Why gender inclusion matters

Almost two years ago I left my permanent position at NHS Digital (now part of NHS England) to launch my own service design consultancy, Design for Joy. During my time at NHS Digital I worked as part of the team that designed and delivered the first release of the Covid-19 vaccination booking service. This was the biggest service I had ever worked on. Not only was I designing a critical service and contributing to a national crisis, but I was delivering a service that had the potential to be used by everybody in England, Wales and Northern Ireland. 

That’s a lot of people. When you’re designing at this scale you need to be sure you really are designing for everyone. While there are many facets to inclusive design and accessibility, the area of inclusion I was particularly interested in was sex and gender. 

This first came to my attention when, a matter of weeks before we were due to launch the service, we were informed that the service would need to ask people to input their gender to gain access. We did not need the data, it was a technical requirement. We were also heavily constrained around how we designed the question due to how the data was structured and how the backend systems operated. 

I wrote about my experience of navigating this problem and designing an inclusive service. I’ve also since delivered a talk on the same subject over 20 times. It’s a story that has clearly connected with people.

Why does designing for gender diverse people matter?

The simple answer to this is that everybody deserves to be able to access the services they need without facing harm or discrimination. 

Let’s take the discrimination aspect first. Trans and non-binary people are currently facing unprecedented levels of abuse in society. Negative news articles have increased hugely and rights are being rolled back on a daily basis. Services that ask about sex and gender without designing with inclusion in mind are adding to this avalanche of discrimination.

When it comes to harm, this is especially pertinent for healthcare services as exclusion could have devastating consequences for people.

When it comes to harm, this is especially pertinent for healthcare services as exclusion could have devastating consequences for people. The 2021 Trans Lives Survey reported that 57% of trans people have avoided going to the GP when they felt unwell. We only have to look at a small number of more specific examples of where healthcare services could introduce clinical risk into their services by not designing with gender diverse people in mind to see that this matters.

Take cervical screening for example. A trans man with a cervix will not be invited for cervical screening if the gender marker on his healthcare record is male. It’s obvious to see where repeatedly missing cervical screening appointments could lead.

Another example, taken from the Oxford Academic Journal, details how lab results for kidney function are interpreted differently for males and females. In this case the patient's renal function was incorrectly calculated based on the lack of consideration for his gender history resulting in a delay in being considered for a renal transplant. 

How to design for gender inclusion

It might feel like we’re getting deep into the human aspect of healthcare service delivery here, but as customer experience professionals this is very much in our gift to influence.

As customer experience professionals this is very much in our gift to influence.

Many services, especially those with digital touchpoints, will ask their customers/users to input demographic data without much consideration for how, when and why this information is being requested. Healthcare services are an example of when sex or gender data might be required for a legitimate reason, however there are many services that don’t need to know someone’s sex or gender and ask anyway. The first thing to do is consider, do we need this data. If the answer is now - don’t ask.

The second consideration is to question why the data is required and build a deep understanding of this. I recently worked with Drink Aware to explore how they could ensure their digital drink tools were inclusive for gender diverse people. The first thing I did was work to understand the science behind how alcohol affects male and female bodies differently. Understanding this helped me to assess how this knowledge impacted on the calculations the tools were making and the feedback they were giving.

The last thing to do is remember that there is no one size fits all. While there is guidance from the ONS and others on how to best ask about sex and gender, every context is different. Time and effort should be given to involving trans and non-binary customers/users and designing around the needs they have in this specific context.

True inclusive design requires diverse teams

What really powered me forward during my time at NHS Digital, and kept me going when things got tough, was my personal connection to the subject matter. My Dad is transgender and while I don’t have personal lived experience, I do have a deeper empathy and knowledge because of my situation. 

Sadly the customer experience industry still lacks diversity. This leads to services largely being designed to meet the needs of the people that are designing them.

We all bring a unique perspective, one that is shaped by the intersectionality of who we are.

We all bring a unique perspective, one that is shaped by the intersectionality of who we are. Our race, gender, sexuality, our upbringing and experiences, what disabilities we have and much more. Humans are complex and that is what makes us so amazing. Imagine how much more inclusive our services would be if we combined the power of these differences.

This is a subject I'm really passionate about. I've designed a talk with a friend and colleague Lee Brown that makes the case for designing for gender inclusion. We need more people to have these conversations.