When we think about breastfeeding, the image that comes to mind -- the one pushed on us by society, medical professionals and the media alike -- is that of a mother nursing her newborn baby. Brochures, websites and PSAs promote the picture of a woman lovingly looking at her child as the baby suckles at her breast. The language accompanying this imagery is inevitably gendered, specific to cisgender women who are nursing a baby that they themselves gave birth to.

For a long time, no one has questioned that language. But in recent years, as acceptance of genders outside the binary grows, our understanding of many things that have long gone unchallenged have needed to shift. There has been a push for gender-neutral language when talking about reproductive justice, from abortion to pregnancy. And we've recently seen gender-neutral maternity clothing hit the market.

Yet, that inclusivity continues to fall short when it comes to nursing.

Nursing parents are typically referred to as "nursing mothers" or "women who nurse." How does that language affect people who don't necessarily fit into those categories? And what does that mean for transgender or non-binary parents and their ability to access services or legal protection?

According to Trevor MacDonald, a transgender father who has nursed his two children, "I think what really surprises people are the numbers" of transgender people who nurse babies. "The general public doesn't give a second thought to female-gendered language, because it doesn't cross most people's minds that anyone other than women could possibly nurse."

But MacDonald, who is currently wrapping up a research study funded by the University of Ottawa about transgender men and nursing, says that he had no trouble finding people to interview for his study. He also runs a Facebook group for trans men who nurse, and that group has well over 1,000 members. "People are studying and writing about this," MacDonald says.

The birthing community, as a result, has finally taken notice. In 2011, the American Congress of Obstetricians and Gynecologists issued a statement urging Ob/Gyns to be prepared to treat transgender patients.

Yet transphobia in birthing communities persists. Take, for instance, Women-Centered Midwifery, a group of gender-critical midwifes that recently issued an open letter to the Midwives Alliance of North America (MANA). The group expressed concern over the gender-neutral language being used by MANA, and expressed the antiquated belief that gender is tied to biology.

Their damaging statements included:

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.

Rethinking The Term "Nursing Mother"

Despite acknowledgment by many in birthing communities that pregnancy is not limited to women, the language used by most people still hasn't changed. Jasper Moon, a genderqueer parent who prefers to be called "ren" by their child (short for "parent"), notes that when they hear the term "nursing mother," they know "that obviously doesn't apply to me."

The term "mother" is itself problematic. As J. Kathleen (Jake) Marcus, an attorney in Philadelphia who specializes in parenting and gender legal issues, notes, "Kids are nursed by people who are not their mothers all the time." While this is less common in Western culture, people have been nursing their friends' and family members' kids throughout history.

The majority of the current laws that are on the books about breastfeeding, however, speak to the right of "a mother to breastfeed her child." Some use the term "woman." Most are gendered.

That said, "the vast majority of breastfeeding-related legislation has no enforcement provision at the state or federal level," says Marcus. "We are not providing any recourse for the people named with the gender-specific language, either." Currently, less than 10 states have any sort of enforcement provision at all.

And essentially, without an enforcement provision, these laws are worthless -- they don't even protect the people named in the legislation itself, let alone a male-identified person who isn't. Marcus notes that current statutes "look good but do nothing." She says that these bills started being drafted in 1994, "when there was a different idea of what we were trying to accomplish." At that time, she says, "we thought there was confusion about whether breastfeeding was being mistaken for indecent exposure. Somewhat naively, we proceeded thinking that a statute clarifying that breastfeeding was not a criminal act would be sufficient to stop harassment."

As far as Marcus knows, issues of trans people being discriminated against under breastfeeding laws has never come up in court. However, she speculates that if it comes up in the future, it will probably be related to workplace-pumping laws, or tied to the gender-neutral bathroom issue, as currently, lactation rooms tend to be gendered spaces.

In that case, "it will most likely be a court challenge that will come down to legislative interpretation of what was intended by the legislation. So there's no telling how that will go."

She adds that it is possible to pass breastfeeding legislation using inclusive language--Marcus has been using the term "breastfeeding person" for at least the last five years in all the bills that she has helped draft. "I would never draft legislation without gender-neutral language," she says.

Current Breastfeeding Support Services Exclude Many

What about transgender men or non-binary individuals who want to access breastfeeding support services? La Leche League International (LLLI), one of the best known peer-to-peer breastfeeding support groups, has a tagline that says, "Happy Mothers, Breastfed Babies."

