Best practices for inclusive writing

UW Medicine follows the UW Brand Equitable Language Guide and The Associated Press Stylebook guidance on inclusive storytelling. In addition, the Office of Healthcare Equity has a glossary of terms by topic. Following these guidelines contributes to a more respectful and welcoming environment for our patients and community.

We acknowledge that inclusive writing requires continuous learning, listening and adapting as language and terms evolve.

Six Considerations When Creating Inclusive Content

1. Be thoughtful and precise.

Be as specific as possible to relay accurate information and respectfully portray identities and experiences.

DO: Avoid generalizations or labels, like older adults.

Example: Women and people assigned female at birth in their 40s should speak with their doctor about getting breast cancer screening or mammograms.

DON’T: Don’t use the term “diverse” as a synonym for people who are not white. A group can be diverse, but an individual can’t.

2. Use gender-neutral language.

In general, use terms that can apply to all genders. Balance this with common sense, knowledge of your audience and an understanding that gender-neutral language is evolving and sometimes challenging to achieve.

DO: Use both common and gender-neutral terms, starting with the most familiar or commonly used term.

Example: Maternal fetal medicine, or perinatology, helps take care of people having complicated or high-risk pregnancies.

WHY: While more inclusive, perinatology is not a familiar term to many people.

DO: Explain terms that may be less familiar to an audience outside of an academic or healthcare environment. We strive to be inclusive while using language that anyone can understand.

Example: Cases in cisgender women (cisgender means a person’s gender identity corresponds to their sex assigned at birth) have increased since 2015.

DO: When using they/them/their as a singular pronoun, explain if it isn’t clear in context. Be sure that the phrasing does not imply more than one person. Rephrase if needed to avoid confusion about the antecedent.

Example: Smith, who uses the pronoun they, said they will retire in June.

DON’T: Don’t refer to someone’s pronouns as chosen or preferred — instead use the pronouns they use, whose pronouns are, who uses the pronouns, etc.

DO: Use ‘they’ rather than ‘he/she’ for an unspecified or unknown gender or reword to avoid pronoun use.

Examples: Smith, who uses the pronoun they, said they will retire in June. The foundation gave grants to anyone who lost a job this year.

3. Recognize that you have unconscious biases.

Everyone has bias formed from repetition and reinforcement of stereotypes throughout their lifetime. These unconscious biases may contradict our declared values and beliefs.

DO: Explore your assumptions and how your life experiences affect your view of a topic.

DO: Scrutinize your writing to identify possible stereotypes you may inadvertently suggesting, including stereotypes of majority groups or white people.

4. Represent a diverse range of perspectives, backgrounds and experiences.

Consider the wide range of interests, needs and voices of people reading and viewing your content. Content should reflect a full range of diversity: race, ethnicity, gender, sexual orientation, age, ability and socioeconomic background. When writing about marginalized people, recognize the impacts of intersectionality the ways in which people’s social identities overlap and how various forms of inequality operate together and exacerbate each other).

DO: Let your sources guide you on how they want to be identified, and then use your judgment to be sensitive and accurate.

DO: Ask for feedback and perspective from colleagues not involved with the content. They may bring additional insights and can help identify inclusion holes. If you would like feedback from individuals who have lived experience with or relevant identities to the topic and you do not know of any for whom the request is professionally appropriate, reach out to the Office of Healthcare Equity for guidance.

DON’T: Don’t engage in tokenism. Tokenism is making a symbolic effort to appear diverse and inclusive when you’re not. It is problematic because it includes a representative from a group for the sake of appearance or superficial diversity. It undermines genuine inclusivity and authenticity. In addition, one person’s perspective does not represent an entire group.

5. Make content accessible.

Follow University of Washington’s IT Accessibility Guidelines

DO:

• Ensure there is alternative text on visuals and text-based graphics use the appropriate contrast ratio.
• Be concise with alt-text descriptions. The general recommendation is less than 100 characters.
• Use closed or open captioning on all videos and provide transcripts.
• Consider audio descriptions in videos for people who are blind or have low vision.
• Use #CamelCase (capitalizing each word/no spaces) when using hashtags so screen readers can accurately read the words.

6. Use plain language.

DO:

• Make your content easy to read and understand at the seventh-grade reading level.
• Avoid using academic or medical jargon unfamiliar to your audience.
• Use these elements, which characterize plain language:
  • Logical organization
  • Active voice
  • Common, everyday words
  • Short sentences
  • Short lists and simple tables
  • Pictures and graphics relevant to the message
  • Easy-to-read design
• See the word substitution list or the Centers for Disease Control and Prevention’s Plain Language Materials & Resources to find accurate, simple options for common healthcare terms. Plainlanguage.gov offers additional guidance.

