AMA seeks to remove sex designation from public birth certificates
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The AMA announced that it recently adopted a policy that will support removing a person’s sex designation from the public portion of birth certificates.
The AMA House of Delegates said it is building on an existing policy that recognizes “every individual has the right to determine their gender identity and sex designation on government documents.”
A 2015 population-based study in Belgium published in Archives of Sexual Behavior reported that gender ambivalence — identifying equally with the other sex as with the sex assigned at birth — was present in 2.2% of adults who were assigned male at birth and 1.9% of adults who were assigned female at birth. In addition, gender incongruence — identifying “strongly” with the sex other than the sex assigned at birth — was found in 0.7% of men and 0.6% of women.
The authors of a 2020 review in The Lancet Child & Adolescent Health wrote that a “considerable proportion” of young people who identify as transgender or gender diverse “do not conform to traditional binary notions of gender (male vs. female) and instead have a nonbinary gender identity.”
The authors also noted that young people with a nonbinary gender identity “experience lower levels of support and are at increased risk for experiencing abuse and victimization than young people who are cisgender.” Compared with those who are transgender and binary, individuals who identify as nonbinary have less access to trans-specific health care and have “similar if not higher” rates of depression, anxiety and suicidal ideation.
According to a press release, the new AMA policy is intended to shield a person from invasion of privacy and to stop discrimination. It would still allow for information on a person’s sex designation at birth to be gathered and provided on the U.S. Standard Certificate of Live Birth form — information that is only used for medical, public health and statistical purposes.
“Designating sex on birth certificates as male or female, and making that information available on the public portion, perpetuates a view that sex designation is permanent and fails to recognize the medical spectrum of gender identity,” Sandra Adamson Fryhofer, MD, AMA board chair-elect, said in the release. “This type of categorization system also risks stifling an individual’s self-expression and self-identification and contributes to marginalization and minoritization.”
References:
AMA. AMA announced policies adopted on final day of Special Meeting. Available at: https://www.ama-assn.org/press-center/press-releases/ama-announced-policies-adopted-final-day-special-meeting. Accessed June 23, 2021.
Chew D, et al. Lancet Child Adolesc Health. 2020;doi:10.1016/S2352-4642(19)30403-1.
Van Caenegem E, et al. Arch Sex Behav. 2015;doi:10.1007/s10508-014-0452-6.
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This AMA policy is a really positive, creative way to bring affirmation, inclusion and clarity around one critical component of what birth certificates currently assert: an infant’s gender as represented by one letter identifying their sex assigned at birth.
There is a certain amount of difficulty for gender-diverse people to change their driver's license, passport, Social Security and other important documents. This process is different in all 50 states; in some it is super easy, and in some it is super difficult. I am not a member of the AMA, but this policy appears to assert that the association acknowledges that our population includes individuals whose gender identity does not align completely with their sex assigned at birth. And for that approximate 1.5% to 2% of our population, as they grow and continue their journey of gender, let us just make some things easier.
It is important to note that if this policy becomes enacted, it is made incredibly clear to the public what it means. Those who work with vital statistics, Social Security and agencies with similar purposes need to know they will not lose any critical data. This policy simply removes the gender marker on that glossy document that families receive about a month after their child’s birth.
Reference:
Tanner, L. More U.S. teens identify as transgender, survey finds. USA Today. https://www.usatoday.com/story/news/nation/2018/02/05/more-u-s-teens-identify-transgender-survey-finds/306357002/. Accessed June 23, 2021.
Perspective
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There is a wide spectrum of gender identities for gender nonconforming persons who may or may not align with the formal Western binary sex designations of “male” and “female.”
This AMA policy supports a person’s ability to designate sex identification as he/she/they/ze/zie/hir deem appropriate, which is unique to each and every individual. The policy also upholds that one’s sex assigned at birth may or may not align to one’s gender identity, which can also evolve over time and be either congruent or incongruent with one’s sex assigned at birth.
The ripple effects of this policy promote equality and inclusion in multifactorial realms (sociopolitical, psychologic, physiologic and cultural). Omission of a person’s sex from the public record provides a degree of anonymity that will not hamper a health care provider’s ability to promote excellent patient-centered care and will facilitate enhanced communication between patient(s) and provider(s) to gain a mutual understanding of one’s gender identity, sexuality, gender expression and sex designation and how this can pertain to one’s overall wellbeing and health.
In a broader sense, this policy will serve to mitigate bias, assumptions and explicit discrimination stemming from prior sociologic constructs by evolving to bring novel meaning and a dynamic understanding representative of the times and the cultural designations upon which language assigns meaning.
Perspective
Back to TopFrancisco Sánchez, PhD
The AMA recently adopted a policy to remove sex designation from public birth certificates — part of a growing movement that has been seen in several countries and in several states. The AMA’s position, however, supports the continued collection of “birth sex” for vital statistics use only.
As birth certificates are primarily used to verify a person’s legal identity, removing sex would have no real practical effect for the vast majority of the population. People do not often walk around with their certificate to confirm their sex (or gender identity) to others, and such information would be carried over in protected health information from birth for medical care.
Instead, this move would help remove hurdles, stigma and discrimination for those among us who develop gender dysphoria and seek to transition. In addition, this move could lessen the burden on parents who have children born with a difference/disorder of sex development (sometimes referred to as an “intersex condition”) who often feel pressured to choose a sex well before their children can speak for themselves.
Overall, removing this information from the public portion of the certificate harms no one.
University of Missouri College of Education
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