The clarity of a British Society for Haematology (BSH) Guideline on the care of pregnant women with mechanical heart valves has been compromised by the use of de-sexed language, critics argue.
In a letter to the editor published in the British Journal of Haematology, Professor Marian Knight, a Professor of Maternal and Child Population Health at the University of Oxford, and Professor Catherine Nelson-Piercy, a Professor of Obstetric Medicine and Consultant Obstetric Physician at Guy’s and St Thomas’ Hospital Trust, said they had “significant concerns” that the guidelines were not clear enough because of the gender neutral terminology used by the authors,
While endorsing all the recommendations in the guideline, Professors Knight and Nelson-Piercy said the terms ‘woman’ and ‘women’ only appear once within the guideline document, which could impact the “intelligibility of many of the recommendations”.
“We continue to observe women dying during or after pregnancy each year in the UK Confidential Enquiries into Maternal Deaths as a result of inadequate anticoagulation, inappropriate switching of anticoagulants or incorrect anticoagulant dose monitoring. Ensuring clear guidance for clinicians who are not expert in the care of pregnant women is essential,” they stressed.
They argue that because of the use of de-sexed language it is unclear who the “intended target” is in several of the recommendations, which could be confusing to those who are not expert in the anticoagulant management of pregnant patients with mechanical heart valves, or those accessing the guidelines from abroad.
“The term ‘individuals with mechanical heart valves of childbearing age’ is hard enough to understand for those of us with English as a first language. How that may be interpreted by those less fluent in English, including colleagues abroad for whom the British Society for Haematology guidelines frequently set a gold standard, we can only speculate,” they wrote.
“We recognise that all people giving birth do not identify as women and strongly support inclusive practice. However, ill-considered language changes such as this are helpful to no-one.”
Professors Knight and Nelson-Piercy have called on the BSH to follow other organisations such as the National Institute for Health and Care Excellence in adopting an inclusivity statement rather than “adopting de-sexed language [which] will have major impacts on clarity and accuracy, as well as other negative impacts such as dehumanising women”.
Guidelines authors respond
However, guideline authors led by Dr Will Lester, Consultant Haematologist at University Hospitals Birmingham NHS Foundation Trust, have refuted the claim that the use of de-sexed language in the guideline was “ill-considered” or “dehumanising”.
In a separate letter of the editor, also published in the journal (link here), they stressed that “in using [the term individual], we were not trying to be obtuse or controversial, we were simply acknowledging that our patient are individuals, deserving the best care, most suited to their needs.
“In fact, a key element of the guideline is the need for individualised care in a very complex and high-risk situation,” they noted.
They also highlighted that several medical journals were revising their position on gender inclusive language, and that the journal Obstetric Medicine had begun using the terms ‘pregnant person’ or ‘pregnant individual’ to articles, in response to “evolving knowledge about gender diversity”.
The authors also disagreed with the argument that colleagues from abroad using the BSH guideline might have difficulty in understanding the term ‘individuals’.
“It is essential to keep in mind that language is constantly evolving; it has to, as it seeks to describe the evolution of society. Medical language is not immune to this evolution, and nor should it be. ‘Correct’ terms are a matter for constant discussion and we agree that the British Society for Haematology should be proactive in this debate,” they stressed.