The Social Diagnosis:
As it stands, we do not stand united as a civil body. Nevertheless, America — our civil body — is made of humans, and the human body is made by sex. We are all a form of sex and we all reside somewhere on a spectrum of gender, as is our nature as human beings.
In light of recent current events and news cycles — the Trump administration’s erasure of transgender civil rights protections in health care; the controversy surrounding J.K. Rowling’s stance and words on gender vs. sex; the fading prospect of the Equal Rights Amendment (ERA) being adopted into law anytime soon; ongoing gender-based violence; and a civil rights revolution taking place as you read — a prognosis seems clear. It is time for society, government, and the healthcare industry to confront and address our fractured gendered civil body.
Preexisting conditions that contribute to our social ailments as a fractured gendered civil body include:
Poor levels of sex and gender literacy
Inadequate supply and comprehension of social narratives and context across the spectrum and history of humanity
Weakened civil conduits for the fostering and preservation of pluralism
Fractured relationships to one’s sexuality and gender, on a mass level
Metaphors of birds and bees, and the marketing of pastel blues and pinks, has done our civil body no good. We need to talk about sex and gender identity/gender in a nuanced and non-sugar-coated way, just as we must continue to discuss the subject of race in a similar vein. Civil rights are human rights. Such rights enable optimal individual and social health.
It is disheartening that even when the subject of race discrimination is under the social microscope, gender discrimination, even if coupled with race discrimination, is not always given the same level of attention and respect as other civil narratives. Though America is a pluralistic society, we have long been failing when it comes to co-existing as a multifaceted pluralistic society. So, as conversations about race are already underway, and in within our realms of consciousness, now is the time for us to exercise our pluralistic muscles as well. Let us also have nuanced conversations and discourse on the subject of gender identities/genders and sex at the same time.
Gender discrimination often plays out in the form of bias and sexism. Gender bias is largely rooted in judgments made upon others’ sexual preferences and behaviors. Sexism is deeply rooted in the force that gives power to androcentric prominence within our long-standing patriarchal civilization. Gender bias and sexism corrodes all of the varying social/civil sectors—religious, political, and racial communities, as well as the LGBTQIA community. As a result, the gendered civil body is fractured, partially because the very subject of gender identity/gender and sex, as a whole, has been fragmented and separated from their intrinsic connection to our humanity.
Let me be clear, I am not suggesting that the LGBTQIA community expand its acronym to include cis men and cis women. I can not speak on behalf of cis men. As a Black cis woman, I do not claim to know what is like to be a member of the LGBTQIA community or cis manhood. I do not claim to speak on behalf of any given community. I do not claim to fully know what my loved ones, from across all communities, go and feel thorough on a given day, or lifetime. I only know what I think I do from the friendships I’ve had/have, what I observe(d) in society/culture, and what I have read and studied. As an ally, I want to learn more.
What I am suggesting is a holistic examination and discussion of gender identities/gender and sex, as a whole, in the context of a collective civil body that coexists in a land and reality of industry and law. Collectively, our society is suffering from an aggressive case of gender discrimination and sexism. We need to have new types of conversations to help us combat against it and achieve optimal pluralistic health.
Last time I checked, there is not one type of universal medicine to heal all wounds. This brief social diagnosis aims to serve as a reflection prompt for constructive discussion and to spark ideas for actionable steps forward. It is meant to help reconstruct a path for social mending and resolve, on the civil level.
(Graphic) Gender identity/gender symbols and various genotypic sex sequences
A Quick Anatomy Lesson on the Gendered Sex Body:
Like many life forces within the animal kingdom, humans are created by sexual reproduction. We are made whole, in part, by the sum of sex. Humans are not binary. We are not 1-D. There is more to us that exists beyond the 2-D realms of texts and screens. We are multidimensional.
Within medical and scientific fields, sex is studied and exists in three categories — genotypic sex (chromosomal makeup), phenotypic sex (visible body characteristics and behaviors), and gender (social identities/constructs). Of these three categories of sex, gender is the most complex for its multifaceted aspects are anchored in a combination of external social and internal personal factors.
Humans are assigned our genotypic sex body by our biological fathers. Why? The “Y” factor. It is the male sperm that determines the sex of a female egg. By default, we all our made of the “X” factor, our female essence. For people who do not have an explicit XX (female) or XY (male) genotypic and/or multiple phenotypic characteristics, their gender assignment, whether male, female, or intersex is selected after deliberation by ones parent(s) or healthcare provider, after birth. For those with a definitive XX (female) or XY (male) genotypic type and corresponding reciprocal reproductive organs, in context of the general theorem of human biology, they are by default assigned the gender of girl or boy at birth.
