Pennsylvania’s health department just proposed swapping “pregnant woman” for “pregnant individual” across core rules, and the fallout tells you where culture and policy now collide.
Story Snapshot
The Department of Health filed a 500-page rewrite that uses gender-neutral terms in pregnancy and postpartum sections.
Changes appear in rules tied to testing, coverage, and postpartum care language, not just press releases.
Critics say the shift erases women and replaces biology with ideology.
The move tracks a wider trend in some health institutions, with sharp debate over clarity and inclusion.
What Changed In Plain Terms
Pennsylvania’s Department of Health introduced a regulatory overhaul on August 8, described as about 500 pages long. Reports say the draft replaces “pregnant woman” and “mother of a newborn” with “pregnant individual” and “postpartum individual” across relevant sections.
The updates land in practical places, like testing rules during pregnancy and instructions tied to postpartum care language. The proposal reflects the administration’s push to use gender-neutral terms in health code text, not only in public messaging.
The update comes amid other maternal and postpartum policy work in the state. Law and policy documents still use sexed terms in many places.
One rule on postpartum eligibility for medical assistance says a woman keeps coverage through the postpartum period, while recent federal approvals pushed that period to 12 months in programs like Medicaid and the Children’s Health Insurance Program. The proposal does not repeal those laws. It rewrites health department regulations, which sit under state statutes.
Why The Language Fight Matters
Words set who is counted, who gets targeted help, and how staff read duties. Advocates argue gender-neutral terms include every patient who can be pregnant, like transgender men and non-binary people. They say it can reduce missed care for small but real groups.
Critics warn that removing “woman” or “mother” can blur sex-specific risks, make data tracking harder, and push ideology into clinical rules. They frame it as a values fight over biological reality and public clarity.
Medical and public health groups do not agree on a single script. Some guidance lists paired terms such as “women and birthing parents” to balance clarity and inclusion.
Others suggest “pregnant patient” or “pregnant person” in general text, while keeping exact sex words where biology drives risk or law demands precision. These split models aim to protect both readability and the dignity of all patients, but their execution varies by agency and audience.
The Case From The Shapiro Administration’s Opponents
Named critics say the department crossed a line. Pennsylvania Family Council’s counsel said the new wording “represents the triumph of ideology over biology” and “erases female identity as a stable category.”
A state lawmaker argued the draft “erases words like ‘pregnant woman’ and ‘mother’” inside hundreds of pages of mandates. That charge lands with many readers because pregnancy is unavoidably sex-linked, and clarity about women’s health is both moral and practical.
The substance behind that critique deserves weight. Public-facing communications research shows heavy shifts to desexed terms can confuse lay readers and risk hiding women’s specific needs.
Experts have warned that generic language like “pregnant people” may reduce visibility for women in studies and guidelines. Health codes must guide real-world practice among busy clinicians and families. Plain, sex-accurate words lower error and protect trust in the rules.
How To Judge The Tradeoff
Two tests can keep both truth and care intact. First, does the rule say who needs what when sex changes risk? If yes, use “women” where biology drives the point. Second, does the rule also need to cover a small group whose care would be missed if the text says “women” only?
If yes, pair terms or add a clear clause. “Women and other patients who can be pregnant” is longer, but it signals scope without erasing sex or people at the margins.
On balance, the facts show a real shift in wording within Pennsylvania’s draft health regulations. The dispute is not about whether pregnancy involves women. It is about whether code text should address every case in neutral terms, and what that does to clarity.
Americans prioritize plain language, biological reality, and family-centered care. Any final rule should protect those anchors while ensuring that no patient falls through the cracks due to a language gap.
