Don’t keep ’em crossed: how not to get ahead in advertising

The photograph below, taken at Manchester Piccadilly station earlier this month, shows an installation commissioned by North West Cancer Research to encourage more women to get screened for cervical cancer. Which is, of course, a worthy goal; cervical cancer screening can save lives. But when I first saw this photo, what I mostly felt was rage. I was so angry, I immediately reposted it with a critical comment on Twitter/X. Evidently this struck a chord: within a couple of days my tweet had racked up 134K views and prompted numerous replies from other women who found the installation “awful”, “crass” and “disgusting”. In this post I’ll take a closer look at what the problem with it is—and why that problem is so common in women’s health campaigns.

The installation consists of five large display boards arranged in a line. Mounted on each of the middle three boards is a disembodied pair of crossed female legs. They’re like the legs you see on mannequins in the hosiery sections of department stores: long, slender, and carefully positioned for aesthetic effect. They begin at the top of the thigh and end in Barbie-style feet wearing high-heeled court shoes. They are “diverse” insofar as they represent a range of skin colours, but there is no diversity in relation to age, body-size or personal style. The imaginary woman these legs belong to is clearly young, slim, and conventionally feminine. On its own the visual element of the display could easily be mistaken for a lingerie ad: it’s far from obvious what legs have to do with cervical cancer. But the connection is spelled out in the verbal message, which is split between the two outer display boards. Both parts address the viewer directly and in the imperative: on the left, “don’t keep ‘em crossed”, and on the right, “get screened instead”.

While there are many things to object to about this installation, the thing I found so shocking that it rendered me temporarily speechless was that injunction “don’t keep ’em crossed”. It’s offensive because the crossing and uncrossing of a woman’s legs is a well-worn metaphor for sexual continence or incontinence. That’s the real reason why girls are taught that it’s “ladylike” to sit with your legs crossed (and “unladylike” to sit with them apart): while this is often presented as a matter of aesthetics or good taste, what it’s really about is modesty, in the sense of chastity. By adopting a posture that completely conceals her genital area, a woman signals that she is not available for sex.

The flipside, of course, is that the uncrossing of a woman’s legs becomes a sign that she is open to sexual propositions. When I was growing up in the 1970s people often said, about both rape and unwanted pregnancy, that all a woman had to do to prevent it was “keep her legs crossed”. This was a commonplace form of victim-blaming and slut-shaming, but it also had a flipside which might be called “prude-shaming”. The woman who did “keep ’em crossed” could be accused of denying men access because she was “uptight”, frigid and sexually repressed. Which is also what “don’t keep ‘em crossed/get screened instead” implies—that it’s uptightness that stops women from getting screened.

This sexualization of a medical procedure is offensive in its own right, but if the aim is to increase the uptake of screening it also seems strategically ill-conceived. If women are really deterred from getting smears by a prudish reluctance to open their legs, then surely it would make more sense to try to take sex out of the equation, and talk about smear tests in the same way you’d talk about any other medical procedure involving the probing of a bodily orifice. These are, after all, quite numerous: if sexual references are not a staple feature of campaigns encouraging men to get their prostates checked, why should they have any place in campaigns about cervical cancer?  

I say “campaigns”, plural, because the NHS and cancer charities have form for this. In 2021 the health app myGP ran a bizarre online campaign suggesting young women could remind their social media followers about the importance of regular smear tests by posting a picture of the type of cat (long-haired, short-haired or hairless) that best represented the current state of their pubic hair. The cat, obviously, was code for the explicitly sexualized term “pussy”. And it’s not just cervical cancer that gets this treatment. One Twitter commenter reminded me that in 2020 the Sun newspaper, which for several decades was famous for featuring a daily topless pin-up photo on page 3, ran a campaign to encourage breast self-examination whose title and slogan was “CoppaFeel!”. And in Canada a campaign to raise awareness of ovarian cancer renamed women’s ovaries “ladyballs”: its slogan was “have the ladyballs to do something about it”.

These campaigns persistently use the register of laddish banter, sometimes in combination with the visual language of pornography, in which women are reduced to their component body-parts (and often, as in this case, shown without faces, the most individualizing and emotionally expressive parts of the human body). It’s as if the designers are incapable of viewing female bodies from anything but a heterosexual male perspective, or of talking about diseases that affect thousands of women (some of whom will die from them) in anything but a laddishly jokey way. Does that not suggest an extraordinary level of obtuseness about, or indeed contempt for, women’s own experiences and feelings?

