Respectful and Inclusive Language in Scholarly Writing

The language we choose in scholarly writing in describing the populations we serve is of utmost importance. As such, thoughtful attention to these choices depicts our respect, concern, and care. However, language can also reveal implicit and explicit biases, even when unintended. The Journal of Midwifery & Women's Health (JMWH) editors acknowledge past harms due to unintended implicit biases. Through our process of ongoing review, JMWH continues our aim of respectful and inclusive language ^1-3 and to adapting our style as approaches to language evolve.

The JMWH approach to inclusive language is based on 3 principles: (1) respectful language is a necessary condition for inclusivity; (2) identities such as gender, race, and ethnicity are socially constructed; and (3) inclusive language should be specific and accurate. In combination, these principles help guide authors and editors to consistently use inclusive language in their writing.

Authors must be transparent in how gender, race, ethnicity, and other descriptors are defined within their scholarly work and who contributed to the decision-making process. As socially constructed descriptors, there is no absolute way to categorize people, nor should there be.⁴ Allowing research participants to self-identify shifts the decision-making process and helps address the inherent complexity in describing participants.

JMWH adheres to the American Medical Association's Manual of Style (eleventh edition)⁵ unless specific differences are identified in the JMWH Manuscript Preparation and Style Guide.⁶ The American Psychological Association Inclusive Language Guide is another good resource and provides recent advances in language use with careful explanations.⁷ Additional guides are available to authors, including the GLAAD Media Reference Guide⁸ and the Coalition for Diversity & Inclusion in Scholarly Communication Guidelines on Inclusive Language and Images in Scholarly Communication.⁹ Our goal as editors is to support language that allows individuals and groups to choose how they prefer to be identified, while understanding that language use is dynamic and not everyone will always agree.

The evolution of gender identity language is a prime example of the importance of staying abreast of rapidly changing demographic descriptors in research and scholarly writing. Systematic reviews and other types of evidence syntheses often include studies where researchers assumed participants identified as cis-gender women, thus excluding pregnancy-capable individuals whose gender identity is not female. Likewise, research projects have not always sought nonbinary participants outside of the traditional cis-normative boundaries. In response, JMWH authors have begun to include disclosure statements within their article submissions, acknowledging these discrepancies and describing how gender-inclusive language has been addressed within their scholarly writing. Authors can find examples of these disclosures in previously published JMWH articles and the JMWH Style Guide.⁶ The recently published seventh edition of Varney's Midwifery¹⁰ aimed to use gender-inclusive language throughout. These examples demonstrate the commitment of midwifery editors and authors to advance gender equity in scholarly work.

Multiple approaches can be used to increase respectful language. People-first language encourages word order that places people and their identities before diseases. For example, “participants with diabetes” is typically preferred to “diabetics” or “diabetic participants.” Although subtle, this approach avoids over-identifying people with their conditions. Another approach, identity-first language, is used when individuals strongly identify with a health condition or disability and do not consider it a disease. A notable example is individuals who are unable to hear. In this case, their preferred terminology may be “Deaf participants” to acknowledge belonging to the Deaf community with its distinct culture and language.^{11, 12} This contrasts with someone who may become hard of hearing later in life when people-first language might be more appropriate. Although it is ideal to use terms acceptable within a social group, such language can be disrespectful when used by outsiders. People with a substance use disorder may describe themselves as addicts, yet it would be inappropriate for researchers and clinicians to use such a term.

Using self-identified terms increases the precision of research variables. Groups are often heterogeneous, and specificity increases the ability to generalize to a larger population. For example, the country of origin, such as Mexico or Cuba, or country of birth, or generation of immigration, provides greater information than the broader terms of Latina, Latino, or Latinx. Similarly, American Indian people may prefer to be identified by their specific tribal name rather than broad categorizations such as American Indian or Native American.¹³ When broader categories are used, clear definitions will help avoid losing the unique identities of diverse populations and individuals.

As researchers design projects, it is important to be transparent about how variables addressing race and ethnicity are identified and operationalized. This includes identifying how and why categories were chosen, who chose the categories, and what options were available to participants. Authors should be cautious about the inclusion of race and ethnicity in predictive models of disease course or outcome to avoid mistaken assumptions about essential biological differences among socially determined groupings of people. Instead, authors should examine race within the context of exposures such as social determinants of health and racism. Disparities in the incidence and outcomes of disorders are widely reported across racial and ethnic groups, for example, diabetes, maternal mortality, and hypertension in pregnancy. It is important to recognize these disparities are not explained by race and ethnicity.

Respectful and representative language is equally important within our profession. JMWH provides examples of inclusive language preferences for midwifery within the Style Guide.⁶ We consider the term midwives to be the most inclusive for the United States and other countries. As the professional Journal of the American College of Nurse-Midwives (ACNM), we primarily represent Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs), who share a single scope of practice and national certification from the American Midwifery Certification Board. Both are identified when it is important to specify ACNM-represented midwives. Certified Professional Midwives (CPMs), as practice and professional colleagues, are also represented in these pages as peer reviewers, authors, and on the editorial board. Specification of the CPM credential may also be required in some instances.

JMWH has a responsibility to respectfully represent the members of ACNM, the midwifery profession, and the communities we serve. As part of a commitment to do just that, our editorial and peer reviewer teams represent the many differences among us, including race and ethnicity; gender; sexual orientation; length of time in the profession; practice focus whether that is clinical, academic and research, or policy; and geography, both within and external to the United States. Our commitment to inclusion is expressed in the JMWH Statement of Inclusivity published in 2023.¹⁴

As we begin a new year, the JMWH commitment to respect, inclusion, and thoughtfully representing the many differences among and within individuals and populations is stronger than ever. As JMWH editors, we will continue to advance the most respectful use of language in providing the latest in midwifery-focused research, innovation, and scholarship. We invite your partnership as authors, reviewers, and readers in using the most respectful and inclusive language possible and continuing to help us advance the conversation.

The authors thank Ali Cocco, CNM, MSN, MDiv and Meghan Eagan-Torkko, CNM, PhD, ARNP, JMWH Associate Editors, for their review and comments on this editorial.