Perspectives on gender-inclusive language in Canadian sexual and reproductive health care: findings from a modified Delphi survey

Abstract

Background: Two-Spirit, transgender, and nonbinary (2STGNB) people in Canada face systemic discrimination in sexual and reproductive health (SRH) care, impacting their health outcomes. Language in SRH is often cisnormative and heteronormative, which can misgender and marginalize 2STGNB individuals contributing to care avoidance and distress. Gender-inclusive language (GIL) can affirm identities, but debate exists about its impact and acceptance. Methods: This study is one part of a larger project examining GIL in SRH care. From May to November 2023, a survey was administered across Canada to clinicians and service-users including 2STGNB individuals and cisgender women. Survey topics included self-assessed competency (Miller’s Pyramid) and attitudes toward inclusive language. Data were analyzed descriptively and with Spearman’s rank-order correlations. Results: A total of 303 participants completed the survey, including 131 clinicians and 172 service-users. Most respondents supported GIL and did not perceive it to have a negative impact on any group. Despite this support, clinicians reported greater comfort using patients’ chosen names than asking for pronouns, indicating uneven adoption of inclusive practices. 2STGNB participants identified misgendering and being relied upon to educate clinicians as barriers. Clinicians cited limitations in charting systems and fear of making mistakes as obstacles. Higher self-assessed competency among clinicians was positively associated with affirming clinical practices. Conclusion: Our findings demonstrate widespread support for GIL among most clinicians and service-users. However, this support does not consistently translate into practice. Key barriers – including provider discomfort, charting limitations and undue reliance on 2STGNB patients for education – highlight the need for structural and educational interventions. To promote inclusive care environments, patient-informed training, revising of documentation forms to accommodate diverse gender identities is needed. Clinical trial number: Not applicable.