Every human’s life journey between youth and adulthood entails either one or more of the following phases: (1) becoming and being one’s assigned gender; (2) choosing and being a self-selected gender; (3) processing and conforming to an assigned gender; and/or (4) processing and rebelling against an assigned gender.
(Chart) Modern Gender Identities/Genders and Sex Overview
Gender identity/gender is an expression of one’s self and sex body. There is an intrinsic relationship between the two, a trinity of sorts. We have various forms of relationships with others, outside of ourselves, partially enabled by our consciousness. As social creatures, communication is a crucial element of our existence as human beings. We are animated and coded by different language, cultural, knowledge, and belief systems. How and why we adopt and express our gender identities/genders is partially subject to a collective social body, who co-authors meaning, norms, and social scripts, whether or not anchored in truth, ethics, and virtue.
A root cause for any form of discrimination is a lack of knowing. Language to render, and context to comprehend, can help expand realms of knowing. However, it is important to be mindful that across ancient geographies and cultures, much of history has been predominately authored, and widely disseminated, by “males.” Singular channels of knowledge systems and networks can become petri dishes filled with bias, omissions, and inaccuracies.
We are unable to grasp a fuller spectrum of the variations of gender identities/gender, from the perspective of womanhood from history, due to the small body of historical evidence that remains from female authors and creators. Nevertheless, vernacular to describe and categorize gender identities/genders and sex bodies has existed within the expansive human time continuum. It has evolved over the millennia.
(Painting Detail)Zachariah in the Temple,a fresco by Domenico Ghirlandaio (1486–1490) in the Tornabuoni Chapel, Florence. [From left to right] Marsilio Ficino, Cristoforo Landino, Angelo Poliziano and Gentile de’ Becchi or Demetrios Chalkondyles; Ficino, was an Italian scholar, Catholic priest, and influential humanist philosopher of the Early Italian Renaissance (1433 –1499); He was the first known person to have written the phrase, “platonic love;” According to historianRictor Norton,his love letters reveal his romantic affections for a man named Giovannie Cavalcanti.
In addition to textual and verbal forms of expressing gender identities/genders, archaeological and historic records tell of long held practices from across the millennia that were/are conducted to create, conceal, and/or express gender identity/gender and sex-based narratives. They include (non-permanent) disguise and cross-dressing; and (permanent) both voluntarily and involuntarily castration [this created a multifaceted male gendered class regarded as eunuchs in Western scholarship]; male and female circumcision [male circumcision is an older practice than female circumcision, each gendered practices had/has their own collection of stories as well]; and most recently self-selected sex reassignment surgery [advancements in science, technology, and medicine paved the way for a gender evolution].
Some of the earliest mentions of castration and/or eunuchs and circumcision can be found in the ancient Egyptian mythology (the myth of Osiris — 24th century BCE) and records, ancient Sumerian records (21st Century B.C.), the Hebrew Bible and the Old Testament and New Testament, and records from the early Byzantine Empire. (Left) Detail fromThe Baptism of the Eunuch(1606–1669).By Rembrandt; and(Right)Habit of a whiteeunuch (1749). By Unknown, the New York Public Library’s Digital Library under the digital ID c21e1890-c5fb-012f-e333–58d385a7bc34
“For there are eunuchs who were born that way, and there are eunuchs who have been made eunuchs by others — and there are those who choose to live like eunuchs for the sake of the kingdom of heaven. The one who can accept this should accept it.” — Matthew 19:12
One of the earliest female primary source in history, who wrote on the subject of gender identity/gender and sex-based narratives, is Sappho (c. 630 — c. 570 BC). She was an ancient Greek poet from the island of Lesbos. The etymology of the gender identity/gender type, “Lesbian,” stems from the name of the island of her origin. During her lifetime, she was included amongst a collective of great poets, regarded as the esteemed Nine Lyric or Melic Poets. She was the only woman member of the elite club of nine. That is not to suggest that there were no other active female writers in ancient Greece, and in other contemporary places. The existence of such has been preserved in historical records, such as writings left behind by Antipater of Thessalonica.