Topical guidance

Below are quick style references or notable exceptions to AP Style. Please refer to the AP Stylebook for complete guidance on these topics. UW Libraries provides limited AP Stylebook access for employees with NET IDs.

Age

• Use age when relevant to the content and aim for specificity.
  • Example: The researchers found that weekly exercise decreased the risk of diabetes among people in their 70s and 80s.
• Understanding varies about the age range denoted by the term older adult. Provide context and specifics to make the meaning clear. OK to use in headlines if explained later in the content.
• Terms like senior citizen, elders and elderly are acceptable if an individual or community prefers them.

Terms to avoid:

• the elderly in reference to a group
• elderly people
• the aged
• seniors

Disabilities

• Default to person-first language if the preference is unknown—person with a disability, not disabled person.
• Preferences regarding identification supersede matters of style. Identity-first language may be appropriate for the community or person being discussed. For example, many deaf individuals prefer to be called deaf rather than hearing-impaired.
• Avoid terms that are condescending or patronizing. Also, avoid metaphors that depict disability as a shortcoming, such as “lame excuse,” “fell on deaf ears” or “blind to the truth.”
• Avoid using “see more” or “view” in call-to-action buttons.

Terms to avoid:

• special needs
• differently abled
• physically challenged
• mentally challenged
• handi-capable
• wheelchair-bound person
• suffers from [condition]

Gender, Sex and Sexual Orientation

• Gender dysphoria is the distress felt when someone’s gender identity does not align with their sex assigned at birth.
• Gender-affirming care supports or affirms an individual’s gender identity. It includes a range of social, psychological, behavioral and medical interventions. It can be but is not necessarily part of a gender transition. Such care is not limited to transgender people; it can also serve cisgender, nonbinary or intersex people. Gender-affirming care is the phrasing used by the American Medical Association and the American Academy of Pediatrics. Note that AP Style uses a hyphen in gender-affirming.
• The terms gender-nonconforming and nonbinary are not synonyms. Gender-nonconforming refers to a person whose gender expression does not conform to stereotypical gender expectations. Nonbinary refers to a person whose sense of self is not exclusively one gender. Note that AP Style does not use a hyphen after non.
• Transgender (adj.) describes a person whose gender identity and assigned sex at birth is not aligned. It may be abbreviated as trans. Transgender is not a sexual orientation.
  • Trans man/transgender man/transmasculine (noun): A transgender person whose gender identity is a man or masculine. Some may use these terms to describe themselves, while some will just use the term “man.”
  • Trans woman/transgender woman/transfeminine (noun): A transgender person whose gender identity is a woman or feminine. Some may use these terms to describe themselves, while some will just use the term “woman.”
  • Transition is the correct term for the social, legal or medical process a transgender or gender nonbinary person pursues to align the outward expression of their gender with their internal sense of gender (clothing, hairstyle, name, pronoun, surgical removal or addition of physical attributes).
  • Do not use phrases like biological boy or girl, biological female or male. Use assigned male at birth or assigned female at birth.
  • Avoid the one-word compounds transman and transwoman. Instead, when relevant, say transgender man or transgender woman. In subsequent references, trans man or trans woman are acceptable.
• UW Medicine Transgender and Gender Non-Binary Health Program. (Note the program’s name is an exception to AP Style.)
• LGBTQ+ is an acceptable acronym for lesbian, gay, bisexual, transgender, queer or questioning, and more. Fewer or additional letters, such as LGBTQIA+ or LGBTQIA2S+, can be used in quotations, names of organizations and events to be more accurate or inclusive.
  • Note that LGBTQIA2s+ is an acronym that includes different sexual orientations (L, G, B, A), gender identities (T, I), and both (Q, 2S), and more precise identifications should be used when possible. For example, some people who are intersex do not identify with the other groups in this acronym.
• Use caution when using the term queer, as it is not universally accepted among LGBTQ+ people because of its origins as a slur.

Terms to avoid:

• birth sex
• biological(bio) boy or girl
• biological female or male
• born a girl, female or born a boy, male
• hermaphrodite
• transgendered or a transgender
• transvestite
• Transsexual
• gender identity disorder
• FTM or MTF
• sex change or sex reassignment surgery
• sexual preference
• alternative lifestyle or lifestyle choice
• homosexual to describe people

Mental Illness

• Avoid dehumanizing “the” terms such as the mentally ill. Instead: people with mental illnesses.
• Avoid descriptions that stigmatize mental illness, like crazy or insane, in casual use.

