Measuring Sex, Gender Identity, and Sexual Orientation (2022) / Chapter Skim
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6 Measuring Sex and Gender Identity
6 Measuring Sex and Gender Identity
Pages 103-138
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From page 103... ...
We then offer our recommendations for measurement practices that include both cisgender and transgender people and conclude with recommendations for future research. CONCEPTS AND TERMINOLOGY Measures of gender include questions about a person's gender identity, which reflects their internal understanding of their own gender, as well as questions about gender expression, which is how a person expresses their gender to others.
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From page 104... ...
Furthermore, they are not intended to distinguish between transgender and cisgender people in order to provide representative estimates of the transgender population. Thus, in this chapter we focus our review of gender measures on the most promising measures of categorical gender identity that can identify transgender people and that have been used most frequently in general population assessments of adults.
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From page 105... ...
EVALUATION OF EXISTING MEASUREMENT APPROACHES Currently, there are two types of transgender-inclusive measures of gender: one-step measures that attempt to identify transgender people using a single question and two-step measures that include a broader measure of gender identity and try to enumerate transgender and cisgender people. Two-step measures consist of a two-question sequence -- commonly asking for sex assigned at birth and current gender, though other variations exist -- that is intended to be used as a pair.
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From page 106... ...
Table 6A-1 in the annex to this chapter provides information on two-step measures used in these and other surveys. Although sex assigned at birth is an imperfect proxy for anatomical, genetic, and physiological sex traits, it has utility in health contexts -- including survey research, clinical trials, public health surveillance, and medical settings -- for purposes ranging from clinical decision support to exploring the role of sex traits in health status and the etiology of disease.
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From page 107... ...
Most two-step designs account for this key distinction by measuring both sex assigned at birth and gender identity so that transgender people can be identified either directly by their gender identity response or indirectly by providing different responses for the two items. A variety of one-step measures have also been used to try to identify transgender people.
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From page 108... ...
they conflate transgender experience with either gender identity or sexual orientation, which are different constructs (Grant et al., 2015) . Another approach to identifying transgender people asks, "Do you consider yourself transgender?
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From page 109... ...
" Both sets of people who endorse a transgender identity on single-item measures are, in turn, a subset of the people who would be categorized as transgender based on their responses to a two-step measure that includes both the sex assigned at birth and gender identity questions. Although this two-step measure can also miss some transgender people if, for example, they prefer not to answer the question about sex assigned at birth and do not identify explicitly as transgender on the second step, the two-step approach provides better conceptual and empirical fit to the task of enumerating transgender people than one-step measures that are currently in use.
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From page 110... ...
110 FIGURE 6-1 Conceptual and empirical distinctions in transgender population measurement.
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From page 111... ...
(2019) reported a combined item nonresponse of 1.3 percent for both sex assigned at birth and gender identity in the 2016 National Crime Victimization Survey (NCVS)
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From page 112... ...
. Because of this, nonresponse rates are not available for this survey and the transgender calculation removes cases with imputed sex assigned at birth which otherwise produces an outsized number of respondents with transgender experience (Conron and O'Neill 2021)
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From page 113... ...
For example, the GSS changed the placement of the two-step measure between its 2018 and 2020 waves and, as noted above, item nonresponse declined in 2020, when the questions were asked with other demographic items midway through the survey.10 In the Household Pulse Survey, sex assigned at birth and gender identity are included as the sixth and seventh questions overall (between questions about education and marital status and questions about sexual orientation and household size) .11 These developments in overall survey placement, along with consistently low item nonresponse, underscore both the feasibility and acceptability of implementing a two-step gender measure in the United States.
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From page 114... ...
and has announced it will be implementing new questions for its next census in 2023.12 Canada replaced the existing binary sex question on its census form with one that specifies sex assigned at birth and added a second question about current gender. The answer options for the sex assigned at birth component are male and female, while the responses for the current gender component are male, female, and a free-text option.
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From page 115... ...
Overall, measurement recommendations across these countries are quite similar. They all are either testing or actively using a two-step gender measure that references sex assigned at birth and gender identity, and they all affirm the importance of providing inclusive counts of both cisgender and transgender people in national statistics.
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From page 116... ...
." In settings where it is important to identify transgender people but where privacy protections are deemed inadequate for collecting data on sex assigned at birth, New Zealand endorses asking "Do you consider yourself to be transgender? " in addition to a gender identity question that offers the answer options of female, male, and a free-text field for another gender.
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From page 117... ...
RECOMMENDATION 4: The panel recommends that the National Institutes of Health use the following pair of questions assessing sex assigned at birth and gender identity: Q1: What sex were you assigned at birth, on your original birth certificate? ● Female ● Male (Don't know)
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From page 118... ...
We note that some data collections routinely use a single question with female/male response options to drive skip patterns: for example, the American Community Survey skips a question about recent births for people who are reported as male. In such cases, we suggest substituting sex assigned at birth responses to program skip logics.16 In cases for which detailed information on physical sex traits is needed (such as some health surveys or clinical settings)
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From page 119... ...
Considerations for Component of Sex Assigned at Birth Specific formatting considerations for the sex assigned at birth question in our recommended measure include the wording of the question stem, the wording and ordering of response options, and whether to include a free-text option.
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From page 120... ...