If She May End It at 38 Weeks, Why Not at 8 Months? The Argument Nobody Will Finish
Last week, in a Bronx courtroom that drew almost no cameras, Judge Audrey Stone found Dimone Fleming not responsible by reason of mental disease or defect for stabbing her sons, Daishawn Fleming, 3, and Octavius Canada, 11 months old, to death. The prosecution stipulated to postpartum psychosis. Fleming will not go to prison. She remains in custody for a psychiatric evaluation and returns to court this month. Assistant District Attorney Tiffany Wichman explained afterward that “prosecuting mothers does not and cannot prevent these crimes from happening, but public discourse might.” The New York Times recorded the outcome in a single clause: she will avoid prison.
This morning in Plymouth, Massachusetts, a jury of nine women and three men is back for a fifth day on the case of Lindsay Clancy, a former labor and delivery nurse who killed Cora, 5, Dawson, 3, and Callan, 8 months, on January 24, 2023. She does not deny the acts. She denies responsibility for them. The Commonwealth says she sent her husband out of the house and carried out a plan. On Tuesday, the jurors told Judge William Sullivan they were unable to reach a unanimous decision, and he sent them back to keep working. Outside the courthouse, supporters in pink have treated her as the injured party, and a fundraiser for her family has drawn hundreds of thousands of dollars.
Eighteen days before the Fleming ruling, Governor Maura Healey signed the Prioritizing Patient Access to Care Act, stripping the Massachusetts 24-week abortion limit and leaving late pregnancy to a physician’s “professional judgment.” So the same commonwealth that will not mark a line at a viable unborn child is now asking twelve jurors whether three deadborn children amount to a crime or a medical episode. The jurors’ hesitation is not a failure of nerve. It is what happens when a culture has spent a generation teaching that a child’s claim on life yields when the child depends on a mother who no longer accepts the cost.
Judith Jarvis Thomson’s 1971 essay remains the most cited philosophical defense of abortion in the English-speaking world. She granted the fetus full personhood and argued anyway. Her case is the unconscious violinist strapped to your kidneys for nine months. You may unplug him, she said, even though he will die, because a right to life is not a right to the use of another person’s body against that person’s will. The argument does not turn on whether the violinist is human. It turns on whether you may be forced to keep him alive with your own tissue, sleep, and time.
A born child still lives off his mother, on her breasts or on the wages she earns for formula, on her sleep and her attention, and when those give out, on her sanity. The late fetus needs her to keep existing. The 8-month-old needs her to work, on purpose, every few hours through the night. If the moral fact doing the work in Thomson’s essay is unwanted dependence, delivery does not shrink that fact. It enlarges it. Postpartum depression, which afflicts roughly 1 in 8 American mothers, and postpartum psychosis, which occurs in 1 to 2 of every 1,000 births, are the mother’s body and mind refusing that dependence in clinical form rather than in a slogan. The slogan “my body” was never, examined closely, a claim about a uterus. It was a claim about who can be required to keep another human being alive.
That is why the implication is ugly and why it keeps getting restated in journals rather than on campaign literature. A society that permits a woman to end her child’s life before birth because the child depends on her has not produced a principle that stops at the cord. The infant is still drawing on her body and her hours. If wantedness and burden were enough in the womb, they remain enough in the crib, and postpartum psychosis is precisely the kind of psychological break in which the burden becomes, for the mother, unbearable.
Alberto Giubilini and Francesca Minerva said this in the Journal of Medical Ethics without much throat-clearing. “Killing a newborn could be ethically permissible in all the circumstances where abortion would be,” they wrote, including cases in which the newborn is healthy, and only “the well-being of the family is at risk.” They coined the term “after-birth abortion” so no reader could pretend they meant palliative care. If “economical, social or psychological circumstances change such that taking care of the offspring becomes an unbearable burden on someone,” they added, then “people should be given the chance of not being forced to do something they cannot afford.” Postpartum psychosis is a psychological circumstance. A newborn is offspring. Peter Singer had already supplied the ranking that makes the conclusion feel tidy, holding that human infants are not persons and that a newborn’s life is worth less than a pig’s.
