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Inclusive Language On Medicare Forms

Bill Shorten’s recent intervention to reverse the use of gender-neutral language in a Medicare form was disappointing to many people who value equality and inclusion. It was particularly disappointing to me and other LGBTQ+ parents.

The form in question is part of a pilot running in three hospitals across Australia that enables parents to register their newborn baby to Medicare. It streamlines the usual process of the hospital providing a ‘Newborn Child Declaration’ which parents then submit with the Medicare Enrolment Form.

Shorten’s intervention was prompted by a story in the Daily Telegraph featuring a woman called Sall Grover who had recently had a baby in one of hospitals running the pilot. Having completed the online form, she took objection to the term ‘birthing parent’ describing it as ‘exclusionary’, ‘alienating’, ‘derogatory’ and ‘dehumanising’.

In response, Shorten tweeted: “when I was informed of the situation yesterday, I instructed the responsible officials they should cease using the previous government’s forms.” He promised that the form in the pilot would be replaced with a new form that would use the word ‘mother’ not ‘birthing parent’, consistent with other Medicare Forms.

Consistency with other Medicare forms is not an adequate benchmark when the language in those forms is far from inclusive. The current Medicare Enrolment form can be submitted by anyone who has parental responsibility for a newborn child (up to 1 year old). This may include a grandparent, foster carer, adoptive parent or intended parent in a surrogacy arrangement or other legal parent. Yet this diversity of family structure is not reflected in the binary options of ‘birth mother’ and ‘biological father’ provided for carers to indicate their relationship to the child. And it’s not remedied by asking them to tick ‘other’ and complete a free text box.

When my daughter was born in 2009, it was highly significant that I could be recognised as her legal mother although I had not given birth to her, thanks to changes to NSW legislation the previous year. So if my parenting status is legally equivalent to any other parent, why is this not reflected in in the forms used in the provision of government services?  If, according to the ABS, there were 99,000 same-sex couple families in Australia in 2021 -  an increase from 32,000 in June 2011 - why are we still being ‘othered’?

The Medicare Enrolment form is typical of many forms that attempt to be inclusive but end up reinforcing a restrictive notion of what a family is. If the actual options were more inclusive, there wouldn’t need to be a catch-all ‘other’ option. As has been pointed out by trans equality advocates, the term ‘birth mother’ excludes people who give birth who do not identify as mothers. It also excludes mothers like me who have not given birth.

If it was necessary in a hospital context to identify who gave birth, it was right that this question was asked in a way that respected all gender identities. Beyond this, it’s difficult to see how who gave birth is relevant. Reducing parentage to a biological link as the Medicare Enrolment form does excludes parents and carers whose relationship to their child has come about in other ways.

LGBTQ+ parents regularly have to deal with forms that don’t reflect our identity and family structure. The form I used to apply for a passport for my daughter in 2017 still only included the mother/father options. It wasn’t the first and it wasn’t the last, but it stood out as a key government document. Yet I was breezily advised to ‘just cross out father and put mother’. The passport application form has only been updated to include the gender neutral ‘parent’ option in recent years and there are many forms in a range of educational and other settings that are still waiting. 

It’s not a trivial inconvenience to be excluded by forms and processes that don’t fit your family because they are based on heteronormative assumptions about what a family is. As well as being invalidating, there are practical, real-life implications. The exclusion experienced by LGBTQ+ families in completing the 2021 Census resulted in not being properly represented in the nation’s snapshot, depriving decision makers of important data for service provision.

If you’re a cisgender, heterosexual parent, you are in the privileged position of being able to take it for granted that the forms you fill in for your child will square with your family’s experience. You don’t have to hold your breath whenever you’re handed a form for your child, wondering about the clumsy workaround and awkward conversation that lies ahead. You’re spared the reminder that your family is not considered normal.

For some time now, the LGBTQ+ community has advocated for gender-neutral language precisely because it doesn’t exclude anyone. Being asked to use terminology that you don’t like or is unfamiliar to you isn’t the same as being excluded by a form doesn’t recognise your existence. Change that extends recognition to others does not take anything away from those who will always have recognition by virtue of being in the majority.

There is a movement towards gender-neutral terminology not because it’s a politically correct fad but because it is inclusive to everyone who accesses services that governments are obliged to provide in a non-discriminatory way. Pilots like the newborn Medicare one provide an opportunity to make services more responsive to the needs of those who use them. This usually involves consultation and there’s a move towards co-design of processes that bring together technical expertise and lived experience. Services Australia’s Hank Jongen told media that the language had been tested and received positive feedback. 

It’s pretty disappointing when a government minister can disregard the outcome of a carefully considered consultation process in a knee-jerk reaction to a story in the Daily Telegraph. It's neither here nor there that a woman called Sall Grover didn’t like the use of gender-neutral language. Shorten should have shown leadership by using the opportunity to explain the importance of inclusive language and to shine a spotlight on whether government forms used by the public are as inclusive as they could be. Ideally he would have consulted with the LGBTQ+ community. Instead he drove a wedge through the broader community by characterising it as a culture war.

By Justine Field - a volunteer member of the Rainbow Families Equality Committee. 

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