New England Journal of Medicine: Time to Rethink Sex Designation on Birth Certificates

By Michael W. Chapman | December 22, 2020 | 11:37am EST
(Twitter.)
(Twitter.)

(CNS News) -- Arguing that sex designation at birth -- male or female -- is "particularly harmful" to intersex and transgender people, the prestigious New England Journal of Medicine says in a Dec. 17 Perspective that it is time to move sex-identity on people's birth certificates to an area on the form that is not "legally identifying."

"Recognizing that the birth certificate has been an evolving document, with revisions reflecting social change, public interest, and privacy requirements, we believe it is time for another update: sex designations should move below the line of demarcation," state the two medical doctors and one lawyer who wrote the perspective. 

"Designating sex as male or female on birth certificates suggests that sex is simple and binary when, biologically, it is not," state the authors. "The biologic processes responsible for sex are incompletely defined, and there is no universally accepted test for determining sex."

Jessica Clarke, professor of law, Vanderbilt Law School.  (Vanderbilt)
Jessica Clarke, professor of law, Vanderbilt Law School. (Vanderbilt)

The three authors are Dr. Vadim M. Shteyler, Dr. Eli Y. Adashi, and attorney Jessica A. Clarke

The authors explain that birth certificates were revised in 1949 to include what is called a "line of demarcation." 

"The legally identifying fields above the line appear on certified copies of birth certificates, whereas information in the fields below the line, which is used for statistical purposes, is deidentified and reported in the aggregate," they write. "Race and parents’ marital status, for example, were moved below the line of demarcation to permit self-identification and to avoid stigma, respectively."

"[K]eeping sex designations above the line causes harm," according to the authors, who claim that about "1 in 5,000 people have intersex variations" and that "in 1,000 people identify as transgender, meaning that their gender identity doesn't match the sex they were assigned at birth."

Other people are "nonbinary," states the Perspective, "meaning they don’t exclusively identify as a man or a woman, or gender nonconforming, meaning their behavior or appearance doesn’t align with social expectations for their assigned sex."

Eli Y. Yadashi, M.D.  (MMAAP Foundation)
Eli Y. Yadashi, M.D. (MMAAP Foundation, Twitter)

"Keeping statistical data on newborn sex may further public health interests," state the authors.  "Moving information on sex below the line of demarcation wouldn’t compromise the birth certificate’s public health function."

"For people with intersex variations, the birth certificate’s public sex designation invites scrutiny, shame, and pressure to undergo unnecessary and unwanted surgical and medical interventions," state the authors.

"Sex assignments at birth may be used to exclude transgender people from serving in appropriate military units, serving sentences in appropriate prisons, enrolling in health insurance, and, in states with strict identification laws, voting," they contend. 

Members of the Transgender community and their supporters hold a rally and march to City Hall before the mid-term elections to protest against what they say are continual attacks from the Trump administration, in Los Angeles, California on November 2, 2018.  (Photo: MARK RALSTON/AFP via Getty Images)
Members of the Transgender community and their supporters hold a rally and march to City Hall before the mid-term elections to protest against what they say are continual attacks from the Trump administration, in Los Angeles, California on November 2, 2018. (Photo: MARK RALSTON/AFP via Getty Images)

"Less visibly, assigning sex at birth perpetuates a view that sex as defined by a binary variable is natural, essential, and immutable," they write.  "Imposing such a categorization system risks stifling self-expression and self-identification."

In conclusion, they state, "Moving sex designations below the line would be in keeping with legal developments deemphasizing sex distinctions. ... Leaving any sex designation visible on birth certificates sacrifices privacy and exposes people to discrimination. ... To protect all people, birth-certificate sex designations should be moved below the line of demarcation."

The Centers for Disease Control and Prevention (CDC) reports that nearly 1 million Americans are transgender. According to the U.S. Census Bureau, there are an estimated 328,239,523 people in the U.S. population. 

To read the NEMJ's Perspective, click here

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