Clive James (2007) wrote that at a 1931 premiere of Charlie Chaplin's film, City Lights, Chaplin told Albert Einstein, ‘they cheer me because they all understand me, and they cheer you because no-one understands you’. James (2007) said of science that it has the power to transform the world in ways that are unpredictable even to scientists, whereas the power of the humanities ‘is to interpret the world in ways that anybody can appreciate’.
Medical science has brought the topic of transgenderism into an area that medical scientists might not have predicted, which can only be addressed in a cultural sense through the language of the humanities.
For example, shortly after publication of a brief consideration of transgender-related reproduction (Winter, 2019), an article by Reis (2020) appeared entitled ‘midwives and pregnant men…’, inviting the inference that the fundamental question of ‘womanhood’ had become the subject of urgent, sometimes heated, debate in midwifery circles, perhaps sooner than may have been anticipated. Reis (2020) noted that in 2014, the Midwives Alliance of North America stated its support for the care of transgender patients, ‘which included altering some of the language in its core competencies document’. This prompted a rapid response from the Women-Centred Midwifery group, led by midwife and former Alliance member, United States-based Mary Lou Singleton, who ‘penned an “open letter” to the organisation, accompanied by more than 200 signatures of midwives, doulas, nurses and women who just signed “mother”, decrying the revisions’ (Reis, 2020).
But while the language around transgender-related issues continues to be discussed in the context of the humanities, medical science continues to probe the boundaries of possibility, leaving the finer points of linguistics and semiotics to others. Richards et al (2023) suggested that ‘[t]he first uterus transplant in a transgender female in the twenty-first century is anticipated to take place within the next few years, if not sooner’. The authors not only considered the anatomical, hormonal and technical challenges inherent in such a procedure, but also acknowledged that certain ethical aspects cannot be ignored. In their consideration of uterus transplants for transgender women, they noted the potential for ‘fourth party reproduction’. A neonate born from a transgender uterus transplant may be subject to four genetic and epigenetic influences: ‘the cis-female or trans-male donor uterus, the environment of the trans-female uterus recipient, the oocyte source, and the sperm source (potentially donor or partner sperm or cryopreserved sperm from the transgender female)’ (Richards et al, 2023). These aspects in turn can give rise to ethical, legal and social implications, ‘including considerations of the outcomes not just for transgender individuals but also their resulting offspring’ (Richards et al, 2023).
Such finely nuanced possibilities raise the question of the extent to which equality can be asserted in relation to reproductive rights. As Singer (1979) observed, ‘the principle that all humans are equal is now part of the prevailing political and ethical orthodoxy. But what, exactly does it mean and why do we accept it?’ When Singer asked this question over half a century ago, he might not have expected it to be discussed in the context of conferring a right to become pregnant and have a child on individuals born as biological males. Yet it is a question that the midwifery profession will have to address. As Reis (2020) noted, ‘some midwives (and others) believe that pregnancy and childbirth should remain “women's space”, and see no reason to accommodate trans or non-binary pregnant patients.’
Meanwhile, advances in medical science continue to raise ethical challenges. Lee (2023) reflected on the ethics of live donor recruitment for uterus transplantation, asking, ‘who should provide the uterus?’ Noting that women with children, often recipients’ mothers, are overrepresented as donors, Lee (2023) pointed out that ‘other potentially eligible groups who may have an interest in providing their uterus – such as transgender men, or cisgender women who do not wish to gestate or to have children – tend to be excluded as potential donors’. Yet Lee (2023) also acknowledged the importance of a cautious approach, asserting that ‘the overall risks associated with uterus transplantation ought to be taken into serious consideration on both the recipient and donor's part’.