Australia’s midwifery regulator – administered by Ahpra – has proposed reframing ‘woman’, ‘mother’, ‘she’ and ‘maternity’ as terms kept in its guidelines only for “historical and professional context”, while offering no definition of biological sex anywhere in the document.
AAWAA made a submission to the Nursing and Midwifery Board of Australia (NMBA) in early June, when consultation closed on proposed changes to the Safety and quality guidelines for privately practising midwives (SQG). The review was framed primarily as a housekeeping exercise to align the guidelines with the end of the professional indemnity insurance exemption for homebirth midwives on 31 December 2026.
Insurance and operational changes, clearer guidance on indemnity, transition to private practice, and the role of second health practitioners are all welcome. But embedded in this limited‑scope review are definitional changes that go well beyond housekeeping and to the core of how the regulatory framework understands the women who rely on maternity services.
What the guidelines now say about women
The proposed revised SQG opens its main guidance with an explanatory note stating that midwives provide care to women and people of diverse genders and that terms such as ‘woman’, ‘mother’, ‘she’ and ‘maternity’ appear in the document only in recognition of historical and professional context, while being “intended to be inclusive”. Elsewhere, the expanded glossary defines ‘gender’ as a social and cultural concept concerning differences in identity and expression as a man, woman or non‑binary person, and elaborates gender identity, gender expression and gender experience within that framework. The document contains no separate definition of biological sex.
In effect, the only place a reader can look for an explanation of ‘woman’ is inside a gender definition that treats it as a subjective identity category. Biological sex – the material reality that determines pregnancy, labour, birth, postpartum physiology, pharmacological dosing and maternal mortality – is left undefined. AAWAA’s submission argues that this is not merely an omission; it is a substantive definitional shift with clinical and legal consequences.
The internal contradiction in defining ‘woman’
The SQG does not consistently apply the conceptual move it attempts. In key clinical sections, the guidelines continue to rely on ‘woman’ as a biological referent. The definition of ‘woman‑centred care’ refers repeatedly to the woman’s baby or babies, the woman herself, the woman’s individual circumstances and the woman’s physical, emotional, psychosocial, spiritual and cultural needs. Each of these references assumes that ‘woman’ is the person who is pregnant, giving birth and recovering postnatally.
Only at the end of that glossary entry does the SQG append a sentence extending the model to ‘people of diverse genders who experience pregnancy, birth or parenthood’ and affirming that their needs and identities are supported within woman‑centred care. At the same time, the explanatory note describes ‘woman’, ‘mother’, ‘she’ and ‘maternity’ as terms kept for historical reasons and suggests that more inclusive wording has been used ‘where possible’.
This produces an internal contradiction. The same document uses ‘woman’ as a biological organising concept in its clinical guidance while defining it indirectly as a gender identity in the glossary and characterising it as legacy language in the explanatory note. A regulatory instrument that cannot say clearly what ‘woman’ means is not fully workable for midwives who must rely on it to guide practice and documentation.
Clinical safety and health literacy
This is not simply a matter of conceptual tidiness. The way language is used in health regulation affects clinical safety and health literacy. The NMBA’s own consultation paper cites a 2025 peer‑reviewed article by Bartick and colleagues that examines the consequences of desexed language in healthcare. That paper finds that substituting gender‑neutral terms for sex‑specific language can reduce comprehension among women with low health literacy or limited English proficiency and can create confusion for women from non‑Western backgrounds. Importantly, the authors also conclude that desexed language may cause harm to transgender and gender‑diverse people, who equally require clear, accurate health communication.
Bartick et al call for a ‘path forward’ that distinguishes between interpersonal communication and clinical documentation. In their framework, services maintain biological accuracy in records and public health data, while supporting respectful, personalised language in direct communication with individual patients. The proposed SQG does not make that distinction. The inclusive language framing in the explanatory note is applied to the document as a whole, without a clear separation between how midwives talk with patients and how they record biological realities in clinical notes, risk assessments and perinatal datasets. We argue that this is at odds with the very evidence the NMBA has chosen to rely on.
Sex‑based data and international obligations
Maternal health statistics – covering mortality and morbidity, obstetric trauma, postnatal depression and other outcomes – are collected on the basis of biological sex. These data underpin clinical guidelines, service planning and regulatory oversight of midwifery practice. We have documented in other contexts that replacing sex data with gender‑identity categories in public reporting is already distorting health and safety statistics. When the main regulatory document for privately practising midwives reframes ‘woman’ as a gender‑identity term, it risks nudging perinatal data collection in the same direction.
There is also an international law dimension. The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which Australia has ratified, understands discrimination against women as discrimination on the basis of sex, and Article 12 requires states to eliminate discrimination in healthcare, including maternal health services. In a 2024 expert consultation, the UN Special Rapporteur on violence against women and girls confirmed that, under CEDAW and international human rights law, ‘woman’ refers to a biological female and that discrimination is understood as relating to that biological category. A regulatory framework that redefines ‘woman’ as a gender‑identity term is difficult to reconcile with this standard. As a national regulator operating under Commonwealth law, the NMBA should ensure that its instruments align with Australia’s international obligations.
Define sex, record sex, consult women
In our submission, AAWAA recommends that the NMBA revise the explanatory note to affirm that ‘woman’ in the SQG refers to a biological female, while stating clearly that respectful, individualised care is required for all people who access midwifery services. We propose adding a definition of ‘biological sex’ to the glossary as a distinct concept from gender identity and amending the record‑keeping section to require that biological sex be recorded as a clinical variable in all midwifery records, with gender identity recorded separately where relevant. We also recommend that the forthcoming Fact Sheet explain the distinction between biological sex, for clinical records and data, and gender identity, for respectful person‑centred communication.
Beyond the document itself, we recommend that the NMBA undertake structured consultation — before embedding any new language framework — with sex-based women’s organisations, with Aboriginal and Torres Strait Islander women and communities on changes affecting Birthing on Country contexts, and with health services working with women from non-English-speaking backgrounds.
The NMBA has indicated that it will consider all feedback and that an advance copy of the revised SQG will be released prior to 1 January 2027. AAWAA will continue to engage with this process. Midwifery is among the most sex‑specific areas of healthcare. Women’s safety in pregnancy, birth and the postnatal period depends on regulation that is honest about our bodies, clear about our sex, and rigorous about the data collected in our name.
Read the full submission below.