“They fed these divine-voiced women with odes the Helicon and the Macedonian promontory of Pieria,Praxila, Moero, Anite, the female Homer, Sappho, glory of the lesbian women with beautiful curls, Erina, the famous Telesila, and you, Corina, that you sang the martial shield of Athena, Nosis with a feminine voice, and Mirtis with sweet tones, all producing eternal pages. Nine Muses begot the great Uranus, but at nine o’clock, Immortal rejoicing for mortals, begot them by Gea.” — Epigram AP IX 26 attributed Antipater of Thessalonica (Antipater lived under the patronage of Lucius Calpurnius Piso, who was in power beginning in 15 BC.)
(Painting Detail)Sappho and Erinna in a Garden at Mytilene(1864). By Simeon Solomon. Depiction of Sappho (c. 630 — c. 570 BC) of the island of Lesbos.
A Brief Dissection of 20th & 21st Century Gender Politics in American Law and Healthcare:
Thanks to the efforts of a group of daughters and granddaughters of slaves, from Chicago, in 1916, a firm path toward sex and gender equality was established in America. The women had fought to make it unconstitutional, under local law, to deny voting rights based on one’s sex. They became the first group of women to vote in America. Their first ballots cast were for the President of the United States. Four years later, as a result of the dedication of women suffragists who continued on the path started by their female sisters, on August 18, 1920, the 19th Amendment was ratified, granting women the civil right to vote in America, under federal law. As a result, for the first, and last time since, the word “sex” appeared within the U.S. Constitution. The lack of distinct gender and sex-based narratives within our foundational laws has left many susceptible to various forms of gender and sex-based discrimination.
(Photograph) Nine African American women gather for the Banner State Woman’s National Baptist Convention. 1915 (Library of Congress Prints and Photographs Division Washington, D.C. 20540 USA)
In 1923, the Equal Rights Amendment was first introduced for adoption into law. The proposed amendment seeks to guarantee equal legal rights for all American citizens regardless of sex. It has had many ups and downs in its quest for ratification. On January 2020, the ERA reached a major milestone, but has since been met with yet another major obstacle. Currently, the chances for its adoption in the immediate future seems dim.
A year after the Civil Rights Act of 1964 was passed, two major landmark events took place in 1965 that had great impact for multiple genders and the female sex in America : 1) the Equal Employment Opportunity Commission’s (EEOC) was established to enforce civil rights laws against workplace discrimination; and (2) the U.S. first began to conduct sex reassignment surgeries (The first known successful recipient of male-to-female sex reassignment surgery took place in 1930, Germany).
It was only in 1993 that the United States Congress wrote the NIH Revitalization Act of 1993 into public law. Prior, it was not mandatory to include women and minorities in all clinical medical research. Why is/was that a problematic issue? Well, the physiology of male and female bodies is different (i.e. bone structure, iron counts, hormones levels, etc.). Due to such differences, some procedures and drugs react differently in each physiological/biological sex body type, regardless of one’s gender identity/gender. Take for instance the problematic mass prescription of statins to female patients. Many were taking them to manage their cholesterol health. However, many were unknowingly taking a drug that was primarily studied upon a male body, and that their bodies were susceptible to potentially harmful side effects not experienced with in male bodies.
Because of gender and sex-omission, -discrimination, -biases within the healthcare and medical communities, many Americans have been discriminated against, and/or had their health put in jeopardy due to poor sex and gender literacy.
Even prior to the NIH 1993 motion, efforts had been attempted to make the healthcare and medical industry more gender inclusive and accepting of realms of knowledge that exist beyond androcentric culture. Take for instance the World Health Organization (W.H.O.). Since its inception in 1948, W.H.O. has been advocating for the adoption of a midwifery model of care — female led—for female reproductive healthcare needs.
Yet, according to The American College of Nurse-Midwives (ACNM), in February 2019 there were only 12,218 practicing Certified Nurse Midwives (CNMs) and 102 Certified Midwives (CMs) listed in America. These stats, in comparison to the 18,590 obstetricians and gynecologists listed in a 2018 U.S. Bureau of Labor Statistics report, displays an imbalance and seemingly disregard for the scientific evidence supporting the benefits of a midwifery model of care, a case made by W.H.O.. Furthermore, according to Birthcenters.org, as of 2020 there are only “384 freestanding birth centers in the United States in 37 states and DC. This represents growth of 97% since 2010.” This in comparison to the approximately 2,428 maternity wards within American hospitals further exemplifies the problematic gender politics in healthcare models, as it pertains to female reproductive health.
