Journal of Midwifery & Women’s Health www.jmwh.

org
Editorial

Inclusive Language Promotes Equity: The Power of Words

One of my guiding principles as Editor-in-Chief of the Jour- Table 1. Recommendations for Inclusive Language
nal of Midwifery & Women’s Health (JMWH) has been the Use Avoid
importance of the words people choose to use. Midwives
Race and ethnicity
have a longstanding tradition of being thoughtful about lan-
guage as a means to convey their philosophy of care and the People of color Non-white
work they do, distinguish midwifery from other professions, Black, African American Inner-city, ghetto, urban (as a
and demonstrate respect for the individuals for whom they euphemism for a group of
provide care.1–5 Since its inception, the JMWH Manuscript
people)
Preparation and Style Guide has addressed the importance of
considering bias in word choice and avoiding dehumanizing white Caucasian
words and phrases. During my tenure, the JMWH editors have Asian, of Asian descent Oriental
been increasingly proactive in ensuring inclusive language is Socioeconomic status
used in the Journal. Inclusive language is important for all People with low income At-risk, needy, disadvantaged
midwives and other health care providers to use, not just those
People experiencing poverty The poor
who are writers and editors. Using inclusive language helps re-
duce bias and stigma, which contribute to inequity. People experiencing The homeless
Inclusive language is defined as language that “avoids the homelessness, people
use of certain expressions or words that might be considered who are homeless
to exclude particular groups of people.”6 However, inclusive Sex and gender
language must go beyond merely avoiding exclusion. Inclusive
Different sex Opposite sex
language also needs to be respectful, accurate, unbiased, and
consistent with the preferences of the individuals and commu- Transgender Transgenders, transgendered,
nities who are being discussed. While recent JMWH editori- [man/woman/person] transsexual
als have focused on inclusive language related to gender7,8 and Intersex Hermaphrodite
race and ethnicity,9 there are many other areas for which in-
Non-binary, Gender neutral [people]
clusive language is important. Table 1 presents some inclusive
language alternatives to terms that should be avoided.10 gender-nonconforming
In addition to recommendations for specific word choices, Assigned [male/female] at Born a [boy/girl], biologically
there are some overarching guidelines for inclusive language. birth [male/female]
Avoiding bias and disrespect is essential for inclusive lan- Gender confirmation Sex change surgery, sex
guage. People-first language, which places the person before
surgery, [specific surgery] reassignment surgery
their condition, is usually preferable. For example, use women
with epilepsy rather than epileptic women or epileptics. Some Cisgender, non-transgender Normal, real [man/woman]
individuals prefer identity-first language which places their Is [a man/a Identifies as [a man/a
condition first. Using Deaf individual or autistic people, 2 con- woman/non-binary] woman/nonbinary]
ditions for which identity-first language is often preferred,11
Sexual orientation
follows another core tenet of inclusive language: treating peo-
ple the way they want to be treated. Be intentional in choos- Lesbian, gay, bisexual,
ing the level of specificity required to describe a person or pansexual, asexual,
group.10 Only include identity information, such as race or a
queer [for identity]
sexual orientation, if it is relevant. Do not use general terms Men who have sex with Non-straight, homosexual
when a specific term is more appropriate. For example, if a
men, women who have
study only included individuals who identified as Black, use
Black individuals rather than people of color. Avoid using lan- sex with women [for
guage, such as non-white or non-heterosexual, that shows bias behavior]
toward one group as the norm, and casts those outside that Sexual orientation Sexual preference, lifestyle choice,
group as “other” or abnormal. sexual identity
Using inclusive language requires a conscious decision.
Spouse, partner Husband, wife
Once this choice is made, the pursuit of using the correct
words takes time, effort, and dedication. It is not always a mat- Parent Mother, father
ter of simply replacing words with a more inclusive alterna-
tive. Careful attention must be paid to the context in which (Continued)
the word is being used to determine if an alternative is more

1526-9523/09/$36.00 doi:10.1111/jmwh.13225 
c 2021 by the American College of Nurse-Midwives 7

Table 1. Recommendations for Inclusive Language
Use Avoid
Age
Older adults, older people The elderly, the aged, seniors
Ages XX and older Geriatric (to refer to people)
Ability and disability
Disabled Differently abled
Has, lives with Suffers from, victim of,
afflicted by
Physical disability Handicapped
Uses a wheelchair Wheelchair-bound
Intellectual disability, Mental retardation
developmental disability
Non-disabled, without Normal, able-bodied
disabilities

