POV: We Need to Eliminate Sex from the Public Portion of Birth Certificates

Doing so will help to address the inequities and discrimination faced by transgender and intersex people

photo of a nurse IMPRINTING a BABYS FOOT ON a birth CERTIFICATE. The document is handwritten, but has "Certificate of Birth" printed in a cursive font at the top. The nurse has painted fingernails. "POV" is overlaid.

Photo by Harold M. Lambert via Getty Images

Voices & Opinion

POV: We Need to Eliminate Sex from the Public Portion of Birth Certificates

Doing so will help to address the inequities and discrimination faced by transgender and intersex people

October 21, 2021
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To obtain a passport or driver’s license, register for school, adopt a child, gain employment, and get married, we are required to present our birth certificate. Despite little relevance to the situations, each forces us to reveal personal information on our birth certificates, such as our sex assigned at birth. These situations can be particularly harrowing and even dangerous for transgender, nonbinary, and intersex persons. Thankfully, the American Medical Association now recommends removing sex from the public portion of birth certificates. Such an update to birth certificates has the potential to remove yet another barrier to people living their lives freely.

The U.S. Standard Certificates of Live Birth form is the primary means by which data is collected and standardized, though each state and territory may adapt the standards to local needs. The basic form is two pages long and consists of 58 questions, including the child’s sex assigned at birth. The form is completed by the parent(s) of the child, then certified by a medical professional, and submitted to the state, county, or municipality, which issues the final birth certificate back to the parent(s). As it is currently set up, birth certificates do not appropriately account for intersex persons (approximately 1 in 5,000 people) and put the 0.6 to 2 percent of persons who identify as transgender and nonbinary at risk of discrimination or worse. As a primary care doctor who specializes in providing gender-affirming care, I know government documents such as birth certificates can cause a great deal of anxiety and dysphoria for my transgender patients. For my patients, having a sex designation on their birth certificate that does not reflect their gender identity can result in confusion, discrimination, and violence whenever their birth certificate is requested.

Some states have attempted to offer gender-neutral options on birth certificates, such as the “X” designation. And while a move towards more gender-neutral options could provide additional privacy for persons, this may cause the same amount of confusion and potential threat of discrimination if it is not an accurate representation of a person’s gender.

While some states allow birth certificates to be amended and updated to reflect a person’s gender more accurately, this is a less than ideal work-around. Currently, Tennessee does not allow anyone to amend their sex marker on their birth certificate, and 14 states require proof of gender-affirming surgery to amend their birth certificate. And while many states do allow a person to amend their birth certificate, only 15 states currently allow a gender-neutral “X” designation on birth certificates. Further, as the process to update a birth certificate can vary greatly state to state and frequently requires a medical professional to provide “proof of sex reassignment,” this needlessly creates barriers for someone to ensure their government documents accurately reflect who they are.

And while some argue that removal of the sex designation on birth certificates would undermine our ability to collection population statistics, the proposed update only applies to the public portion of the birth certificate. The sex assigned at birth of a child would still be reported to the Centers for Disease Control and Prevention National Center for Health Statistics. And removing information from the public portion of the birth certificate has been done before without threat to national statistics. As birth certificates have been used to discriminate, promote racial hierarchies, and prohibit miscegenation, the race of a person’s parents is no longer listed on the public portion of birth certificates.

While moving sex off the public portion of the birth certificate will not address all inequities and discrimination experienced by transgender and intersex people, this is a valuable first step rooted in science and history and backed by the American Medical Association.

Carl G. Streed, Jr., a School of Medicine assistant professor of medicine and research lead at Boston Medical Center’s Center for Transgender Medicine and Surgery, can be reached at Carl.Streed@bmc.org. 

Editor’s note: The author is a member of the American Medical Association Advisory Committee on LGBTQ Issues.