But if you’re assuming that the “don’t keep ‘em crossed” campaign must have been developed by men, I regret to tell you that you’re mistaken. The PR agency North West Cancer Research used, Influential, is led by women; a report on the website of Prolific North, a hub for digital and media professionals in the north of England, makes clear that women dreamed up those disembodied legs and came up with that repulsively rapey strapline. What were they thinking? Karen Swan, a director at Influential, explained to Prolific North that

We wanted a campaign that was playful and a bit cheeky in order to grab our audience’s attention, so the strapline “Don’t keep ‘em crossed” was perfect.  

Cara Newton, head of marketing at North West Cancer Research, agreed, saying they’d wanted a campaign whose launch would create what she described as a “real moment”.

When I first saw the installation I did have a “real moment”, of the Proustian variety: it transported me straight back to my teenage years in the 1970s, when “playful and cheeky” sexism was ubiquitous in popular culture. Some of the older women who commented on my tweet also made that connection, drawing comparisons with 1970s British favourites like the Carry On films and the Benny Hill Show. One recalled a piece of health messaging that makes Influential’s effort seem almost tasteful: when she had her first child in 1979, there was a poster in the maternity ward promoting breastfeeding with the message “Breast is best, and Dad can suck on the empties”.

Commercial advertisers in this period often used wordplay that gave their ads a sexist/misogynist subtext. Below, for instance, is an ad for the UK hosiery brand Pretty Polly in which a sexualized image of women’s legs is given a witty caption–“for girls who don’t want to wear the trousers”–that has both an innocuous reading (“for women who prefer wearing skirts”) and a sexist one (“for women who want to be dominated by men”) which is also a dig at feminists, with their presumed desire both to dominate men and to look like them. Influential’s installation is very obviously in this tradition: it uses the same combination of visual imagery (disembodied legs/high-heeled shoes) and verbal innuendo.

Back in the day, this kind of thing certainly grabbed feminists’ attention: it inspired complaints to the Advertising Standards Agency, stickering campaigns on the London Underground (“this advert degrades women”) and illegal spray painting of graffiti on street hoardings (Pretty Polly was one target for this form of activism, as seen below).  

It may be because I’m old enough to remember this that the “don’t keep ‘em crossed” campaign makes me so angry. How did we get to the point where women designing a women’s health campaign in 2023 can reinvent the wheel of 1970s sexism without apparently seeing a problem? Even if they were genuinely unaware of the connection between uncrossed legs and rape, why did they think a cancer prevention campaign needed to be, above all, “playful” and “cheeky”? Why is it still assumed that you can’t get women’s attention by addressing them as serious human beings?       

If you did want to take a more serious approach, one thing you’d need to do would be to think seriously about the reasons why many women are reluctant to be screened. Both in this campaign and in myGP’s earlier cat-themed effort, the key problem is assumed to be embarrassment, and the solution is to joke women out of it. But while embarrassment may be a factor, it’s certainly not the only problem. As many women who commented on Twitter observed, for a non-negligible subset of women the smear test is particularly daunting because of its potential to trigger memories of sexual assault and/or traumatic experiences giving birth. Women who avoid screening for trauma-related reasons are hardly going to be receptive to the “cheeky banter” approach.

Another thing that makes women hesitant is their knowledge that screening is often painful. Some Twitter commenters recalled occasions when they had said they were in pain and been ignored or told it was their own fault for not “relaxing” (the “uptightness” problem again). One woman healthcare professional who had been on both ends of the speculum described that instrument as “grim and bitey”, and wondered why more resources had not been devoted to improving its design, which has barely altered since it was invented.

In this particular case women may not have to endure the pain for much longer. Almost all cervical cancer is caused by the Human Papilloma Virus (HPV), and since a vaccine against HPV became available the case-rate among women young enough to have been offered it has dropped dramatically. Recently the NHS announced that it hopes to eradicate the disease by 2040. Which will, if it happens, be very good news. But it will not solve the larger problem, which is the longstanding tendency, now well-documented by research, for medicine to take women’s pain less seriously than men’s.

Hysteroscopy, for instance, a procedure used to investigate symptoms that could indicate uterine cancer, is typically performed in NHS clinics without pain relief (other than the over-the-counter painkillers women are advised to take beforehand), though it is so painful that it is not uncommon to have to abandon the procedure midway through. Colonoscopy, by contrast, a comparable investigative procedure which is also performed on men, is usually done under sedation.

It isn’t only women’s pain that gets dismissed as trivial. NICE, the body which approves NHS treatments, recently issued guidance suggesting that women experiencing menopausal symptoms like insomnia, mood swings and brain fog should be offered cognitive behaviour therapy (CBT). So, either they think the problem is in women’s minds, or else they think women should be satisfied with a treatment that helps them cope with their symptoms as opposed to one (HRT) that relieves them by targeting the cause. As one woman asked, will they also be recommending that older men with erectile dysfunction should be offered CBT rather than Viagra?  