(Photograph) President Barack Obama delivers remarks before he signs an executive order regarding further amendments to Executive Order 11478, Equal Employment Opportunity in the Federal Government, and Executive Order 11246, Equal Employment Opportunity, to protect LGBT employees from workplace discrimination, in the East Room of the White House, July 21, 2014. (Official White House Photo by Pete Souza)
In 2010, the Obama’s administration amended Section 1557, of Title IX of the Education Amendments of 1972 (Title IX), to redefine sex discrimination “to include termination of pregnancy and gender identity, which it defined as ‘one’s internal sense of gender, which may be male, female, neither, or a combination of male and female.’” The rule extended civil rights protections into healthcare, adding sex, which it defined to include gender identity, to the list of prohibited forms discrimination in healthcare programs and activities that receives federal funding. A decade later, on June 12, 2020, the Trump administration reversed the definition of sex discrimination stating:
“Under the final rule, HHS eliminates certain provisions of the 2016 Rule that exceeded the scope of the authority delegated by Congress in Section 1557. HHS will enforce Section 1557 by returning to the government’s interpretation of sex discrimination according to the plain meaning of the word “sex” as male or female and as determined by biology.” — the U.S. Department of Health and Human Services (HHS), June 12, 2020
Recall what I mentioned earlier, how sex is studied and exists in three categories: genotypic sex (chromosomal/biological makeup), phenotypic sex (visible body characteristics and behaviors), and gender (social identities of given sexed bodies).
Under the recent HHS changes, members of the LGBTQIA gender communities are no longer protected against gender discrimination in healthcare. For example, let me share an actual experience from a lesbian woman I met a few years ago, during an industry-related workshop. She relayed that she stopped going to gynecologists for a longtime because she was bullied and intimidated by both a cis male and cis female gynecologist. They pressured her to go on birth control pills in case she ever changed her mind about having sex with a man or ever was to get raped by a man. What she experienced was gender discrimination. Many with the LGBTQIA community, especially those from the transgender community, has been discriminated against, within healthcare programs, and by care providers, due to their gender. Such is unethical and needs to be prohibited by the law.
Though the ERA was created by, and largely still remains spearhead by, women, if it was given the chance to be ratified into law, the ERA could have helped to create greater civil protections for members of LGBTIQA community, in addition to cis women. The Obama administration had created better grounds for sex and gender protections and liberties under the law. Now, due to recent reversals and actions made by the Trump administration, sex and gender identity/gender protections have been jeopardized with in healthcare again. The gendered civil body has been further fractured.
Potential Remedies for Healing:
How does one go about repairing a fractured gendered civil body? Well, traditionally doctors and healers reposition a fractured bone(s) — in some incidences internal or external fixation is necessary. Fractured bones are placed within a cast, so that it can begin a regenerating self healing process. The collective has multiple “fractures” in our civil gendered “body.” Such fractures require a complex operation and need to be handled with great precision.
Precision medicine is a big buzz word in the realm of healthcare and medicine. In 2015, the NIH established its Precision Medicine Initiative, “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.” What the initiative fails to explicitly include within its construct are the variables of gender and sex. However, before the initiative had the chance to remedy such omissions, there was an administrative change in 2016.
As this article was being written, on Monday, June 15, 2020, the Supreme Court of the United States made a landmark ruling, setting a necessary stage for the discussion and process of creating more laws that protect all gender identities/genders and sexes against discrimination. It helps pave a path for equality for all. By a 6–3 ruling, the court voted that the Civil Rights Act of 1964 bars job discrimination because of of one’s sex. They determined that an employer who fires “an individual merely for being gay or transgender violates” the act, also regarded as Title VII. The ruling specially addresses “homosexuality,” “gay,” and “‘transgender’” gender identities/genders. It does not explicitly mention all gender identities/genders in the ruling. There is still much work to be done within American law. Nevertheless, the court’s recent ruling has created powerful momentum on the collective path towards the social healing of our collective fractured gendered civil body.
Given the social landscape, in which our fractured gendered civil body exists, I recommend the following prescription to help us on a path towards optimal pluralistic health. I precisely address some of the underlying conditions of our ailment, to heal them at their source:
Increase levels of sex and gender literacy within the gendered civil body, on a social and individual level
Increase the dosage of histories, herstories, theirstories, and ourstories within the gendered civil body
Strengthen civil conduits for the fostering of pluralism (i.e. governments, schools, workplaces, etc.)
Pass more laws against gender discrimination, in addition to laws against racial, sexual, and religious discrimination — the essence of civil rights and justice
Enhance and restructure medical and healthcare fields to be more inclusive of sex and gender-based factors within the training and best practices of its profession