The American Medical Association (AMA) is recommending that the United States stop the practice of including a “male” or “female” designation on public portions of birth certificates, saying the marker can cause more harm than good for transgender, nonbinary and intersex Americans.

What You Need To Know

  • The American Medical Association is recommending that the United States stop the practice of including a “male” or “female” designation on public portions of birth certificates

  • Sex markers are often arbitrarily assigned to a newborn based on external genitalia, and little else; gender identity can be the same or different from the sex assigned at birth

  • The AMA says the current practice "perpetuates a view that it is immutable and fails to recognize the medical spectrum of gender identity”

  • There are a growing number of states moving towards more inclusive gender markers on government documents, but the laws vary widely across state lines

In a report first published in June by the AMA’s LGBTQ Advisory Committee, the group noted that while birth certificates are typically not publicly-available documents, people must present their birth certificate for reasons like obtaining passports or driver’s licenses, registering for school or employment, accessing personal medical records and more. 

When an individual’s gender identity does not match that of their birth certificate, it can lead to uncomfortable questions and possible feelings of discomfort, a potentially dangerous scenario for a community already subject to higher-than-average rates of harassment.  

Access to the birth certificate sex identifier should be limited only to the individual and their doctor, the AMA says, adding that the markers are often arbitrarily assigned to a newborn based on external genitalia, and little else.

Gender identity, however, is a person's own concept of themself as "male, female, a blend of both or neither – how individuals perceive themselves and what they call themselves," according to the Human Rights Campaign. The organization adds: "One's gender identity can be the same or different from their sex assigned at birth."

“It is the recommendation of the AMA’s LGBTQ Advisory Committee that our AMA should advocate for removal of sex as a legal designation on the public portion of birth certificates,” the group wrote in part. “Assigning sex using a binary variable and placing it on the public portion of the birth certificate perpetuates a view that it is immutable and fails to recognize the medical spectrum of gender identity.”

The AMA acknowledges that while the proposal “will not address all aspects of the inequities transgender and intersex people face,” the effort would still represent a “valuable first step, with the authoritative voice of our AMA leading the way.”

There are a growing number of states moving towards more inclusive gender markers on government documents, but the laws vary widely across state lines. A handful of states and Washington, D.C., offer an “X” gender identifier on drivers licenses and birth certificates. At least 10 states offer a similar option on drivers licenses, but not birth certificates. 

And in June, the State Department announced passport applicants can now self-select their gender as either male or female, and will no longer be required to show proof or medical certification if their self-selected gender does not match other forms of identification. 

The Department said it plans to add a third self-identification option for those who are non-binary, intersex or gender non-conforming. Officials did not give a timeline for when the gender marker might be made available, saying such changes are “technologically complex and will take time for extensive systems updates.”  

The AMA hopes removing the gender marker from public view on birth certificates nationwide will offer more security to those in the LGBTQI+ community. 

“Gender-neutral birth certificates also allow people of any gender increased privacy around gender on their identification,” the group wrote in part. “While some states have moved toward nonbinary or gender-neutral birth certificates, these options are not widely available across all government documents.”