June 16, 2021 -- Sex should be removed as a legal designation on the public part of birth certificates, the American Medical Association (AMA) said Monday.
Requiring it can lead to discrimination and unnecessary burden on individuals whose current gender identity does not align with their designation at birth, namely when they register for school or sports, adopt, get married, or request personal records.
A person's sex designation at birth would still be submitted to the U.S. Standard Certificate of Live Birth for medical, public health, and statistical use only, report authors note.
Willie Underwood III, MD, author of Board Report 15, explained that a standard certificate of live birth is critical for uniformly collecting and processing data, but the government issues birth certificates to individuals.
Ten States Allow Gender-Neutral Designation
According to the report, 48 states (Tennessee and Ohio are the exceptions) and the District of Columbia allow people to amend their sex designation on their birth certificate to reflect their gender identities, but only 10 states allow for a gender-neutral designation, usually "X," on birth certificates. The State Department does not currently offer an option for a gender-neutral designation on U.S. passports.
"Assigning sex using binary variables in the public portion of the birth certificate fails to recognize the medical spectrum of gender identity," Underwood said, and can be used to discriminate.
Jeremy Toler, MD, a delegate from GLMA: Health Professionals Advancing LGBTQ Equality said transgender, gender nonbinary, and individuals with differences in sex development can be placed at a disadvantage by the sex label on the birth certificate.
"We unfortunately still live in a world where it is unsafe in many cases for one's gender to vary from the sex assigned at birth," Toler said.
Not having this data on the widely used form will reduce unnecessary reliance on sex as a stand-in for gender, he said, and would "serve as an equalizer" since policies differ by state.
Robert Jackson, MD, an alternate delegate from the American Academy of Cosmetic Surgery, spoke against the measure.
"We as physicians need to report things accurately," Jackson said. "All through medical school, residency, and specialty training we were supposed to delegate all of the physical findings of the patient we're taking care of. I think when the child is born, they do have physical characteristics either male or female and I think that probably should be on the public record. That's just my personal opinion."
Sarah Mae Smith, MD, delegate from California, speaking on behalf of the Women Physicians Section, said removing the sex designation is important for moving toward gender equity.
"We need to recognize gender is not a binary but a spectrum," she said. "Obligating our patients to jump through numerous administrative hoops to identify as who they are based on a sex assigned at birth primarily on genitalia is not only unnecessary but actively deleterious to their health."
Race Was Once Public on Birth Certificates
She noted that the report mentions the race of a person’s parents used to be included on the public portion of the birth certificate and that information was recognized to sometimes lead to discrimination.
"Thankfully, a change was made to obviate at least that avenue for discriminatory practices," she said. "Now, likewise, the information on sex assigned at birth is being used to undermine the rights of our transgender, intersex, and nonbinary patients."
Arlene Seid, MD, ,an alternate delegate from the American Association of Public Health Physicians, said the resolution protects the data "without the discrimination associated with the individual data."
Sex no longer has a role to play in the jobs people do, she noted, and the designation shouldn't have to be evaluated for something like a job interview, she said.
"Our society doesn't need it on an individual basis for most of what occurs in public life," Seid said.