February 22, 2024

NEJM proposes change in birth certificates to accommodate transgender concerns

Assigning sex at birth is unfair and even dangerous, the authors of a commentary contend

The Australian census will begin asking questions this year about gender diversity. It plans to ask people what is their “sex recorded at birth” as well as their declared gender. Changing the information recorded on birth certificates is even more radical – but that was proposed recently in a commentary article in the New England Journal of Medicine (December 17).

American birth certificates should be revised to make ticking a box for male or female optional. Legally identifying information should be reported “above the line” because that is publicly available. To avoid stigma and allow self-identification, fields like race, parental marital status and sex or gender should be below the line.

The birth certificate is a document which evolves with time, argue the authors, who come from Brown University Medical School and Vanderbilt Law School: “it is time for another up- date: sex designations should move below the line of demarcation.”

They argue that “Designating sex as male or female on birth certificates suggests that sex is simple and binary when, biologically, it is not … Assigning sex at birth also doesn’t capture the diversity of people’s experiences. About 6 in 1000 people identify as transgender … Sex designations on birth certificates offer no clinical utility; they serve only legal — not medical — goals.”

Assigning sex at birth is unfair and even dangerous, they contend. “Assigning sex at birth perpetuates a view that sex as defined by a binary variable is natural, essential, and immutable … Imposing such a categorization system risks stifling self- expression and self-identification.

The comments of the NEJM’s readers were initially glowing, but rapidly became hostile. “The suggestion that sex is not binary because intersex disorders exist is ludicrous. … spare us the trip down this anti-science, ideological rabbit hole,” was a typical response.

Evolutionary biology Colin Wright, who is also the editor of Quillette, analysed the article in more detail. He pointed out that as recently as August last year, The Lancet published a survey article which concluded that: “The combination of all genetic and hormonal causes of sex differences [yield] two different biological systems in men and women that translate into differences in disease predisposition, manifestation, and response to treatment.”

Michael Cook is editor of BioEdge

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