A coalition of courageous midwives has posted and sent an open letter to the Midwives Alliance of North America regarding its policies erasing the sex of the human beings who get pregnant and give birth to babies – that would be biological women.

Please support them if you can by signing on to the letter, sharing and posting it. If you wish to add your name, e-mail womancenteredmidwifery@gmail.com. Men don’t get pregnant. Men don’t give birth. Men don’t breastfeed infants. If the language we use to describe the sex of the humans who do these things is erased, we have lost our political language for resistance.

Here’s the letter:

Open Letter to the Midwives Alliance of North America regarding the recent revisions to the organization’s standing Core Competencies Document:

August 20, 2015

Dear Midwives Alliance of North America Board of Directors and MANA Membership:

We are writing in response to your revisions of the MANA Core Competencies. MANA’s attempts at inclusivity are commendable in today’s complex world. We are concerned, however, by accelerating trends in our culture to deny material biological reality and further disconnect ourselves from nature and the body, and about the ways in which the revisions may support these trends. Midwives have long practiced the precautionary principle, counseling against the adoption of technologies and theories that have not been proven safe or beneficial to mothers and babies, and by extension, the entire human community. We respectfully ask the MANA board to reverse the 2014 revisions and consider the ways in which the attempted changes may have harmful implications for women.

We are concerned that, except for in the trademarked section from the Midwives Model of Care, the word “woman” has been erased from the MANA core competencies document and replaced with “pregnant individual” and “birthing parent.” We recognize that the words maternal and motherbaby were not removed from the document, implying that the reviewers maintained a mutual and shared respect for the sanctity of the motherbaby unit in midwifery. But women are now all but missing from the language, as if we can separate woman from mother from baby. Woman is recognized now only in relation to her baby. This is harmful to female adult humans; we women have fought long and hard to be recognized as autonomous beings.

Adopting this language change in the context of midwifery and human reproduction is based on either or both of the following assumptions. 1) That MANA and the midwives MANA represents believe that it is biologically possible to change one’s sex. Or 2) That we deny the material basis of biological sex and acknowledge gender identity as primary. We know as midwives that biological sex occurs at the level of our DNA and the gametes we produce, and is immutable. By embracing the idea that any human other than those in a class called women carry offspring to term, give birth to them and nurse them, we are prioritizing gender identity over biological reality. We are also contributing to the cultural erasure of women’s wisdom that the physiological power encoded in our female bodies is what creates, nourishes, and births live offspring and transmits culture. Maintaining this understanding of women’s unique power to give birth does not preclude practitioners from taking into account how individuals in their care prefer to be identified.

We believe that it is a mistake to define the experiences of pregnancy and childbirth though the lens of gender identity. The very few gender-identified males that have given birth or accessed an abortion have only done so because they are female-bodied people, and that scientific fact cannot be erased. We are allowing gender identity to be the primary way that we refer to one another, even for a biological process like birth. Pregnancy and birth are distinctly female biological acts; only women and female-bodied people can give birth. The whole concept that a man can give birth is premised on the supremacy of technology over women and nature, and the primacy of ideology that is detached from our animal, natural selves. Yet midwifery doesn’t only thrive, but survives, on the health of the biological process. We as midwives believe in the inherent wisdom of biology.

Human beings, like the majority of other mammals, are sexually dimorphic. i.e. there are two distinct biological sexes, female and male, with each having particular primary and secondary sex characteristics that allow us to make a distinction between the two. Sex is natural, biological and objectively factual. Gender refers to societal roles and expectations placed upon members of each sex. Gender is cultural and gender norms vary across the globe. Gender is in fact synonymous with what not so long ago were called sex-role stereotypes. Today the word gender is frequently used to stand in for sex but this is true only on a superficial basis. Gender often now refers to the sex one is perceived as or wants to be perceived as. Gender, as used today, also refers to the results of consuming powerful steroid hormones to change secondary sex characteristics, and therefore the perception of one’s sex.

The root of female oppression is derived from biology. Patriarchal systems arise out of male attempts to control female sexuality and reproduction. Female liberation from patriarchal oppression, including brutal and demeaning birth practices, cannot be achieved if we are forbidden from mentioning female biology. Women have a right to bodily autonomy and to speak about their bodies and lives without the demand that we couch this self-expression in language which suits the agenda of others who were not born female. Gender, sex and sexuality should not be conflated. Sex and sexuality are based upon biology whereas gender is a socially constructed concept. We do not give birth with our gender identity but with our biology. The document refers to the midwife’s need to be knowledgeable about the “anatomy and physiology of the birthing parent,” as if the anatomy and physiology of birth were not distinctively female.

The existence of intersexed people does not negate the reality of female biology. Intersex conditions are based upon the biology of the body and not an abstract identity adopted by any particular individual. We have not changed the biological definitions of male and female because of the existence of intersex individuals, just as we have not rewritten embryology texts to delete any mention of human beings having 46 chromosomes in order not to offend those people born with trisomy conditions. Why would we now change the biological definition of woman because a tiny proportion of the population change their gender identification?

We wholeheartedly endorse inclusivity, which above all requires midwives’ provision of the particular care that transgendered people need. Toward that end, we see the need to gather more information on the ways in which body modifications, puberty blockers (Lupron), and long-term synthetic hormones may affect midwifery care in pregnancy and birth. Midwives are well aware of how body dysphoria can negatively impact pregnancy, birth, and breastfeeding. Before uncritically supporting gender transitioning, MANA should be calling for evidence precautionary to its long-term effects, especially in light of the younger and younger ages at which it is occurring. Before rushing into “inclusivity” we need to focus on the clinical needs of transgendered people and an open reflection of whether and how these particular needs fit into the scope of practice for all midwives.

Birth transcends and goes deeper than the western capitalistic concept of the individual. We live in the time where the dominant narrative is of the rights of the individual. We must be careful to examine how individualism harms healthy human society. We must fight the forces destroying the living material world and telling us that cultural distractions are more real than life itself. There is life-giving power in female biology. As midwives we protect the lives of the life-givers: women, mothers, females, and their offsping. We must not become blinded to the biological material reality that connects us. If midwives lose sight of women’s biological power, women as a class lose recognition of and connection to this power. We urge MANA to reconsider the erasure of women from the language of birth.

In sisterhood,