5 Meaningful Ways to Be a Gender Inclusive Provider
For a few weeks now two subjects have been floating around in my brain like hot air balloons drifting past each other but not quite touching. When I was asked to write this piece, the two balloons finally made contact. I’ve been thinking about queer inclusivity and medical ethics. When the question, “ “Why should professionals make it a point to be inclusive of enby, trans, and queer families besides just basic respect?” comes up, I am struck by this answer: Because medical ethics says providers should be inclusive.
I could write a whole other article about whether a lactation consultant is, or should be, or should even want to be considered a ‘medical professional’ and subject to medical ethics. But regardless of where you fall in that debate, today please indulge me, and let's just agree that anyone whose job might include seeing patients in a hospital should abide by basic medical ethics.
The Four Tenets of Medical Ethics
Different organizations have their own ethical guidelines, but the four basic tenets are: beneficence (actively helping your patients), non-malfeasance (avoiding harming your patients), justice (treating your patients fairly), and autonomy (giving your patients the tools to decide what’s best for them.) Let’s take these one at a time and examine how they relate to gender inclusive care.
Non-malfeasance:
This is often the first thing people think of in terms of medical ethics– the famous ‘first, do no harm’. How does gender inequity harm patients? Say your patient is a transmasculine parent who just gave birth and is experiencing severe nipple pain. You may want to see him in-clinic and examine the baby as well. Regardless of how committed he is to providing milk for his baby, if your demeanor and clinic space are making him feel unwelcome, he will be less likely to seek follow up care and may stop earlier than intended. Having a support network is a key factor in parents achieving their lactation goals, and it is the job of providers to make their spaces safe for people of all genders.
Beneficence:
I think everyone knows the feeling of walking into a space and immediately thinking, “I don’t belong here,” or “This place is not for me.” It’s not always a bad feeling, often it’s neutral, but it’s rarely good. People simply feel more comfortable in places where they feel welcomed and celebrated. As lactation consultants, we often have two patients, the parent and the infant. By creating a welcoming environment for all families, we are helping infants get what they need for their growing bodies. Additionally, we are helping parents create that food as well as engage in an activity which can have long-term physiological and psychological benefits for both.
Justice:
Generally, when people think of justice it's in a legal sense. In this context, the word means something more like ‘equal treatment.’ If you would not bar patients based on their race, occupation, national origin, religion or sexuality, it’s fair to think that it would also be wrong to refuse a patient based solely on their gender. We do all have groups of people we are more or less comfortable being around based on our lived experiences and cultural contexts, but as professionals, it is our responsibility to unpack these biases. It is also true that we don’t have to be (and cannot be) the “right” care provider for every patient. Thus, it’s essential that you have a list of colleagues you can refer out to who can provide appropriate care.
Autonomy:
Patient autonomy gives the patient accurate information to decide what’s best for them. If, for example, your patient is transfeminine and has questions about inducing lactation and whether her hormone treatments will affect the amount or quality of her milk, your ethical duty is either to provide her with accurate information about possible interactions or refer her to another consultant who has more knowledge on inducing lactation. Again, the responsibility of the provider is to offer evidence and choices and to hold space for the patient to make informed decisions without coercion or pressure.
5 Ways to Become a Gender Inclusive Provider
What if you’re a person who wants to be more inclusive but are unsure how, especially if you’re a straight, cis person worried about cultural appropriation? Let’s start with a few little things you can do around your clinic. Most people may not notice these things but for a few it will make a big difference.
If you have a restroom, especially if it’s single occupancy and/or has a lock, label it unisex.
If you have wall art, make sure to include gender diverse individuals or families. Stock footage can be hard to find, but Vice has a selection you might find helpful. If it’s in your financial means, you could also hire a local LGBT artist or photographer to make something for you.
Intake paperwork is tricky because for reasons outside of your control, it may either be incredibly easy or incredibly difficult to change. If you can make simple changes to your basic intake questions the three changes I would emphasize are:
Ask for a patient’s name and if you need it, their “name as it appears on insurance”. This emphasizes the idea that there is not a “real name”’ or “preferred name”’ just their name and the information the insurance company needs for billing purposes.
Ask which term a patient prefers for feeding. Some options include breastfeeding, chestfeeding, lactating, bodyfeeding or something else. Avoid the word ‘other,’ as it can be emotionally triggering and people in a lactation consultation may already be in an emotionally difficult state.
Ask for a patient’s pronouns, but keep the options simple. (eg He / she / they / something else: _________ ) Again, don’t use the word ‘other.’
4. If you have magazines or books around your space for either staff or patients, get a subscription to a current events magazine like The Advocate or Out and whatever your local gay publication is. If you have a shelf of reference books, make sure you have some on LGBT lactation or medical issues. Some good examples include: Trans Bodies, Trans Selves (2nd ed. just came out, and I was fortunate enough to write a section!) and Queer Nursing by Liesel Burdich. You can also refer clients to gender inclusive lactation resources such as Kate York’s guides, which you can find here.
5. Practice using the singular ‘they’ (a great thing about ‘they’ is that everyone can be ‘they’) and try an exercise, either by yourself in the mirror or with a friend, where you practice misgendering a person, briefly apologize, and get back on track. That way, when you do misgender a patient you don’t get flustered and make it more uncomfortable. If you accidentally misgender a patient, I recommend that you treat calling someone by the wrong gender like calling them by the wrong name. Just apologize, correct yourself, and move on.
Even if you have a hard time with the idea of gender diversity, particularly in a field long considering to be the domain of cis-women, I encourage everyone to consider these points and take as many of these steps as you can if only because they will make you better at your chosen profession. For more extensive information on how health care staff can provide inclusive service, I recommend this guide put out by The Fenway Institute.
Finally, check out BADT’s Queer and Trans Birth class, which will be available as a a self-paced prerecorded class here.
Jacob Engelsman, IBCLC (he/him) is a nanny, childbirth educator, and lactation consultant who lives and works in Atlanta, GA. He specializes in lactation concerns specific to LGBT families including inducing lactation and lactation after top surgery or after receiving implants. He also speaks and writes on these subjects for both parents and professional audiences. Jacob can be contacted on Instagram @jacobibclc or through his website jacobengelsmanibclc.com