c CommunicateHealth. Reprinted with permission.
a
Queer should be used with caution. This term was used a slur for many years. It
has been reclaimed as a positive term by many people, but there is still controversy
about acceptable use.
appropriate. For example, when discussing a health topic for
which it makes a difference whether someone has a vagina
or penis, one cannot simply change every gendered word to a
gender-inclusive alternative (eg, changing she or he to individ-
ual or they). Nuances must also be considered. For example,
it is important to avoid conflating sexual behavior with sexual
identity (eg, not all women who have sex with women identify
as lesbians).10
Inclusive language is ever evolving, sometimes at a rapid
pace, and there can be controversy and lack of consensus
around various terms. Choosing the most appropriate term
to use is an ongoing process that requires being attentive to
changes in language use among identity communities as some
terms become outdated and new terms emerge. The JMWH
editors reevaluate our inclusive language guidance on a reg-
ular basis. Fortunately, in addition to primary style guides,
such as the AMA Manual of Style and Publication Manual of
the American Psychological Association, there are a number
of excellent sources of information about inclusive language.
Appendix 1 provides online resources for inclusive language
guidance. Many of these online resources are updated more
frequently than primary style guides, which is helpful given
the pace of change in preferred terms.
Fear of making a mistake or offending someone can make
people hesitant to use inclusive language in written or oral
communication. Inclusive language is constantly evolving,
and preferred terminology is not always universally agreed
upon, so it is possible to use a word that is controversial or
later becomes outdated. There are a few examples from my
own writing where my preferred word choices have changed
over time. One is that I have shifted from using gender-neutral
to gender-inclusive because the latter conveys active inclu-
sion of people across the gender spectrum rather than a more
passive position of neutrality. Additionally, I now frequently
use perinatal in place of maternity because the latter is gen-
dered. While I might write or say some things differently to-
day than I did in the past, I believe an imperfect attempt at
8 Volume 66, No. 1, January/February 2021
15422011, 2021, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jmwh.13225 by Cochrane France, Wiley Online Library on [03/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
using inclusive language is better than avoiding any attempt
to eliminate potentially harmful language. It is important to
bring a sense of humility to the process of using inclusive
language, setting aside ego, and welcoming correction and
improvement.
Language is powerful, and its influence on perceptions
and behaviors can have negative or positive effects. Com-
municating without consciousness of inclusive language can
marginalize and misrepresent individuals and communities,
perpetuate stereotypes, and be offensive. Inclusive language
conveys respect and promotes equity. Using inclusive lan-
guage requires work. All of us can and should make this effort
in whatever work we do. Across clinical practice, education,
research, and all areas in which midwives and other health
care providers work, conscientious use of inclusive language
in our written and oral communication gives each of us an
opportunity to make a positive difference with our words.
Frances E. Likis, DrPH, NP, CNM
Editor-in-Chief
ACKNOWLEDGEMENTS
Thank you to Brittany Swett, MPH, JMWH Managing Edi-
tor, and Stacy Robison, MPH, MCHES, CommunicateHealth
President and Co-founder, for their contributions to this
editorial.
REFERENCES
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and Western childbirth paradigms. J Midwifery Womens Health.
2006;51(2):119-124. https://doi.org/10.1016/j.jmwh.2005.11.009
3. Lichtman R. Midwives don’t deliver or catch: a humble vocabulary
suggestion. J Midwifery Womens Health. 2013;58(2):124-125. https:
//doi.org/10.1111/j.1542-2011.2012.00253.x
4. Likis FE. The words we choose. J Midwifery Womens Health.
2013;58(2):123. https://doi.org/10.1111/jmwh.12040
5. Likis FE. Midwifery is not obstetrics: the importance of precise ma-
ternity care language. J Midwifery Womens Health. 2017;62(4):395-
396. https://doi.org/10.1111/jmwh.12660
6. Inclusive language. Dictionary.com. Accessed February 5, 2021.
https://www.dictionary.com/browse/inclusive-language
7. Likis FE, King TL, Murphy PA, Swett B. intentional inconsistency
as gender-neutral language evolves. J Midwifery Womens Health.
2018;63(2):155-156. https://doi.org/10.1111/jmwh.12746
8. Likis FE. New aims and scope for the Journal of Midwifery &
Women’s Health support health equity, sexual and reproductive
health, and gender-inclusive language. J Midwifery Womens Health.
2019;64(4):369-370. https://doi.org/10.1111/jmwh.13026
9. Likis FE. Black lives matter: a message from the editor-in-chief. J
Midwifery Womens Health. 2020;65(4):459-461. https://doi.org/10.
1111/jmwh.13156
10. Robison S. Writing for equity and inclusion. American Medical
Writers Association webinar. August 19, 2020.
11. National Center on Disability and Journalism. Identity-first lan-
guage. Disability Language Style Guide. Accessed February 5, 2021.
https://ncdj.org/style-guide/

Appendix 1. Resources for Inclusive Language Guidance
GENERAL
Conscious Style Guide
https://consciousstyleguide.com/
The Diversity Style Guide
https://www.diversitystyleguide.com/
The Language of Inclusion
https://documentcloud.adobe.com/link/track?uri=urn:aaid:
scds:US:ea4f0dbc-5575-49f0-a071-fee19f095838#pageNum=
19
A Progressive’s Style Guide
https://s3.amazonaws.com/s3.sumofus.org/images/
SUMOFUS_PROGRESSIVE-STYLEGUIDE.pdf
Radical Copyeditor
https://radicalcopyeditor.com/
DISABILITY LANGUAGE
Disability Language Style Guide
https://ncdj.org/style-guide/
Journal of Midwifery & Women’s Health r www.jmwh.org
15422011, 2021, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jmwh.13225 by Cochrane France, Wiley Online Library on [03/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND QUEER
TERMINOLOGY
The Association of LGBTQ Journalists Stylebook on Lesbian,
Gay, Bisexual, Transgender, and Queer Terminology
https://www.nlgja.org/stylebook/
GLAAD Media Reference Guide
https://www.glaad.org/reference
RACE AND ETHNICITY LANGUAGE
Asian American Journalists Association Guidance on Cover-
ing Asia and Asian Americans
https://aaja.org/2020/11/30/covering-asia-and-asian-
americans/
National Association of Black Journalists Style Guide
https://www.nabj.org/page/styleguide
National Association of Hispanic Journalists Cultural Com-
petence Handbook
https://nahj.org/wp-content/uploads/2021/01/NAHJ-
Cultural-Competence-Handbook.pdf
Native American Journalists Association Tribal Nations Me-
dia Guide
https://najanewsroom.com/wp-content/uploads/2020/10/
2020-NAJA-Tribal-Nations-Media-Guide-1.pdf
9