The 14th July marks International Non-Binary People's Day—a day dedicated to celebrating the rich diversity of gender beyond the binary. Non-binary individuals, who do not exclusively identify as male or female, contribute significantly to our communities. After clarifying what it means to be non-binary, the focus then moves on to consider the challenges of identifying as non-binary in a paramedic context—both as a paramedic and as a person receiving paramedic care.
Understanding non-binary identity
The term ‘genderqueer’ emerged in the 1980s as a precursor to the term ‘non-binary’ (Hendrie, 2019). It was increasingly used in the 1990s, particularly among political activists (Tobia, 2018) and entered the mainstream by the 2010s, predominantly via celebrities who publicly identified under the genderqueer umbrella (Hendrie, 2019). Non-binary and genderqueer are umbrella terms for gender identities which are not solely male or female (Richards et al, 2016). Since non-binary people typically identify with a gender that is different from the sex assigned to them at birth, non-binary identities are often considered under the transgender umbrella (Ennis, 2021), although some non-binary people do not consider themselves transgender.
Gender identity is separate from sexual or romantic orientation, with non-binary people having various sexual orientations, including lesbian, gay, bisexual or heterosexual. It is also important to recognise that identifying as non-binary is not the same as being intersex. Some intersex people do however identify as non-binary, genderfluid, or as a non-binary man or non-binary woman.
A number of gender identity labels fall within the non-binary umbrella including queer, gender non-conforming, genderfluid, genderqueer, agender, demigirl, demiboy, genderflux, and bigender. Multigender, or polygender refers to individuals who experience multiple genders simultaneously, or alternatively. Multigender, or polygender identities include demigender, bigender, pangender, and genderfluid people.
Using correct pronouns is essential; many non-binary people prefer the pronouns they/them/their, although non-standard pronouns, or gender-neutral neopronouns such as xe, ze, sie, co, and ey may also be used. Many non-binary people also use neutral language such as the title ‘Mx’.
The 2021 Census in England and Wales included a voluntary question on gender identity for those aged 16 years and over, with 0.06% of this population identifying as non-binary and a further 0.04% reporting a different identity. The 2021 Australian Census also collected responses on non-binary identity, with 0.17% of respondents identifying as non-binary, although there are limitations to the validity of this dataset due to the way the question was asked (Australian Bureau of Statistics, 2022).
Challenges faced by non-binary paramedics
Non-binary paramedics encounter unique obstacles in their professional lives including visibility and representation, navigating gendered spaces, pronouns and identity, and healthcare access and discrimination. The experiences of non-binary paramedics are further complicated when considering the diversity of sexual orientation present in the non-binary population, as the challenges associated with heteronormativity in paramedic, and other health workplaces generally, are likely to exacerbate workplace challenges.
Visibility and representation
Despite the Health and Care Professions Council (HCPC) (2021)Diversity Data Report 2021 highlighting that paramedicine in the UK had the highest proportion of lesbian, gay, or queer registrants (8%), the number of non-binary paramedics, while not reported independently, is likely to be below 1%. With such small numbers, non-binary paramedics are likely to lack the same level of representation in the profession which lesbian and gay paramedics have managed to gain. The absence of visible role models can impact career choices for non-binary paramedics and may hinder their professional advancement.
Navigating gendered spaces
Paramedicine as a profession has traditionally been male-dominated, with an at-times, hypermasculine culture (Sengstock and Curtis, 2023), resulting in a significant degree of discomfort for paramedics who may not fit the accepted gender norms of the profession. Given the traditionally gendered workspace, for example male or female restrooms, and uniforms, non-binary paramedics may feel uncomfortable in such settings, potentially leading to attrition. Efforts to create gender-neutral spaces and policies are crucial for fostering inclusivity and ensuring that non-binary paramedics are retained in the profession.
Pronouns and identity
The correct use of pronouns (they/them/their) or neopronouns is essential as misgendering can cause distress, while also eroding the inclusive culture needed to ensure a safe and healthy workplace for all. The use of correct pronouns is also important in the provision of paramedic care to patients, as this approach ensures the delivery of gender-affirming care. Identifying a recipient of care's preferred pronouns can be achieved through simply asking what their preferred pronouns are.
Unique experiences in paramedic care
Non-binary paramedics bring valuable perspectives to patient care, to ambulance services, and to the profession through empathy and understanding, advocacy and education, and breaking stereotypes. Through their personal experience, non-binary paramedics may be better placed to understand the complexities of gender identity and gender dysphoria, leading to a more empathetic approach to the provision of paramedic care when treating transgender or non-binary people. Their empathy and understanding of the experiences that transgender and non-binary people may have had in the healthcare system can positively impact patient interactions and encourage access to necessary healthcare.
Non-binary paramedics play a vital role in advocating for inclusive policies within their organisations—not just for paramedics, but also for recipients of care. Promoting paramedicine as a safe and inclusive profession is integral to attracting, and retaining non-binary paramedics, and through an increased visibility, providing visible role models to encourage professional advancement for other non-binary paramedics. Non-binary paramedics also play an important role in educating colleagues about gender diversity and respectful communication. Through challenging traditional gender norms, promoting diversity and acceptance, the presence of non-binary paramedics in the workplace helps to break down stereotypes and fosters a more inclusive profession.
As we celebrate International Non-Binary People's Day, let us recognise the resilience and contributions of non-binary paramedics to our profession. By addressing challenges and fostering understanding, we can create a more equitable and compassionate paramedic care system for all recipients of paramedic care, regardless of their gender identity or sexual orientation.