This systemic sexism is the larger context in which health messaging for women needs to be seen. The problem with campaigns like “don’t keep ‘em crossed” isn’t just their crassness: even if the form of the message were less offensive, if its content still boils down to “stop being a prude and get a smear test” then it will still be treating women who avoid screening like irresponsible silly girls, while ignoring the evidence that many are deterred by their prior experiences of being patronized, insulted, dismissed or blamed.    

That said, there’s no getting away from the crassness—and that part of the problem could easily be fixed if the producers and commissioners of health messaging for women simply decided to stop using sexualized language and imagery. It isn’t just feminists, or women over 50, who find this inappropriate and offputting. Women may also object to it for religious or moral reasons, or because they find its humour tasteless, or just because they don’t see how it’s relevant. In Canada, some women criticized the 2016 “ladyballs” campaign for insulting their intelligence; one wondered if a campaign about testicular cancer would refer to men’s testicles as “brovaries”. Yet the marketing and PR professionals remain convinced that their “provocative” and “cheeky” approach is the right one. Why are they so wedded to the idea of sexing up cancer? Do they really know their audience, and do they actually care what it thinks? 

In that connection I find it interesting that Karen Swan’s comment, quoted above, begins with the words “we wanted a campaign that…”. By “we”, presumably, she meant the creative team at Influential. And what agencies like Influential want from a campaign isn’t always what’s most effective for the target audience. Of course they have to pay attention to the client’s brief (if they didn’t they’d find it hard to stay in business), but they also want their campaigns to be noticed and evaluated positively by their peers. And for that purpose, being provocative has its advantages: a campaign that generates controversy is also one that gets attention.  

This strategy was famously used in the so-called “bra-wars” of the 1990s, when rival bra manufacturers and their advertising agencies competed to produce more and more “daring” ads. First we had the Wonderbra “Hello, boys” campaign, which put supermodel Eva Herzigova’s breasts almost literally in the viewer’s face: the giant billboard version even prompted fears that it would cause traffic accidents by distracting male drivers. Then came Gossard’s even more provocative depiction of an underwear-clad model reclining in what appears to be a haystack over the line “Who said a woman can’t get pleasure from something soft?”. This thinly-veiled allusion to erect penises attracted so many complaints that Gossard was forced to switch to “when a firework is smouldering, stand well back”.

This change in language was forced on Gossard by the Advertising Standards Authority (ASA), the body which regulates print and billboard advertising in Britain, and which adjudicates complaints about it from the public. But overall, their response to complaints about the bra-wars ads was surprisingly restrained. Gossard was only required to remove the “something soft” reference, while complaints about “Hello, boys” were dismissed altogether. The ASA’s adjudication said that “the copy lines invest [the model] with a particular personality and sense of humour”–or in other words, “Hello, boys” was not offensive and dehumanizing, it was just “playful and a bit cheeky”.

By contrast, a couple of ads which took a similarly playful and cheeky approach to men’s underpants, using close-ups of the model’s crotch area alongside jokey captions like “Loin King” and “Full Metal Packet”, were judged to have breached the ASA’s rules about “taste and decency”. Women’s breasts might be a legitimate subject for cheeky humour, but men’s penises were no laughing matter. Asked about this apparent double standard, an ASA spokesperson said: “The Authority reacts to prevailing standards. To some extent we live in a sexist society, and to some extent we reflect that”.

But by the mid-1990s it had also become possible for the makers of sexist ads to deploy a different argument, one that wasn’t about humour or playfulness–that using sexualized images of female bodies to sell products was not, as 1970s feminists had argued, degrading to women, but on the contrary, empowering. The women in the ads were not mere objects, they were agents; far from displaying submissiveness, they were making a statement about the power of female sexuality. The bra-wars ads might look to the uninitiated like 1970s sexism on steroids, but in fact what they represented was an “edgier”, more modern form of feminism. If you couldn’t see that a supermodel in a Wonderbra was the ultimate symbol of female empowerment, that was probably because you were a middle-aged, pearl-clutching prude.

This line went down well with the art-school/cultural studies crowd, and “Hello, boys”, in particular, is still remembered as “iconic” and “groundbreaking”. But that assessment overlooks an interesting if less well-known postscript to the bra-wars story. Both the UK companies involved, Gossard and Playtex (the makers of the Wonderbra), changed their marketing approach dramatically after realizing that the “iconic” bra-wars campaigns had done more to enhance the ad agencies’ prestige than to increase sales of the product being advertised.

