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.

Mother, father, parent

Last Monday the Prime Minister Boris Johnson returned to work from sick leave; two days later it was announced that he would miss Prime Minister’s Questions because he’d just had a baby. Obviously, Johnson hadn’t given birth himself: he’d delegated that task to his partner Carrie Symonds. But in the media coverage the baby was very much ‘Boris’s’, and its birth was presented as a major life-event. The political commentator Robert Peston tweeted: 

Having babies change [sic] us. Near-death experiences change us. @BorisJohnson has the full set. So will he become a very different PM from the one the UK voted for in December?

This take was greeted with some incredulity, because we all know Boris Johnson has a number of children already–though we’re not sure exactly how many, because he’s refused to answer the question. Many responses to Peston’s tweet were joking references to this:

The first 7-9 kids didn’t do it but I’ve got a good feeling about this one

Ah you know what they say, nothing like getting a sixth/seventh [subs pls check] child to change a man

There were also some more serious responses. One man suggested that

For a certain class of man, having children really does not change him at all… They’re what you do, and after they have arrived in the house, they’re simply there while your life carries on. They have their rooms, you yours. You know their names; birthdays not so sure.

Boris Johnson, who by his own account has never changed a nappy, belongs to the class that delegates routine childcare to others. Its young children have nannies, and are later sent away—as Johnson himself was—to boarding school. Women of this class may not do much nappy-changing either. But their class privilege does not completely cancel out the effect of their sex. Women generally are expected to be able to keep track of their children’s birthdays; and it’s hard to imagine a woman becoming prime minister who’d had (at least) five children with (at least) two different men, had abandoned and tried to conceal the existence of (at least) one child, been denounced by another as a bastard, and launched her bid for the highest office while pregnant by a third man. A woman with this record wouldn’t just be joked about: she’d be vilified as a terrible mother, irresponsible, negligent and selfish.

This difference is also evident in some uses of the English words ‘father’ and ‘mother’. These may look like a straightforward pair of terms denoting, respectively, a male and a female parent; but if we look more closely it becomes apparent that their meanings aren’t entirely parallel. As many feminists have noted, the difference is most obvious when they’re used as verbs. To father a child is not at all the same thing as to mother one.

By way of illustration, here’s a list of synonyms for the verb ‘to father’ taken from an online thesaurus:

Sire, beget, originate, generate, create, procreate, found, get, engender, institute, conceive, initiate, spawn, author, reproduce, breed, produce, trigger, bring to life, give life to, sow the seeds of

and here’s the same thesaurus’s list of synonyms for the verb ‘to mother’:

Pamper, nurture, coddle, raise, tend, cherish, cosset, protect, care for, deliver, look after, overprotect, spoil, mollycoddle, indulge, take care of, mind, minister to, fuss over, give birth to, bring into the world

Whereas the ‘father’ synonyms focus on men’s contribution to the biological process of reproduction (‘sowing the seed’, supplying the sperm that fertilises the egg), most items in the ‘mother’ entry relate to women’s social role as carers. They also illustrate the tendency for women’s performance of mothering to be scrutinised and judged (good mothers ‘nurture’ and ‘cherish’, bad mothers ‘spoil’ and ‘mollycoddle’) in ways men’s performance of fathering is not.

Though motherhood also has a biological element and fatherhood a social one, the way the verbs are used and interpreted underlines that one is conceptualised primarily as a social role and the other primarily as a biological function. If you say ‘he fathered six children’ you cannot mean, or be taken to mean, ‘he brought up/took care of six children’; you can only mean ‘he begat/sired six children’. With ‘to mother’ the reverse is true: ‘she mothered six children’ will be interpreted as meaning that she brought them up, not that she gave birth to six children who were then raised by other people.

These non-parallel meanings reflect a combination of social facts and ideological beliefs which have a long history in patriarchal cultures. But in recent decades we have seen the rise of a more ‘modern’ ideology which rejects the traditional division of roles in favour of something more equal and symmetrical. One sign of this shift is linguistic: the increasingly widespread use of the gender-neutral or inclusive verb ‘to parent’.

The meaning of ‘parent’ as a verb is close if not identical to the meaning of ‘mother’: if you insert it in the same hypothetical sentence I used before—‘he/she/they parented six children’—the meaning (at least according to my intuitions) has to be ‘brought up, took care of’, not ‘begat’. In this case, then, the purpose of switching to inclusive terminology is to include fathers in the caretaking role traditionally assigned to mothers. But it might be asked: does this new language correspond to any new reality? If in reality it’s still women who are doing most of the work involved in raising children, but we now call what they’re doing ‘parenting’ rather than ‘mothering’, has anything, from a feminist perspective, been gained?