 

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POV: We Need to Eliminate Sex from the Public Portion of Birth Certificates

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There are 11 comments on POV: We Need to Eliminate Sex from the Public Portion of Birth Certificates

  1. since a lot of medical indication guidelines are sex dependent, how does one address this? for example, the guidelines for diagnosing anemia are sex dependent, where the threshold for anemia in g/dL of blood is different for adult males, adult non-pregnant females, and adult pregnant females. so if an adult identifies as male, but their sex at birth was female, how does this play into diagnosis of medical conditions where guidelines are sex dependent?

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    1. A medical record is a legal document, and is not a public record. Therefore your doctor would know your sex assigned at birth, your weight, your gender identity, other medications you may be on etc. This would just remove sex from the public view.

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  2. I don’t understand the confusion, if you have a Y chromosome then you are a male. For the rare intersex situation, that could be handled differently.

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  3. This has been a controversial topic. Race was once public on birth certificates, and it was removed since it was not necessary. For the transgender and intersex communities, removing sex from birth certificates just makes life less complicated. Having a gender identity that does not match the sex designation on a birth certificate can create confusion and potentially expose people to discrimination when an identity document is requested, such as when they register at a school or university or apply for a passport. Birth certificates are also used to accumulate identity “points” for anything from applying for a credit card to commencing a job. However, many believe in sex is an important identifier for a person. If sex is removed from birth certificates, what else is left on there, name and date of birth? The primary purpose of a birth certificate is to provide verification of a person’s legal identity, and gender is different than sex.

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  4. Removing sex designation at birth will lead to less discrimination and will increase gender equity. Yet, assigning sex at birth is essential for data analysis, collection, and future health-related matters. Thus, it is still essential to record a person’s sex designation at birth in one form or another. Thus, it is essential to keep using the U.S. Standard Certificate of Live Birth which is critically used for medical, public health, and statistical uses only. This way the government-issued certificate of live birth wouldn’t need to have sex designation at birth, as it’s not a piece of important information to the public.

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  5. I think rather than removing sex from birth certificates, as this could lead to confusion with medical procedures and such, we should rephrase how gender is asked for official documents and jobs. I’m applying to jobs at the moment and every application I fill out has a different way of asking for gender. Some companies will ask what you identify as, with more than two answer choices, while others ask what’s on your birth certificate and give no option besides male and female. I think the first step is to hold companies accountable, especially since pretty much every company says they believe in diversity and inclusion. Beyond jobs, for government ID’s, school registration, etc. the same question- on how you identify- should be asked.

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  6. I also believe we should remove sex from the public portion of birth certificates. We live in a progressive era, where being part of the LGBTQ+ isn’t as taboo as it was a couple years ago. This means people are going to be more comfortable “coming out”. Anyone can have an epiphany and realize their true identity later on in life, and having sex as a question on the public portion of the birth certificate may make one feel misgendered or mis-identified. Because there are many sex-specific diseases/disorders (men are more likely to be colorblind, or various types of cancers), I think having another document that says your birth state for professionals to see is a very good idea. As long as there is an official document that states what your birth sex is (and is only disclosed to professionals), I don’t see an issue with eliminating sex from birth certificates. Thank you for the article!

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  7. I also agree we need to eliminate sex from the public portion of birth certificates. We live in a progressive era, where being part of the LGTBQ+ community isn’t as taboo as it was a couple years ago. Sex is assigned from the day we are born, but how are we supposed to know our identities when we haven’t even experienced life yet? It is very likely people are going to be more comfortable “coming out” and realizing their true identity. By already having a sex on an official document like the public birth certificate, it can make someone feel misgendered down the line. I believe that as long as there is another document that privately discloses your birth sex to officials/professionals (like doctors or to whomever it may concern), then removing sex from birth certificates seems like a great idea. Having a separate document that states your birth sex can be extremely useful to doctors since there are many gender-specific diseases/cancers/disorders, and it would be really harmful to be misdiagnosed regardless of what you identify as.

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  10. Thank you for narrowing my choices of colleges for my children. Boston University is a ridiculous institution and not worth a penny of my money.

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