well as how might this person interpret your intentions—and either frame your question appropriately or rethink if you are asking the right question in the first place.

In the end, no one is perfect, but we can all improve if we are willing to be honest, humble, and thoughtful—even when it’s hard.