• Recommended by the Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys (2016) What is ● Female Conceptual Fit • Clearly distinguishes between sex assigned at birth and current gender, which allows for your current ● Male enumerating the broadest definition of the transgender population gender?
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From page 121... ...
also may grow in popularity and need to be assessed for inclusion as explicit options • Asking for sex assigned at birth is considered sensitive for some transgender people and may not be appropriate in settings where privacy and confidentiality cannot be assured (e.g., employment contexts) • Sex assigned at birth question offers only binary responses though some states have begun to allow nonbinary options on birth certificates 121
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From page 122... ...
We recommend that only two categories -- female and male -- be offered for sex assigned at birth, as they are the only options available on original birth certificates in the United States. We recognize that some U.S.
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From page 123... ...
Specific Considerations for the Component of Current Gender As for the component of sex assigned at birth, specific considerations for the current gender component of the recommended measure include the wording of the question stem, the wording and ordering of response options, and whether to include a free-text option. Other considerations related to implementing the gender identity measure, such as whether to allow for multiple responses, are covered in the section below on recommended research areas.
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" most appealing among the existing alternatives. The panel's recommended question uses female and male answer options, which is intended to keep the response categories consistent between sex assigned at birth and current gender.
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From page 125... ...
Finally, as with sexual orientation, the panel's recommendation includes the Two-Spirit category in general population surveys, provided they collect racial identification data prior to gender identity and can be automated to ensure that this response option is available only to AIAN respondents. When this is not possible, respondents who want to identify explicitly as Two-Spirit can write in that response. We note that the Indian Health Service recommends using a two-step measure with the inclusion of a Two-Spirit response option, as well as a write-in gender response option in its strategic plan for gender-affirming care (NPAIHB 2020)
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From page 126... ...
. In addition to the issues already noted above, these include the following concerns: • whether the sex assigned at birth component should be replaced with a question about transgender identity in nonresearch and nonhealth administrative settings; • whether the current gender question should be measured as "mark all that apply"; • the need to reevaluate and expand answer options over time, par ticularly with regard to nonbinary responses; and • the need for further assessment of item performance across all sur vey modes, including proxy reporting, in languages other than Eng lish, for all major U.S.
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From page 127... ...
. A similar option is currently being used on the employment application form for the Biden Administration.20 Other alternatives to using sex assigned at birth to enumerate transgender people could include a modified two-step approach that combines a current gender question with a second question like those used in either the Scottish census or the census of England and Wales: "Do you consider yourself to be trans, or have a trans history?
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From page 128... ...
As noted above, the transgender populations identified using different measurement approaches cannot be assumed to be identical or directly comparable: people who might be classified as transgender using the panel's recommended two-step method may not endorse a transgender identity on an alternative measure. Considerations of when to use different approaches require assessment of the relative importance of generating more complete counts of the transgender population and respect for individual privacy around either sex assigned at birth or transgender experience.
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From page 129... ...
We note that a nonbinary response option for sex assigned at birth, in addition to female and male, may need to be considered in the future. As noted above and discussed in more detail in Part I, there have been rapid changes to state laws regarding amendments to birth certificates and other legal identity documents over the past few years, and more than a dozen states currently allow adults -- or parents of newborns -- to change a birth
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From page 130... ...
Other English-speaking countries, including Canada, England, and Wales have collected gender identity using proxy reporting in their censuses, but little quantitative research has been conducted on proxy reporting of gender identity or transgender experience in the United States. In 2016, the federal interagency work group on measures of sexual orientation and gender identity listed proxy testing among its highest research agenda priorities (Federal Interagency Working Group, 2016c)
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and the lowest rates among Bengali and Haitian Creole speakers (0% on either item) ; Spanish speakers fell somewhere in between (1.7% for gender identity and 0.8% for sex assigned at birth)
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• Alternative two-step gender measures that offer an inclusive count of both cisgender and transgender people for use in contexts where the privacy and confidentiality of sex assigned at birth responses cannot be assured or where specific information on sex assigned at
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From page 133... ...
• Evaluation of the utility of including a nonbinary response when asking about sex assigned at birth, particularly if nonbinary sex markers on birth certificates become more widely available, and consideration of how nonbinary gender identities should be counted in terms of cisgender or transgender status. • Expanded testing of the recommended two-step gender measure beyond general population assessments of English-speaking adults, including updated translations and studies of response equivalence, as well as further testing among youth and in settings where a single respondent replies for all household members.
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What is your ● Male What sex were ● Male Add Health gender? you assigned at (Wave V)
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were you current gender? ● Male ● Man assigned at birth?
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● Non-binary Gender refers ● [I/They] use a Gender identity: to current gen- different term Recommenda der, which may (please specify)
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From page 137... ...
NOTES: Add Health, National Longitudinal Study of Adolescent to Adult Health; CDC, Centers for Disease Control and Prevention; GSS, General Social Survey; HSLS:09, High School Longitudinal Study of 2009; NATS, National Adult Tobacco Survey; NCVS, National Crime Victimization Survey; NHIVBS, National HIV Behavioral Surveillance System; NISVS, National Intimate Partner and Sexual Violence Survey; NORC, National Opinion Research Center; START, Survey of Today's Adolescent Relationships and Transitions.
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