For many Americans, birth certificates are not only an important identity marker, they are an entry point into many aspects of life. But for trans and non-binary people, birth certificates can be a barrier – a document that invalidates their identity – unless they change it.
Today, the American Medical Association, the largest association of physicians in the country, has taken an important step to ease that burden. In a June report, WADA’s LGBTQ advisory committee advised the organization to lobby for sex tags to be removed from the public portion of the birth certificate.
Assigning a gender “male” or “female” at birth, the authors wrote, “does not recognize the medical spectrum of gender identity.”
“The involvement of the medical profession and government in gender attribution is often used as evidence to support this binary” view of gender, the report continues. Not only does this stifle a person’s ability to express themselves and identify themselves, it can lead to “marginalization and minorization”.
For nearly two months, the recommendation went largely unrecognized by supporters and detractors, but it resurfaced recently after popular medical website WebMD shared an article about the decision on its social media accounts.
The article went viral, in part thanks to right-wing publications and conservative figures, who rejected WADA’s recommendation. Among them was former United Nations Ambassador Nikki Haley, who tweeted that it was “the most ridiculous thing I have ever heard.”
Rep. Mary Miller, R-Ill., Also responded by tweeting, “Is ‘science’ we’re supposed to trust?”
For LGBTQ advocates, WADA’s recommendation is an important step in recognizing people whose identities do not perfectly match gender and sex binaries. But some have cautioned against celebrating the news too soon.
“People are still really attached to a binary sexual model,” said V. Varun Chaudhry, assistant professor of women, gender and sexuality studies at Brandeis University, whose pronouns are he / they.
This includes conservative lawmakers across the country who have decided to ban trans and non-binary children from receiving health care and participating in youth sports.
“The recommendation may say that gender is not important to something like a birth certificate, but if people are still attached to a binary sex pattern, they find other ways to determine these things,” Chaudhry said. .
Birth certificates are not public documents, but they play an important role in asserting a person’s identity and enabling them to work, travel or start a family. They are required to obtain passports or driver’s licenses, and to enroll in school, adoptions, employment or marriage.
This is a problem for non-binary or trans people, whose gender identity does not match the sex assigned on their birth certificate. According to a study released in June by the Williams Institute at UCLA Law School, approximately 1.2 million non-binary LGBTQ adults live in the United States.
Most states now allow people to change the sex designation on their birth certificate to reflect their gender identity, but the process can vary widely from state to state. Fifteen states allow people to use a non-sexist “X” when a baby is born.
Stepping away from gender designations, as AMA recommends, is “deeply exciting,” Chaudhry said.
While changing a birth certificate is not expensive, it can be time consuming and often requires institutional knowledge – being familiar with the process or having someone who can walk you through it.
Removing the assigned sex from the public part of the birth certificate not only recognizes the “diversity of bodies” that exists on the gender and sex spectrum, Chaudhry said; it could also remove a major barrier that gender non-conforming people face when trying to participate in society.
Chaudhry specifically refers to children who are growing up now and whose identity does not match their birth certificate.
It would be “one less obstacle that these future children will have to overcome.” And it’s pretty exciting, ”they said.
But there are still a lot of variables to consider in whether medical providers will adopt the recommendation, Chaudhry noted, predicting that there would be disparities in how the guidelines are applied. It also does not prevent officials from applying gender binaries in other ways.
Chaudhry pointed to recent state bills restricting the way transgender youth participate in sports. Lawmakers in Florida, for example, have proposed that children undergo a “routine sports physical exam,” in which their genitals and testosterone levels would be inspected before they can compete. (This requirement was removed from the final version of the bill, which was enacted in June.)
WADA’s recommendation is also well below what intersex people have been pushing for years, said Kimberly Zieselman, who heads the intersex youth advocacy group interACT.
Intersex people are born with sex characteristics associated with both males and females (genitals, internal reproductive organs, hormones, or chromosomes). When a child is born intersex, doctors may perform medically unnecessary surgeries so that they more directly fit into a “male” or “female” gender category. Often, children are under 2 years of age when they have these surgeries and cannot consent to them, Zieselman said.
The AMA recommendation is helpful in reinforcing the idea that sex and gender is not as “black and white or cut and dried as we once thought,” Zieselman said. But she and others have lobbied the WADA for years to issue guidelines outright banning surgeries: “It’s not even close to the number one problem for the intersex community.”
While removing sex assignment from a birth certificate may relieve parents of the pressure to pick a box when their child is born, the central issue of bodily autonomy has yet to be resolved, Zieselman said. .
“This is a step in the right direction, but it is high time they took more steps.”
WADA did not respond to a request for comment.
Yet Kimberly Inez McGuire, executive director of Urge, an advocacy group focused on reproductive and gender issues, says recommendations like WADA’s are “essential” to pushing the needle forward.
“Young people create a world with such a broad concept of gender,” said Inez McGuire. “They express gender identities that we don’t even have the language of yet. “
Inez McGuire doubts the recommendation will have much impact in socially conservative areas, where people may simply not be paying attention. She is particularly concerned about young people of color who are queer, trans and non-binary.
“A birth certificate without [sex] marker means something, but it doesn’t mean as much as creating a world in which they can be safe and live with dignity, ”she said. Still, she said, it’s a validation move from an influential group.
“It’s so important to recognize any victory, regardless of its size, because we know that any victory for gender justice is incredibly contested. “