Terms to avoid:

• mentally ill

Race and Ethnicity

• Capitalize Black when discussing culture or race. Lowercase white.
• Latinx and Latine are both acceptable as gender-neutral descriptors for people of Latin American heritage. Latino or Latina may also be preferred.
• Hispanic refers to the heritage of people who have ancestry in or are from a Spanish-speaking country. This term can be viewed as problematic due to its colonial origins, so use a more specific identification when possible, such as Cuban, Puerto Rican or Mexican American.
• If source material (such as U.S. Census or research) uses a potentially problematic term, such as foreign-born or Hispanic, it may be helpful to explain.
  • Example: The U.S. government recognizes Sept. 15 through Oct. 15 as National Hispanic Heritage Month. UW Medicine recognizes there is debate about whether “Hispanic” represents all of the cultures that we are celebrating.
• ANHPI is the preferred acronym for Asian, Native Hawaiian and Pacific Islanders. For example, Celebrating ANHPI Month in May. (Note that acronyms should be spelled out on first reference.)
• BIPOC is an acceptable term for Black, Indigenous and people of color.
• However, avoid using acronyms to reference groups of people who are not white. Use more specific identification when possible.
• Native American and American Indian are both acceptable terms. However, when writing about individuals or individual tribes, tribal affiliation should be used. Capitalize Indigenous when discussing culture or identity. Do not capitalize when used as an adjective for things, such as indigenous plants.

Terms to avoid:

• urban when referencing a community or when describing a person
• mixed when referring to someone’s race, unless they specifically describe themselves this way
• foreign or foreign-born
• exotic
• ethnic
• Oriental
• Ninja, Guru, shaman, Sherpa, Sensei, when used to imply expertise in an area
• Nazi when used in jest, such as soup nazi or grammar nazi
• tribe, totem pole, spirit animal, pow-wow as metaphors or casually to describe non-Native experiences.

Reproductive Health

• When writing about reproductive health, use judgment and decide the most appropriate term for the content and audience.
• Pregnant people is the preferred term. It moves toward an inclusive understanding of pregnancy that is not associated with gender identity. People seeking abortions is also preferred.
• Based on AP Style, pregnant women and women seeking abortions may also be used depending on what is most appropriate for the audience or context.
  • Example: Research shows many pregnant women may have psychological well-being issues after giving birth.
  • Why: The National Institutes of Health style guide notes that using more limited and specific language is sometimes important. For instance, if discussing a study that only involves cisgender women, gender-specific language would be most accurate to reference that study’s findings.
• Pregnancy care or pregnancy health may be used instead of maternal care and maternal health.
• Perinatology is the medical term for the obstetrics subspecialty of maternal-fetal medicine. However, this term may not be familiar to some audiences as maternal-fetal medicine and may need to be defined. Maternal Fetal Medicine Clinic is the correct name of the clinic at UW Medicine.
• Avoid using overly clinical language, like people with prostates, people with uteruses or birthing people in marketing content. Phrasing like women and other pregnant patients or men and people assigned male at birth can provide an inclusive alternative.
• People who have periods is an acceptable phrase to describe menstruation. However, do not use it as a gender-neutral alternative to women. Not all women menstruate or have uteruses; some people who do not identify as women menstruate.
• Breastfeeding and chestfeeding are acceptable terms. Many masculine-identified trans people use chestfeeding to describe feeding their baby from their chest, regardless of whether they have had chest/top surgery (to alter or remove mammary tissue). Note that while chestfeeding can be a gender-neutral term, it may feel exclusive or even be offensive to people who have breasts and prefer the term breastfeeding.
  • Example: Breastfeeding, or chestfeeding, has numerous benefits for both lactating parent and child.
• Breast milk or human milk are acceptable terms for milk produced by the human mammary glands to feed infants and young children. Terms can be used interchangeably.

Terms to avoid:

• pro-life
• pro-choice
• pro-abortion
• abortionist

Substance Use and Addiction

• Addiction and substance use disorder are acceptable terms to describe a treatable condition that affects a person’s brain and behavior due to drug and alcohol use.
• Do not use stigmatizing or punitive language that emphasizes the person instead of the disease.
• Alcoholic is an adjective used to describe beverages but do not use it to describe a person. Avoid using  “an alcoholic” unless individuals prefer that term for themselves or if it occurs in quotations or organizations’ names, such as Alcoholics Anonymous.
• Terms like addict are acceptable if an individual is using it to refer to themselves.
• Use alcohol overdose instead of alcohol poisoning, which is not an accurate term.
• Avoid addiction analogies, such as “these caramels are like crack” or “this pizza is addicting.”

Terms to avoid:

• addict
• abuser
• a drunk or drunks
• user
• junkie

For additional topical guidance, such as for immigration or religion, please consult the AP Stylebook.