The usual reply is that birth is a bright legal line and that what I have just described is already a crime. The reply is weaker than lawyers like to admit. The United Kingdom’s Infanticide Act of 1938 charges a mother who kills her child under 12 months while “the balance of her mind was disturbed” by birth or lactation with infanticide rather than murder, and prison is rare while hospital orders are the norm. Roughly two dozen countries run a version of that statute. The Boston Globe, covering Clancy on August 1, called the US an “outlier in prosecuting infanticide,” which is a polite way of saying that American juries and prosecutors are late to a settlement much of Europe reached before the Second World War. Illinois has already written postpartum depression and psychosis into its sentencing code as a statutory mitigator, at 730 ILCS 5/5-5-3.1(a)(17), after Public Act 100-0574. Massachusetts advocates spent this summer pushing H.1924 to import the same logic, requiring expert screening for mothers charged within a year of birth and treating the diagnosis as a reason to reduce a sentence.
The federal record is not a hypothetical either. On January 23, 2025, the House passed the Born-Alive Abortion Survivors Protection Act 217 to 204, with a single Democrat, Rep. Henry Cuellar of Texas, voting yes. The White House said the bill would “protect the most vulnerable and prevent infanticide.” Senate cloture had failed the day before, 52-47, with every Democrat present voting no. The Heritage Foundation has spent years pointing out that CDC and state reports already record infants who survive abortion attempts and then do not receive ordinary care. A party that will not require that care for a child who has already been born, and who survived an attempt on his life, has answered the personhood question in the only register that counts. Governor Ralph Northam said in 2019 that after a live delivery the infant “would be kept comfortable,” resuscitated only “if that’s what the mother and the family desired,” and that then “a discussion would ensue.” A discussion, with a living newborn in the room, about whether the newborn continues. That is after-birth abortion spoken by a sitting governor, and the country treated it as a gaffe that expired in a news cycle.
No legislature will pass a bill titled the Infanticide Permission Act, because it does not have to. It needs findings of no criminal responsibility, hospital orders instead of verdicts, statutory mitigators, juries that cannot agree, and a prosecutor of two dead boys who offers public discourse as the remedy. The practice is already here. It arrived through diagnosis rather than through a floor speech.
I do not accept the premise that got us here. Thomson’s violinist is a stranger strapped to you by an accident you did not choose. A son or a daughter is not a stranger, and the duty that follows birth is not a kidney you may disconnect because the night has become unbearable. The inferences from Thomson to Giubilini to a Bronx courtroom are tidy, which is why the starting point cannot be kept. Daishawn Fleming was 3 years old. Octavius Canada was 11 months old. Cora Clancy was 5, Dawson was 3, and Callan was 8 months. No diagnosis, no statute, and no rally in pink turns those names into a footnote about somebody else’s suffering. Unlimited abortion is wrong for the same reason the quieter sequel is wrong: a small human being’s life does not belong to anyone else’s convenience, comfort, or crisis, however genuine the crisis may be.
We have ended roughly 67 million lives since Roe, and that figure is almost certainly conservative because the newer counts leave out self-managed medication abortions obtained outside the formal US health-care system. National Right to Life and the Charlotte Lozier Institute, working from Guttmacher’s own revisions, have been raising the cumulative total as the clinic and telehealth numbers were restated upward. This was a national commitment made without a single election that ever put the full cost on the ballot in those terms. Meanwhile the general fertility rate in the US has fallen to record lows near 53 births per 1,000 women of childbearing age, and a country that cannot talk itself into having children should at least stop talking itself into discarding the ones already here, the collapse is not a mystery of economics alone when the official ethic keeps teaching that a child’s claim is negotiable the moment the child becomes costly. We need more babies, more households that can stand a crying night, and more neighbors who notice when a new mother is coming apart. If more mothers are reaching the point where they cannot stop themselves from killing their own children, the answer is not to rename the killing after the fact. The answer is to reach them beforehand to build the screening, the family, the church and the block that catch a woman before psychosis takes the wheel. Save the mothers if we can, but the children are not a remainder.
Recent Comments