This is one instance of a more general dilemma which radical political movements have often grappled with: should we choose our terms to reflect the world as it currently is, or the world as we would like it to become? The answer, in practice, is ‘it depends what you’re trying to do’. Sometimes what you want to do with words is name the reality of injustice and oppression; sometimes what you want to do is model alternatives to that reality, on the basis that (put crudely) words shape thoughts and thoughts shape actions.

This second argument was used in the 1970s by feminists who supported the introduction of gender-neutral job titles, even in cases where the job was still restricted to one sex: they hoped that inclusive terms, by making it easier for women to imagine themselves in new roles, would hasten progress towards their actual inclusion. In other cases, however, feminists have taken the opposite position. Neutral terms like ‘gender-based violence’ and ‘intimate partner killing’, for instance, have been criticised for glossing over the fact that these are acts committed predominantly by men against women, not vice-versa. Here the argument is that male violence needs to be named: the problem can’t be addressed effectively using language that renders it invisible.

As these examples illustrate, different problems call for different solutions. It’s entirely possible to maintain that sex-specific terms are preferable in some cases and inclusive terms work better in others. But that’s not to say feminists always agree among themselves about either the nature of the problem or the optimal solution. The language of parenthood is a case in point.

Recently a case which dramatises the dilemma has been making its way through the English courts. It concerns Freddy McConnell, a trans man who gave birth to a baby after he had already been legally recognised as a man. Because he had given birth to the child, the law required him to be recorded as its mother on the birth certificate. He contends that this was a breach of his rights, and that he should have been allowed to register either as the baby’s father or as its parent.

So far the courts have rejected this argument. Last week an Appeal Court judge, upholding an earlier decision against McConnell in the High Court, reiterated that the law requires whoever gives birth to a child to be registered as its mother. From the moment of a child’s birth there must be someone who is authorised to make decisions about its care, and the 1989 Children Act assigns that responsibility specifically and automatically to the child’s mother. ‘No-one else’, the judge explained, ‘has that automatic parental responsibility, including the father’.

Though this case is about the rights of trans parents, the principle set out by the judge applies to all parents, and many who are not trans may also find it questionable, since it is at odds with the modern, inclusive concept of ‘parenting’. If a birth certificate can be issued which doesn’t name the father—though every child must axiomatically have a male as well as a female progenitor—why is it impossible to issue a certificate which doesn’t name the mother? And why can’t a registered father be given ‘automatic parental responsibility’? The law seems to follow the same logic as the verbs ‘to mother’ and ‘to father’: it applies a similar understanding of how reproductive functions are connected to social roles, assuming that the caretaking element is central to motherhood (it is seen as following naturally from mothers’ reproductive role) whereas the social element of fatherhood is dispensable or peripheral.

In McConnell’s case these two elements have been separated, so deciding whether he should be identified as a mother or a father means deciding whether to give priority to the biological or the social component of parenthood. Since I think of parenthood as primarily a social role and a social relationship, my own view is that it makes more sense to identify McConnell as the child’s father, that being the only role in which the child has ever known or related to him. It is true, however, that while ‘father’ is closer to the child’s experience, it elides material facts about its history. Neither term is a perfect fit with all the relevant facts.

Is this a situation where gender-neutral or inclusive language would be preferable? There are jurisdictions which have adopted neutral terms as standard on some official documents: in the state of New York, for example, the parties to a marriage are recorded simply as ‘Spouse A’ and ‘Spouse B’. In addition to being inclusive (putting both men and women and same-sex/mixed sex couples on a par), this terminology has the advantage of not carrying the same ideological baggage as the traditional terms ‘husband’ and ‘wife’ (I’ve written before about my problems with the word ‘wife’). ‘Spouse’ defines you as a party to a contract that entails certain rights and obligations, but beyond that it says nothing about your role in the relationship. In theory there seems to be no reason why this minimalist approach could not be extended to birth certificates, replacing ‘Mother’ and ‘Father’ with ‘Parent A’ and ‘Parent B’.

But in practice there might be good reasons to resist that move. As I said before, inclusive terms are open to the objection that they do women a disservice by glossing over or concealing politically consequential facts—such as, in this case, the fact that motherhood and fatherhood are not generally treated as equal and interchangeable roles. Most fathers still do significantly less childcare than most mothers (even, it turns out, when both are working from home), and plenty of men still father—that is, ‘beget’—children while treating the social role/relationship as optional. Society as a whole is still organised on the assumption that women, not men, will be primary carers, and it’s women, not men, who experience discrimination because of their actual or potential status as mothers, Does the language of ‘parenting’ help feminists’ efforts to change this reality, or does it hinder them by obscuring what the real problem is?

Clearly, different feminists have different views. But what’s also clear is that you can’t resolve issues of terminology simply by asserting that language should represent reality (whose reality?) Disputes about terms arise because there’s conflict about the reality they relate to: they are political through and through.