There are differences between sex, gender, and sexual orientation that are important to recognize so we can start talking about achieving equity. Sex, gender, and sexual orientation are often confused with each other, leading to difficulties in making changes to program and policy designed to uplift people who are underserved and left behind in our data systems. Each of these – sex, gender, sexual orientation — is a distinct concept, but as categories, there can be overlap.
Sex is based on biological characteristics. Categories most often include female, male, and sometimes, intersex.
Gender is more of a social construction of the roles, norms, and power structures a society attaches to individuals. Many cultures think of gender as corresponding with biological sex and therefore assign man and woman as the two options for gender. There is variability in how cultures view gender, however, and can include more than two categories.
Many countries use “third gender” to include various non-binary (not woman/man) gender categories. And many gender scholars note that gender is not so categorical and view it instead as a continuum. For instance, a person can identify as a woman but not follow stereotypical or traditional cultural norms for women.
Sexual orientation is who you are attracted to sexually or romantically. Sexual orientation is often conflated with sex and gender because a majority of people are heterosexual, but scientific research shows there is variability in sexual orientation in humans and even some animals.
Norms about third gender people vary by culture. In some places people who are not men or women categorically are seen as crucial members of society, such as in several South Asian countries. Other cultures stigmatize third gender people, causing them to hide their true identities.
Cultural norms towards third gender are that they are not respected in most societies. This has an effect health policies and outcomes. In some countries, third gender is being introduced into the mainstream. The situation is changing gradually for the better.
Bangladesh is one example of a country that is part of the change. Their official identity documents contain a field for third gender. The daily newspapers in Bangladesh started surfacing information about the suffering faced by diverse gender identity people. Third gender can compete in local and national elections. We are now moving to include third gender people in all our CRVS registries. It’s important to note that civil society organizations and communities worked together with governments in order to advocate and affect change.
Barriers to Third Gender CRVS Registration
The first barrier to overcome is understanding that there is a difference between gender and sex. This helps with CRVS registries in that people will be able to choose both their biological sex and their gender identity.
Strides have been made in some countries. Since February 2023, gender self-identification, where no judge or medical expert are involved, is part of the law in 20 countries: Argentina, Belgium, Brazil, Chile, Colombia, Costa Rica, Denmark, Ecuador, Finland, Iceland, Ireland, Luxembourg, Malta, New Zealand, Norway, Pakistan, Portugal, Spain, Switzerland and Uruguay. We are beginning to see the option for gender, “X”, on some countries’ passports and other forms, which could transfer to seeing it reflected in death certificates, but it is hard work and there is an uphill climb before there is global change.
Sexual Orientation and CRVS and DHIS2 Systems
Often the LGB part (lesbian, gay, bisexual) is not included in many parts of CRVS and DHIS2 systems (ie birth registrations and household surveys) because these categories are about sexual orientation. However, sexual orientation may be important to note in death registration, because if combined with cause of death, they may be able to uncover population data related to gender-based violence and bias-motivated homicides.
Sexual orientation may also be important to note on household surveys in order to identify health disparities. Sometimes people who identify as gender diverse do not receive adequate health services to meet their needs because of bias and stigma, resulting in worse health outcomes.
How to Mitigate the Challenges
There was a report released by the by United States National Academies of Science and Medicine that speaks to the idea that we have to ask about all three categories – sex, gender identity, and sexual orientation – in each and every survey effort because there is not enough data to date on health disparities among lesbian, gay, bisexual, and transgender people.
It is important to note that in some contexts, it may be dangerous to ask some of these questions, and people may not want to answer. As data professionals, we must do the most we can while also keeping these populations safe until such data collection efforts becomes the norm. There is still stigma attached to sexual orientation, as well as third gender.
We can all learn from Bangladesh and aspire to include third gender in our data collection efforts. It can take many years, and also many different segments of society working together to make these types of changes to societal norms and policies.