In 1996, when Playtex announced that a new campaign for their Affinity range would feature the “elegant” but “accessible and clean-cut” Helena Christensen, the company’s account director at Saatchi and Saatchi explicitly related this change of direction to the controversy around Gossard’s “something soft” ad, saying “we don’t want to offend or upset women, which I think these ad campaigns do.” When a woman later became marketing director at Gossard, one of her first actions was to sack the agency that had created “something soft”, explaining, “I want to advertise to women, not men”. Even if they weren’t offended, market research showed that women were unimpressed by sexy poses and suggestive straplines. What they most wanted from a bra ad was “a good representation of what the actual bra looks like”.

Though this backlash against hypersexualized, controversy-courting bra ads was described in one report I read as a return to “the ethos of a bygone age”, in reality it was more like a return to the basic principles of marketing: if your aim is to sell more bras you should design your advertising for the people who actually buy bras. And that principle also applies to women’s health campaigns. To the professionals who design them it may seem obvious that effective advertising is “provocative” or “edgy”, and that sexualized imagery is “empowering”: those ideas are simply the water today’s creatives swim in. But if the reception of “don’t keep ‘em crossed” shows us anything, it surely shows it’s time to pull the plug.  

Many thanks to everyone who commented on my Twitter thread    

Body language

At the girls’ grammar school I attended in the early 1970s, most of my peers’ most hated subject was Latin, which was generally considered to be super-hard, super-boring, and of no practical use whatsoever. I too found it pretty tedious, but there were several subjects I hated more, including geography, PE and, above all, domestic science. So I was content, if not exactly ecstatic, to plod on with Latin until O Level, the ancient equivalent of today’s GCSE. The school encouraged us to do this if there was a chance we might go on to university, and especially if we aspired to study medicine. Whenever we complained about the uselessness of Latin, we’d be told that ‘Latin trains the mind’, followed by ‘and you’ll need it if you want to be a doctor’.

Today’s medical students are not expected to have studied Latin, but they still need to learn a technical vocabulary which is heavily reliant on it. In anatomy, for instance, much of the standard terminology dates back to the Renaissance, when Latin was the language of learning across Europe. And sometimes, decoding medical Latin reveals that it isn’t just the language that’s ancient.

Last year the New York Times reported on the experience of Allison Draper, who as a first-year medical student came across a reference to the ‘pudendal nerve’. Not knowing the word ‘pudendal’, she consulted a dictionary of anatomy. She was shocked to learn that it derived from the Latin verb ‘pudere’, meaning ‘to be or make ashamed’, and that ‘pudendum’, a gerundive form meaning, roughly, ‘thing to be ashamed of’, was the standard anatomical term for the outer female genitalia. She decided to write a paper arguing that such terms had no place in modern medicine. Her (male) anatomy professor supported her, though he admitted that before she raised it he had never given the matter any thought.  

Another male anatomist, Bernard Moxham, had already concluded that ‘pudendum’ was a problem. To his mind it was not only sexist but also unscientific, putting moral judgment in place of description. Moxham had previously served as president of the international organisation that oversees the standard reference work on anatomical terms, Terminologia Anatomica, and he proposed that organisation’s terminology group should consider replacing ‘pudendum’ and ‘pudendal’ with more objective, descriptive alternatives.

He was surprised when this proposal met with resistance. Some members of the group maintained that the terms weren’t really sexist: they could be interpreted as referring not to the negative concept of shame but to the ‘positive’ concepts of modesty and virtue (though it’s hard to see what’s positive about locating women’s virtue in their genitals). Others warned darkly of a slippery slope: if ‘pudendum’ went, how many other traditional terms might also have to go because they were scientifically uninformative or out of tune with modern sensibilities?  Eventually the group agreed that ‘pudendum’ should be removed from Terminologia Anatomica, but ‘pudendal’, as in ‘pudendal nerve’, should stay; they were concerned that its removal might cause difficulty for colleagues in other branches of medicine. However, a pain-management specialist who regularly performs the procedure known as a ‘pudendal block’ told the Times she found its survival ‘incredible’. ‘What’, she asked, ‘does that say about the medical establishment and their attitudes to women?’ 

The story of ‘pudendum’ does say something about the sexism of medicine as an institution, but arguably it says at least as much about the culture in which medicine exists. In the 21^st century it may seem crassly offensive to label women’s genitals ‘the thing to be ashamed of’, but historically that label served the same purpose which is more often served today by using vague expressions like ‘undercarriage’ or ‘bits’. These are forms of polite avoidance, ways of not directly naming the offensive thing itself. And what’s behind that is not a specifically medical prejudice, but a far more general and culturally pervasive view of female sexuality, and the associated body-parts, as a source of shame and disgust. That view remains widespread among women themselves: surveys have found that many or most of those questioned regard terms like ‘vulva’ and ‘vagina’ as embarrassing and offensive.

But while medical terminology reflects the prejudices of the surrounding culture, the authority and prestige of medicine give its language a particular power to define the realities it speaks of—including the female body and the processes which affect it. Challenging that power, and medical authority more generally, has been an important feminist project more or less throughout the history of the movement. But as the case of ‘pudendum’ shows, it isn’t easy (even for insiders) to shift the norms of a linguistic register whose traditions are so revered and so jealously guarded. How changes happen, when they do, is a complicated question–as we see if we consider an earlier challenge to the language used by doctors about women’s bodies.    

In 1985 the UK medical journal The Lancet published a letter from a group of senior obstetricians calling on the profession to stop using the term ‘abortion’ to refer to both induced terminations of pregnancy and ‘spontaneous’ or involuntary pregnancy loss. The letter stated that in the writers’ experience, women who had experienced pregnancy loss found the use of ‘abortion’ distressing and offensive. It proposed, on ‘humanitarian grounds’, that non-induced cases should instead be called by women’s own preferred term, ‘miscarriage’.

Research has shown that ‘miscarriage’ did subsequently become more common in medical usage. But there has been some debate on the role played by the Lancet letter. Was it the letter that changed doctors’ attitudes, and thus their linguistic choices, or was a gradual shift from ‘abortion’ to ‘miscarriage’ already happening in response to external pressure? Patient-led groups and women’s health activists had established a clear preference for ‘miscarriage’ before 1985: in 1982, when a charity was set up to support affected women, its founders named it the Miscarriage Association. Might these ongoing developments, led by women outside the profession, have played a more important role than the letter in shifting the professional consensus over time?      

That question has recently been revisited in an article by the corpus linguist Beth Malory, who investigated the use of ‘abortion’ and ‘miscarriage’ in the titles of articles published in three UK medical journals (The Lancet, the British Medical Journal and the British Journal of Obstetrics and Gynaecology) between 1975 and 1995. Using a statistical modelling technique called ‘change point analysis’, which is designed to identify sudden (rather than gradual) changes in an established pattern, she found that in this case there had been a moment when the pattern abruptly changed, and there was an 85% probability that this occurred in 1986—within months of the publication of the Lancet letter. In Malory’s view this is strong evidence that the letter played a pivotal role in the shift towards ‘miscarriage’.

That doesn’t mean external pressure played no role: the letter was, by its authors’ own account, a response to the concerns expressed by patients and organisations representing them (the letter cites a survey conducted by the Miscarriage Association in which 85% of respondents opposed the then-current medical use of ‘abortion’). But it does seem likely that the effect of the letter reflected the authors’ status as eminent members of the medical profession, which enabled them to make the case for ‘miscarriage’ more authoritatively than the women they spoke for could have done. So, in this case as in the case of ‘pudendum’, the moral of the story seems to be that changing the language of medicine is not something sisters can do for themselves: they may be instrumental in preparing the ground, but ultimately they need the support of high-ranking insiders. (Who will often, as in these cases, be men.)    

Nearly 40 years have passed since the Lancet letter, but the issue it addressed hasn’t gone away. ‘Miscarriage’, once recommended as a compassionate and respectful choice, is increasingly under fire itself. And this time women are voicing their objections from a platform that didn’t exist in the 1980s.

In 2020, after the model and media personality Chrissy Teigen shared the news of her recent pregnancy loss on Instagram, the response quickly spread across social media, and then to mainstream publications like Glamour magazine, which ran an article headed ‘Women are calling for the word “miscarriage” to be banished for good’. The article reproduced a Twitter exchange in which a woman expressed her appreciation for Teigen’s use of the term ‘pregnancy loss’, observing that ‘“Miscarried” is such an awful description…it’s like you did something wrong’. Other women agreed: ‘miscarry = mishandle’, tweeted one, while another added, ‘you’re so right…it’s no wonder so many women carry feelings of shame and guilt after their loss’. Many women commented that the term ‘pregnancy loss’ was new to them, and said they planned to start using it instead of ‘miscarriage’.

This change already had some professional support. In 2011 the US journal Obstetrics and Gynecology published a paper entitled ‘Nomenclature for pregnancy outcomes: time for a change’ (note: no question-mark), which argued that new terms were needed to reflect both advances in scientific knowledge and what it called ’emotional considerations’. The authors’ own list of suggested terms contained several that included the word ‘loss’ (e.g. ‘embryonic loss’ and ‘early pregnancy loss’). ‘Pregnancy loss’ also appeared in some of the article titles in the paper’s bibliography, showing that some specialists had already adopted it.

Though it hasn’t happened yet, it wouldn’t surprise me if ‘pregnancy loss’ became the dominant term in the not-too-distant future. Personally I think it’s a good term: it’s straightforward, transparent and acknowledges what the experience means to those affected by it. But it’s still striking, as Beth Malory also comments, how fast and how far ‘miscarriage’ has fallen. The responses to Chrissy Teigen suggested that it is now widely seen as a woman-blaming term (in the words of the tweet quoted earlier, ‘miscarry = mishandle’). That isn’t just a lay view, either: in 2015 a doctor writing in the Toronto Globe & Mail argued that ‘miscarriage’ was a harmful term because the ‘mis-’ prefix leads women to believe their pregnancies have ‘gone wrong’ (when in reality it’s more likely they were never viable) and that this must be because of something they did wrong.

This argument implies that the negative associations of ‘miscarriage’ are–and always were–an integral part of its meaning. Yet if we look back to the 1980s, there is no reason to think it was perceived as negative. In those days it was championed by feminists, patient groups, charities and eventually doctors; it was presented as the term women themselves preferred. One of the advantages it was said to have over ‘abortion’ was that it didn’t carry a stigma, or make women feel they were being blamed. Evidently that’s changed during the last 40 years; but what has happened to change it?   

The short answer is that changes in word-meaning may reflect changes in the surrounding culture, and in this case I can think of two developments which might be relevant. One is the increasingly aggressive promotion of the idea that individuals are responsible for their own health, and the associated tendency to blame any problems on people’s own unhealthy choices; in the case of pregnant women, whose choices also affect their unborn children, this attitude is particularly punitive (think of all the total strangers who feel entitled to intervene if they see a pregnant woman drinking alcohol). The other is the rise in popular culture of a new ideal of perfect motherhood, embodied by celebrities and social media influencers who plot an exemplary and very public course from conception (which happens exactly as planned) through a radiantly healthy pregnancy to birth (ideally ‘natural’), after which they have no trouble bonding with the baby, and quickly shed any excess weight. For the great majority of women (maybe all of them) this ideal is unattainable, but that doesn’t stop them feeling guilty for falling short.

Of course it’s true that pregnant women in the 1980s—and for that matter the 1880s—were nagged about their health and presented with unrealistic images of motherhood; it’s also true that women who lost a pregnancy were always susceptible to feelings of shame and guilt. But I’m suggesting that the pressure on prospective mothers to be ‘perfect’ has been massively ramped up in recent decades, and that this may at least partly explain why ‘miscarriage’ has taken on more negative, judgmental or accusatory overtones. It’s a projection of our feelings about the thing onto the word that names it. And one question that might raise is whether changing the word will solve the problem.

Critics of this kind of change are fond of pointing to cases where terms which were introduced to replace a stigmatising label rapidly became pejorative themselves, necessitating a further change in the approved terminology (‘handicapped’ replaced ‘crippled’, and was replaced in its turn by ‘disabled’; ‘lunatics’ became ‘insane’ and then ‘mentally ill’). New terms are corrupted by the persistence of old attitudes, turning the project of reforming language into an endless game of whack-a-mole. My response to this is ‘yes, but…’. Changing linguistic labels may not eliminate social stigma, but that’s not an argument for sticking with terms that have become pejorative. You wouldn’t tell someone suffering from chronic headaches that they shouldn’t take a painkiller today because it won’t stop them getting another headache tomorrow. Temporary relief is still relief.

But when feminists get involved in debates about medical terminology, we should be clear about what renaming can and can’t achieve. Terms which were targets of feminist criticism in the past, like ‘hysteria’ and ‘frigidity’, may no longer appear in doctors’ diagnostic manuals, but they live on as everyday sexist insults (also, how enthusiastic are we about replacements like ‘female sexual dysfunction’, which arguably just repackage the old sexist ideas under a new, blander label?) What we’re ultimately fighting is not a war on words, but a battle against oppressive beliefs and practices. Language can play a part in that, but it isn’t the only thing we need to change.

I’m grateful to Beth Malory for sending me her article (which I hope those of you with access will read for yourselves), but she should not be held responsible for the opinions expressed in this post.

Mind the respect gap

There’s a woman I know who does a lot of broadcast interviews, because she’s an expert on something that’s often in the news. And she’s noticed something annoying: the interviewers she talks to—not all of them, but quite a few—are in the habit of addressing her with just her first name, whereas the male experts on the same programme are typically given an academic title. ‘Thank you, Dr Jones. Now Sarah, if I could turn to you…’.  ‘I’m not usually precious about titles’, she says, ‘but I’ve got a Ph.D too’.

Sarah’s experience is not unusual. I regularly get emails from students which hail me as ‘Ms’ or ‘Mrs’ Cameron, though my official title (‘Professor’) is on everything from my office door to the university website. Do the same students address my male colleagues as ‘Mr’? I have no way of knowing, but I doubt it happens very often. The writer and university teacher Rebecca Schuman agrees, reporting that she often hears male faculty members referred to as ‘Dr’ or ‘Professor’ by people who routinely address her as ‘Ms Schuman’. ‘It happens all the time’, she emphasises, ‘and I often hear a sneer in the “izzzzz”’.

This isn’t just an issue in academia. It’s also been noted in another titled profession, medicine. In a study published earlier this year, researchers analysed video-recordings of a medical ritual known as Grand Rounds—a sort of regular mini-conference where hospital doctors present recent cases to their colleagues and medical students. They focused on the part of the proceedings where presenters are introduced by a colleague, and recorded, for each introduction sequence, whether the introducer named the presenter as ‘Dr X’, ‘Joe/Joanne X’ or ‘Joe/Joanne’. Then they crunched the numbers to see how the choice was affected by the sex of the introducer and the presenter. They found a clear pattern: in a context where every speaker is by definition ‘Dr X’, women were significantly less likely to be referred to by that title.

Actually, that wasn’t the only noteworthy finding, so let’s just unpack some of the details. The researchers found that women performing introductions at Grand Rounds nearly always introduced presenters, of both sexes, as ‘Dr X’: they used first names in just four cases out of a total of 106. Male introducers had a much lower overall usage of ‘Dr’ (which suggests that in general they favoured a more informal style), but the sex of the presenter made a significant difference. Men used ‘Dr’ far more frequently when introducing other men (72%) than when introducing women (49%).  It’s true that factors other than sex might play some part in this: we know, for instance, that the use of titles is influenced by age and professional status/seniority (variables which unfortunately this study did not investigate). But while those variables might account for some proportion of the male/female difference, at this point in the history of medicine it seems unlikely they could explain it all. It’s hard to avoid the conclusion that there’s a tendency for men to withhold professional recognition from women, because subconsciously they don’t regard women as equals.

The pattern revealed by this study is reminiscent of some other patterns I’ve discussed in earlier posts, like the tendency for men to dominate discussion in professional contexts and their habit of using endearment terms like ‘honey’ and ‘sweetheart’ to female co-workers. It’s more evidence of what we might call, by analogy with the gender pay gap, the gender respect gap: other things being equal, women get less respect than men. But what I want to talk about in this post isn’t just the title-vs-first naming pattern itself–I’m sure that will come as no surprise to anyone who reads this blog. It’s also my own (and I think, many other feminists’) ambivalence about it.

When I first read the Grand Rounds study, I thought: ‘yes, that’s happened to me’—and then I thought, ‘and actually I’ve been complicit in it’. I don’t think I’ve ever asked a media interviewer or the person introducing me at a conference to use my academic title rather than my first name. If students send emails to ‘Ms Cameron’ I normally let that pass too. And if I do ever feel moved to say something, I have the same impulse Sarah had to preface my complaint with a disclaimer: ‘I’m not usually precious about titles, but…’.  I don’t think this is because I suffer from that much-discussed female malady, impostor syndrome (‘don’t mind me, I shouldn’t really have this title anyway’). It’s more that, on the question of professional titles, feminists are caught between a political rock and a hard place.

As I’ve explained before, what address terms convey depends not only on which terms you choose, but also on whether or not they’re used reciprocally. Reciprocal usage of titles signals mutual respect between equals, along with a degree of social distance and formality; non-reciprocal usage (e.g., you call me ‘Professor’ but I call you ‘Susie’) suggests a status hierarchy in which one person must defer to the other. With first names and endearment terms, reciprocal usage signals intimacy or solidarity, whereas non-reciprocal usage, once again, implies a hierarchy. This dual-axis system (status versus solidarity, hierarchy versus equality) is what makes professional titles potentially a difficult area for feminists to negotiate. We may resent being addressed as ‘Sarah’ when the man beside us is ‘Dr Jones’, but we also tend to be uncomfortable demanding deference from others. We’re in favour of equality and reciprocity, not hierarchy.

This isn’t just a feminist thing. For people of my generation (I was born in the late 1950s), the use of first names rather than titles was one symbolic expression of the egalitarian values championed by progressive social movements in the 1960s and 70s. By the time I went to university in 1977, our teachers divided neatly along generational lines. The old guard maintained the traditional etiquette of distance and deference (we called them Dr/Professor, they called us either by our given names, or in some cases Mr/Miss), while the young Turks marked their cool, lefty credentials by telling us to call them ‘Bob’ (obviously they weren’t all named Bob, but they were, almost without exception, men).

Of course, this didn’t mean there was no hierarchy—the Bobs were marking our exams, not vice versa—but we liked the idea that they were treating us as equals, and encouraging us, as we also used to say, to ‘relate to them as people’. So when I became a lecturer myself, I found it natural to ask my own students to use my first name. As I saw it, insisting on a title meant you were old and out of touch, not to mention self-regarding and/or socially conservative. I wanted to make clear that I was none of those things.

The trouble is that, like so many symbolic gestures, this one doesn’t work for women or minorities the same way it works for white men—a point made forcefully by the Australian academic Katrina Gulliver, who explicitly takes issue with the young Turk tendency:

In most departments there is the species of (white) male professor, who wants to be seen as “cool” (you know the one, who shows up dressed like he’s come to mow the lawn), who invites all the youngsters to “call me Dave,” resting safely in the comfort of assumed male authority. If you’re one of these guys: you are not helping the rest of us.

Gulliver got a lot of flak for this, with many commenters telling her that she just didn’t understand Australian culture (she mentioned in the piece that she had previously worked in Germany). We’re more relaxed here, they said, we don’t go in for all that stuffy formality. But while it’s true there are cultural differences, we should be suspicious of the claim that first-naming is just about informality. Findings like the ones reported in the Grand Rounds study show that this isn’t the whole story: there really is a gender respect gap, and the ‘let’s not fixate on titles’ argument is too often trotted out on autopilot by people who don’t want to acknowledge that or to think about its real-world consequences. People like Will Miller, whose response to Gulliver was this:

I worry about making sure I deserve the respect of my students rather than expecting my title or position to simply demand it. I want students to respect me as an individual, not solely for my role, title, or degrees.

This pious sentiment is hard to argue with, because today it is a truism that people should be respected for what they do rather than who they are, what they wear or what title they go by (whether that’s ‘Lord Muck’ or ‘Professor Miller’). But while in principle feminists also subscribe to this belief, we have reason to know that in practice respect, like money, is not distributed purely on the basis of individual merit.

Rebecca Schuman’s answer to Miller was scathing: ‘It takes a particularly privileged individual’, she commented, ‘to insist, though he commands unearned respect when he walks into a room (even in jeans), that respect must be earned’. Her point was that the Bobs, Daves and Will Millers can have their cake and eat it too. As members of the social group that provides our cultural template for authority, they can expect to retain students’ respect while also getting extra credit for not insisting on the deference to which their status in theory entitles them. Women, on the other hand, have often discovered that a symbolic display of humility from them is interpreted less as principled egalitarianism and more as a confirmation of their assumed inferior status. When it comes to authority, Katrina Gulliver suggests, a woman must either use it or lose it:

So, I’ll keep insisting on formality from my students, even if they make comments about my being pedantic or bossy on their student evaluations.

But that ‘if’ clause points to a further complication. A woman who is—in Sarah’s words—‘precious about titles’ does risk being labelled bossy (not to mention arrogant, unfriendly and uncool). She can easily be cast as one of the stereotypical ‘nasty women’—the schoolmarm, the nagging nanny or the hideous old battleaxe—who turn up with such monotonous regularity in cultural representations of powerful women. All her options have costs as well as benefits; for her there is no magic ‘get out of jail free’ card. So what, in practice, should women do?

What I do myself is what I’ve always done: I ask students to use my first name, and—since language is my subject—I take a moment to discuss with them what this might communicate in the specific context of higher education (not that I want to be their friend, but that I recognise them as fellow-adults and expect them to act accordingly). I have never, personally, had much trouble with students being openly disrespectful: the sexism I’ve encountered has been more the ‘she’s a scary old battleaxe’ variety. At my advanced age and career stage, I can live with that (which is not to say I like it or think it’s fair). But when I read about other women’s experiences, I do wonder if I’m doing a disservice to my colleagues—especially the young women and women of colour who are likely to encounter a more extreme version of the respect gap.

I’m under no illusion that language on its own can close the gap. As I’ve said more than once on here, patterns of language-use do not arise in a social vacuum: ultimately I don’t think there is any kind of sexism which can be effectively addressed using purely linguistic measures. But language is part of the bigger picture. Is it incumbent on all of us to be ‘precious about titles’ so that the larger message about equality comes across more clearly and consistently? So that a title like ‘professor’ will stop automatically conjuring up a picture of a middle-aged white man in a tweed jacket?

I’m not sure what the answer is, and to be honest I can’t see myself changing the professional habit of a lifetime. But writing this has prompted me to make one new resolution. The next time I hear a woman expert being treated like Sarah—first-named by a media presenter who uses formal/deferential address terms with the male experts on the programme—I’m going to complain. And before you ask, yes, I’ll be signing the complaint ‘Professor’.

The comic book image in this post shows the 1940s character Jill Trent, Science Sleuth.