Diana West, director of media relations for LLLI, says that they "do not have a policy about transgender people accessing services or attending meetings." When it was pointed out that there was no language on the site that indicated that trans parents were welcome at their meetings, she responded: "We would not want our website or any publications to be off-putting to trans parents" and noted that they are "continually accessing our materials to bring them up-to-date and make them as inclusive as possible."

It's not that LLLI is unaware that trans parents are utilizing their services. MacDonald attended his local meetings regularly. When he applied to become a leader, he was initially turned down. After he wrote about it on his blog, LLLI changed their policy "to reflect new understandings of gender issues," says West.

They also issued a press release noting that "in the spirit of nondiscrimination . . . La Leche League International has refined the eligibility qualifications for its volunteer breastfeeding counsellors to include men who otherwise meet the prerequisites for becoming a volunteer applicant." However, as MacDonald points out, "they haven't changed the wording anywhere else [on the website]." He notes that the Canadian branch of the organization published tip sheets that he wrote for transgender men who nurse, but they're only available on the section of their website for leaders.

When I emailed Baby Cafe U.S.A., a drop-in support group for breastfeeding mothers, to find out what their policy on transgender parents utilizing their service was, they admitted that they'd never thought about it, but they were open to suggestions. They did express concern that some women may be uncomfortable nursing in front of men.

Mike Roberts, who nursed his two children, thinks that's a valid consideration. "I feel that it's reasonable for there to be spaces for women who nurse that do not include or welcome me," he says. "For me, it's part of having my gender recognized to be excluded from women-only spaces."

The way Moon sees it, it's all about language:

When folks use words like 'nursing families,' I don't have to stop and ask myself if I am OK passing as a woman. However, even with 'everyone' type of language, I often wonder if the inclusivity was an accident. I think the most supportive language is that which directly names those who are not generally included.

Says Roberts, "I don't need every nursing class ever to say 'ladies and gentlemen,' but I do need the person at the front of the room I'm actually in to say 'ladies and gentleman.'"

MacDonald says that when people see language that does not apply to them, they may very well be less likely to seek those services even if they need them. "There are people who go anyway, for sure. There are also people who just don't get the help that they need." Gender non-conforming parent Anna agrees: "My discomfort in highly gendered 'mommy' spaces prevented me from trying to access services or groups centered around nursing."

Other help that people may not be getting is support that includes knowledge about transgender bodies, as there are some actual physical differences that go well beyond language. MacDonald notes that helping a trans person who has had chest surgery to chest-feed their baby is different than helping someone who has never had surgery.

Several other people that I spoke to also mentioned eventually weaning their toddlers because their dysphoria had gotten to the point that they didn't feel they could hold off on starting testosterone any longer. Body dysphoria refers to the discomfort that occurs when the gender someone has been assigned does not align with their actual gender. Due to the fact that there is very little research about the safety of hormone replacement therapy and breastfeeding, they had to stop nursing.

MacDonald cites a study from Trans PULSE that found trans people will often avoid seeking emergency care because they fear discrimination and adds that:

If people avoid getting emergency care when they really need it, I'm sure you can bet that there are people who are uncomfortable going to a provider or space that doesn't give some kind of explicit cue that they are going to be welcoming of all genders.

The Intersection Of Marginalization And Legislation

Many argue that the failure to pass non-inclusive breastfeeding bills further marginalizes trans parents and their ability to care for their children. When we marginalize transgender parents, we're actually marginalizing their babies, too: "The reason I nursed my babies was not for me," says MacDonald. "Ultimately, I feel like the one who suffers the most if we can't nurse in certain spaces is the baby."

If the entire purpose of passing breastfeeding legislation is to see better outcomes for children, then the gender of their parent shouldn't matter. In essence, bills that leave any number of children behind shouldn't be pushed through. Marcus agrees: "Passing breastfeeding legislation that doesn't protect everyone that needs protection isn't worth doing. It has to be inclusive or nothing."

So what might help us better support trans nursing parents? MacDonald sees the need for training and awareness. Roberts would love to see more research being done on Hormone Replacement Therapy and breastfeeding. Moon finds inclusive language and materials to have the power to make a real difference. And Anna wants the nursing community to "recognize that a person's desire to carry a pregnancy, nurse, and/or parent isn't connected to their gender or sex."

According to her: "Any body might be a nursing body. No body is required to be. Make room for all of us."

This piece by Britni de la Cretaz originally appeared on The Establishment, a brand new multimedia site funded and run by women.

Other recent stories include: