Translating gender-neutral content in gendered languages

Whether we’re aware of it or not, gender is something that we all interact with every day through the medium of language. It influences how we communicate, which affects how we think, and vice versa.

Depending on your native language, the language you live your day-to-day life in (if different), the culture that surrounds you, or your self-identification, some of us may have to think about gender more than others. And certainly, as linguists and translators, we actively deal with it, as it relates to language, every working day. As the life sciences sector (especially those running clinical trials) begins to reckon with the importance of gender identity in the work they do, so too are we tackling the challenge of how to translate gender-neutral usage into languages that are inherently gendered. It’s a complex issue, made no less so by the multiplicity of languages, contexts, and cultures we tend to work with on a single project. And so it bears analysis and discussion, to illustrate why and how we make the decisions we do for our clients, their content, and – most importantly – their patients.

What is gender-neutral language and why does it matter?

According to the European Parliament – one of the first bodies to adopt official guidelines on the subject – “Gender-neutral language is a generic term covering the use of non-sexist language, inclusive language or gender-fair language. The purpose of gender-neutral language is to avoid word choices which may be interpreted as biased, discriminatory, or demeaning by implying that one sex or social gender is the norm.”

And why is it important? Well, as we mentioned above, the way we think and the language we use are inextricably linked. As such, the manner in which we address people (and in which they address us) can have a very real impact on how we receive information, interact with those people, and generally view the world. Take the example of this 2021 study that showed that, in a math exam, women addressed by male pronouns scored poorly. When identified with the correct feminine pronouns, their scores rose by 33%. Essentially, the study found that, when addressed using words they identified with, women felt less excluded by the process, made more effort, and performed better.

Now apply that logic to a clinical trial context. At a time and in a sector where increasing diversity is high on the agenda, and recruitment and retention figures are less than impressive, it seems like common sense to make every effort to reach out to and include as many people as possible. As the British Medical Journal states: “Some patients may avoid contact with healthcare services if they perceive that interactions will be uncomfortable, hostile, or likely to trigger psychosexual factors […] The use of mutually agreed and inclusive language can aid successful discussions of such matters and will build trust between patient and clinician.” And, of course, if you stop to think about it, that makes total sense! Why would someone choose to participate in a clinical trial if their previous experience and expectation is that they will feel at best excluded; at worst triggered or threatened? Would you? And in terms of research results, too, the impact is positive. Giving people the option to identify themselves correctly should lead to a richer, more detailed data set, enabling more specific analysis and action, and ultimately, improving outcomes.

Making content gender-neutral

Moving on, then, to how we introduce gender-neutral language into clinical trial content. First of all, it’s important to say that this is easier to do in some languages than others. Linguists divide the world’s languages into 3 distinct groups based on how they use gender. These 3 groups are referred to as Genderless, Natural Gender, and Grammatical Gender languages. English falls within the Natural Gender group, which is quite easy to make gender-neutral. (This may not seem to be the case given some of the controversy surrounding gender-neutral English usage, but this is largely a cultural and political issue, rather than a linguistic one!) English can make use of the they/them pronouns that already exist in the grammar, and can replace a lot of gender-specific terms with gender-neutral ones that perform the same linguistic function, e.g. chairman to chair or chairperson; stewardess to flight attendant; or fireman to firefighter. Swedish is another language in the Natural Gender group, and is doing similar things, with the hen gender-neutral pronoun introduced as an alternative to han (he) or hon/han (she/he). It’s also interesting to note that Natural Gender languages are linked with more gender-equal societies than both the other groups (rather than the Genderless group, as one might have thought). This was evidenced clearly by a 2011 study that investigated 111 countries across all 3 language groups, with one of the conclusions drawn being that the ability to identify and easily update sexist language is a significant contributing factor (a mechanism not afforded by Genderless languages, where – given the historic gender roles in place in the vast majority of modern human society – the default masculine is assumed and cannot be corrected). This offers yet more evidence that efforts to actively update and neutralize language have a tangible impact.

But what about Grammatical Gender languages? These pose the most significant linguistic challenge for gender neutrality, with everything from pronouns to nouns to adjectives being gendered. The most spoken languages in this group are Hindi, Spanish, French and Arabic, and they feature a lot of the same linguistic approaches to gender – the masculine as default, mixed groups referred to in the masculine (e.g. a group of 9 women and 1 man is treated as masculine), and feminine nouns being derived directly from their masculine counterparts. It’s impossible to speak or write in these languages without assigning a gender to everything from tables to countries. So how do we translate a gender-neutral English source into these languages? The answer is complicated and language-specific. And it’s worth noting that, even within this group, we can do more in some languages than in others. There are movements in some Grammatical Gender languages to start using a neuter version of terms, such as using the suffix -x or -e in Spanish instead of the usual masculine -o and feminine -a. Or the controversial introduction of the pronoun iel in French. But these approaches are not yet accepted by the relevant linguistic institutions, and so are not common practice (yet!). Which leaves us with the options currently available.

Some language-specific approaches

A few notes first: There are a number of strategies for each language, which also vary by country, so below is a sampling of the approaches we’re seeing used most frequently in our work and others’. All these languages use gendered nouns, so words like doctor, participant, or child will change depending on the gender of the person. And it’s important to note that generally – although there are exceptions as mentioned above – these languages don’t have a neuter version like they in English (which can be used to refer to male, female, and non-binary people). So, even where “gender-neutral” language can be applied, it tends to only cover male and female (not non-binary people).

In Spanish, the most practical approach we’ve seen thus far is to include both masculine and feminine articles, as well as both endings, e.g.

In German, we tend to include the feminine and masculine separately, e.g.

In French, meanwhile, we combine the masculine and feminine forms, e.g.

As for the languages, like Arabic, where all pronouns, nouns, and verbs are gendered, it becomes even more complicated. For example, in Arabic, the phrase “your child” would require 4 different variants:

1. masculine parent/masculine child
2. masculine parent/feminine child
3. feminine parent/masculine child
4. feminine parent/feminine child

As well as that, in order to be grammatically correct, all subsequent verbs and adjectives relating to “your child” would also need to agree with all 4 variants – essentially making the content so overstuffed it would be unreadable. There are some options to neutralize the language, such as the use of the dual pronouns huma (هما) and intuma (انتما), but these are old forms which currently read as overly formal. Some Arabic dialects settle on the feminine form as default, as an attempt to move away from the default masculine, but – thus far – a suitable, generally accepted gender-neutral form is elusive. Given the cultural (and legal) context surrounding gender non-conformity in some Arabic-speaking countries, too, it’s best to think carefully and seek advice about the specific audience to whom you wish to speak in this language, and other languages like it.

Knowing your audience

On this note, it should be said that speakers of any given language are not a monolithic group, so the approaches we have highlighted are some of the most commonly used only. This does not necessarily mean they will work for your specific intended audience. On every project, we work with our clients to dig into who their target demographic actually is, as granularly as possible, and what each piece of content is intended to achieve, from Marketing material to ICFs. It’s also incredibly important when creating or localizing any patient-facing materials to acknowledge the evolving nature of language preferences and encourage ongoing dialogue with diverse linguistic communities. By way of example, just look at the discussion and debate within the Latin American community about the very term used to define them as a group! We work with linguists in-country and within the target demographic to ensure we stay aware of changes and trends like these. And, as always when it comes to anything addressing or affecting your patients, if in doubt – we advise asking them for their preferences and advice.

Clearly, incorporating more inclusive language is easier said than done in some languages but, in all cases, we do the best we can with the linguistic tools and mechanisms at our disposal. If you are struggling with making your multilingual content more inclusive, please speak with the team. We are investigating and learning on this subject all the time, so we will be more than happy to advise, information share, and work together to ensure your content keeps up with the pace of change around the world. Inclusive medicine begins with inclusive trials. And inclusive trials begin with inclusive language. Let’s help to shape and disseminate that language together!