‘Scientific bottom line’: Pediatricians stand up against AMA over whether sex should be on birth certificates

The American College of Pediatricians (ACPeds) is clapping back at the American Medical Association after the latter recommended earlier this month that sex markers be left off of newborn birth certificates.

”The AMA is receiving warranted criticism after it called for removing sex markers on birth certificates, with an advisory committee arguing that their inclusion ‘perpetuates a view that [sex] is immutable,'” the ACPeds said in a statement Thursday.

”Identifying sex in the public portion of the birth certificate affirms the scientific fact that sex is an innate and immutable binary trait of public significance; a trait determined by genetics at fertilization,” wrote Dr. Michelle Cretella, ACPeds executive director.

Cretella wrote the organization’s position paper, titled, “Sex is a Biological Trait of Medical Significance,” with Dr. Michael Artigues.

The controversy ignited in June when the AMA declared its support for dropping sex designations on birth certificates, though the organization still said that a child’s birth sex should be reported to various official agencies for statistical purposes and other uses.

“Existing AMA policy recognizes that every individual has the right to determine their gender identity and sex designation on government documents,” the AMA said. “To protect individual privacy and to prevent discrimination, U.S.  jurisdictions should remove sex designation on the birth certificate.

“Our American Medical Association will advocate for the removal of sex as a legal designation on the public portion of the birth certificate, recognizing that information on an individual’s sex designation at birth will still be submitted through the U.S. Standard Certificate of Live Birth for medical, public health, and statistical use only,” the AMA’s Board of Trustees added.

“Designating sex on birth certificates as male or female, and making that information available on the public portion, perpetuates a view that sex designation is permanent and fails to recognize the medical spectrum of gender identity. This type of categorization system also risks stifling an individual’s self-expression and self-identification and contributes to marginalization and minoritization,” added Dr. Sandra Adamson Fryhofer, the chair-elect of the AMA, which has 240,000 members.

But in their policy paper, Cretella and Artigues made several arguments for the inclusion of sex markers on birth certificates and throughout medicine in general.

“In the midst of society’s questioning of the gender binary, the American College of Pediatricians (ACPeds) is concerned that the field of medicine risks denying the reality of biological sex. Sex is a dimorphic, innate trait defined in relation to an organism’s biological role in reproduction,” the paper notes.

“In humans, primary sex determination occurs at fertilization and is directed by a complement of sex determining genes on the X and Y chromosomes. This genetic signature is present in every nucleated somatic cell and is not altered by drugs or surgical interventions,” it adds.

The paper goes on to note that “sex and gender are not synonyms,” and that “disorders of sex development are disorders, not additional sexes.”

Also, the physicians note that there are “sex differences in neuroscience” and in pharmacology, as well as sports medicine, cardiovascular health, and other biological areas.

“Due to genetics, males are different from females at the cellular level from fertilization,” Artigues said. “Biological sex differences due to genetics and sex hormones affect the tendency to develop certain diseases, alter responses to drugs, toxins and pain, and also cause important physical, cognitive, emotional and behavioral differences between the two sexes.”

Both noted that the “scientific bottom line” is that “sex markers belong in the public portion of birth certificates because acknowledging the innate differences between males and females in healthcare and public policy is critical to ensuring the health and safety of children and adults alike.”


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