Measuring Sex, Gender Identity, and Sexual Orientation (2022) / Chapter Skim
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3 The Role of Measurement Context
3 The Role of Measurement Context
Pages 45-62
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From page 45... ...
In this chapter we discuss the purpose of data collection in each setting to determine which measures are relevant, and we touch on how the purpose and characteristics of each setting might influence how these data are collected. The committee first categorized data collection contexts into the three settings included in the statement of task (surveys and research, administrative settings, and clinical settings)
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From page 46... ...
These administrative settings are distinguished from each other because, although vital statistics data are often used for research purposes, their use for legal identification and other administrative purposes mean that they often need to meet regulatory or legal requirements that do not apply to other data collection contexts. ENUMERATION, SOCIAL RESEARCH, AND DEMOGRAPHY The most common data collection method for enumeration, social research, and demographic data collection is general population surveys.
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From page 47... ...
Therefore, the more important measures to gather in these surveys are those associated with proximal and distal minority stressors: gender identity, transgender experience and identity, intersex status, and sexual orientation. In these survey contexts, data about specific sex traits are needed only in circumstances in which knowledge of these traits is necessary to accurately direct skip patterns for survey questions, interpret responses, or calculate values for composite measures.
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From page 48... ...
. For vital statistics and legal identification, the only measure of sex, gender identity, or sexual orientation that is routinely collected is a single binary measure of sex or gender.
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From page 49... ...
Overall, in the vital statistics, data collection on transgender experience or sexual orientation is rare, while data collection on intersex status is nonexistent. This is partly because many of these documents serve foremost as forms of identification, and sexual orientation, transgender experience, transgender identity, and intersex status are not necessary for identification purposes.
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From page 50... ...
The possible implementation of routine data collection of measures of sexual orientation, gender identity, and transgender experience in vital statistics data poses several challenges that may affect data quality, particularly for measures of identity. One challenge is the role of proxy reporting, in which the respondent is providing information on someone else, a practice that is necessary when collecting data on infants and decedents.
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From page 51... ...
birth certificate, and NCHS data record standards do not currently recognize a third category, such as nonbinary, on birth certificate data when they are transferred electronically to the federal government. Moreover, because the United States does not have a population registry system, when an original birth certificate is modified to reflect an individual's current gender, this information is not transferred to the federal government or reflected in national vital statistics data.
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From page 52... ...
The collection of sex and gender data on legal identification documents can have negative repercussions for people whose recorded sex or gender on their documents does not match their current gender, which underscores the need to ensure that both the collection and reporting of this information is done with a clear purpose that outweighs the potential harms. The introduction of sexual orientation, gender identity, transgender experience, and intersex/DSD status to vital statistics data could potentially 8 Several states have also attempted to explicitly bar such changes.
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From page 53... ...
Measuring sex or gender, sexual orientation, and transgender experience is important in these contexts because of documented disparities, discrimination, and barriers in access to services in all of them (NASEM, 2018, 2020)
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From page 54... ...
For applicants, some employers collect data on gender, transgender, or sexual orientation identities.9 These practices are consistent with Supreme Court rulings, which have found that the legal prohibition of discrimination based on sex extends more broadly to protections against discrimination based on sexual orientation and gender identity.10 To our knowledge, information on intersex status has not been collected in any administrative setting. As is the case for vital statistics and legal identification data, an important feature of these administrative data is the ability to link this information to a specific individual.
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From page 55... ...
As in other administrative settings, this access can leave individuals vulnerable to mistreatment, and some respondents may prefer not to disclose this information due to fear of mistreatment or loss of services. For this reason, data collection and use of case management files requires high levels of competence among staff when they ask about or discuss sexuality and gender, particularly when sexual orientation and gender identity questions are open ended.
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From page 56... ...
CLINICAL SETTINGS Clinical settings include a wide variety of contexts in which sex, gender, and sexual orientation are critical for health and well-being, at both individual and population levels: they include health surveys, public health surveillance, clinical trials, and medical records. In health surveys and public health surveillance, these data are critical for identifying and addressing disparities between groups on health-related outcomes and understanding the social determinants of health.
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From page 57... ...
In health contexts, each of these characteristics may be independently relevant: gender identity; sex assigned at birth; transgender experience and identity; intersex status; sex traits, including chromosomes, gonads, internal and external genitalia, secondary sex characteristics, and hormones; the components of sexual orientation, identity, behavior, and attraction; and gender pronouns. It is important not to use any one as a proxy for any other one (see Chapters 1 and 2)
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From page 58... ...
. The collection and use of data on sex traits, sexual orientation, gender identity, and intersex status are challenging areas for health care delivery organizations, health plans, and payers.
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From page 59... ...
The U.S. Office of the National Coordinator for Health Information Technology has identified various terms that can be used to capture sex assigned at birth, gender identity, and sexual orientation in electronic health records,14 but little work has been done on how to measure intersex status as a demographic measure.
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From page 60... ...
Another way in which the three settings differ is the purpose that the data collection serves. Although sex, gender identity, and sexual orientation data can be used to document group-based disparities in treatment and outcomes in all three data collection settings, data collection also serves a unique purpose in each setting that informs the specific measures of sex, gender identity, and sexual orientation that are collected: • When data collection is conducted solely for the purposes of es tablishing identity, measures of gender identity, sexual orientation, transgender experience or identity, or intersex/DSD status are not
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From page 61... ...
• When data are collected to enumerate populations and conduct research that elucidates the structural mechanisms through which population-based disparities are created and could be addressed, measures that can identify the relevant sexual and gender minority populations, such as sexual orientation identity, gender identity, transgender experience, and intersex status are the most relevant. Even when collecting data on sex, gender identity, and sexual orientation is relevant in a specific context, data collection efforts need to balance the benefits of the data with the risks associated with unauthorized data disclosure and the potential misuse of data by those with authorized access.
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