IT'S Cervical Cancer Prevention Week and, yet again, those who have an important health message to get across just can't seem to muster the nous or the gumption to do it clearly.

Scotland has 14 health boards and, judging from their Twitter output on the topic, none of them are quite sure who it is they're trying to encourage to book potentially life saving smear tests. NHS Ayrshire and Arran asks: "Did you know together, we can end cervical cancer? You can play your part... go for your screening." Who? Who needs to go for their screening?

NHS Borders has the answer: "When anyone with a cervix turns 25 they'll be invited for a cervical screening test". Right...

NHS Fife has gone with: "Did you know the frequency of routine cervical screening (smear test) has changed from every three to every five years?" as have a couple of the other health boards, retweeting other organisations, such as Public Health Scotland.


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NHS Forth Valley has also retweeted Public Health Scotland's tweet, which reads: "Once you’ve had your cervical screening (smear) test, you will receive your results by post." Who will though?

NHS Grampian adds further mystique to the situation. "#DYK #cervicalcancer is one of the most successfully treatable forms of cancer if it is detected early?" The words "do you know" clearly didn't fit the tweet character limit. It follows up with four bullet points of advice, including "don't ignore the signs" and "know your normal". Who needs to know their normal? Their normal what?

NHS Greater Glasgow and Clyde swoops in. "This week 23-29 January is #CervicalCancerPerventionWeek" (That should obviously be "prevention week" but mistake is health board's own).

"Knowing the signs and symptoms of #CervicalCancer," it adds. But... who might have these symptoms?

NHS Lanarkshire has shared several tweets on the topic such as "From age 25 you’ll be invited for the cervical screening/smear test." I'm going to ask again - who will?

NHS Orkney has a tweet about results coming out in the post and the frequency of cervical screening changing from three to five years but still mention of who might need a test. NHS Western Isles sticks with "anyone with a cervix"; NHS Shetland has lots of retweets but nothing that suggests a specific cohort in need of the screening; ditto for NHS Shetland and NHS Lothian.

NHS Tayside gives no mention of who might want to look into cervical screening - but they do mention the final winter vaccine drop-in clinic for pregnant women is in Dundee this week so it seems that they do know about targeted advertising, they're just selective about it.

NHS Dumfries and Galloway and NHS Highland have just sacked it altogether. Not a mention of Cervical Cancer Prevention Week between them on Twitter.

I have a useful word for Scotland's healthboards and that word is... women. Women need to go for cervical screening because women have a cervix. Not all women have a cervix but if you're looking to encourage take up of health screening programmes, particularly when that which is being screened is a delicate subject, being coy about the issue is not the way to go.


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Not all female people with a cervix identity as women. Guess what? There's a way around this. You tailor your advertising accordingly.

Several of the health boards tweets link to the charity Jo's Trust, which is involved in Cervical Cancer Awareness Week. Jo's Trust has an interesting article on its website in which it details research showing that 50 per cent of women in the UK do not know what their cervix is, where it is or specifically what it does.

So you might think it's a nonsense that women have to be given specifics when it comes to cervical screening but many do, and that will be largely due to a squeamishness around women's bodies that prevents effective education about all our various bits.

Some women will have English as an additional language and struggle with medical terms; some will have learning difficulties or literacy difficulties. A very basic rule of public health messaging is that it needs to be clear and easy to read.

It's not about any sort of idealogical objection to the language, it's just really poor communication.

It's important that all people feel they are being seen and that their specific needs are being considered and respected. The Government of Jersey has managed it part of the way there. It has an advert for the trans community with: "If you are a transgender man, a gender non-conforming person, or assigned female at birth and with a cervix, you can book your free cervical screening today."

Really clear, really comprehensive. It has two further adverts for cervical screening - one references being "female or having a cervix" while the other one doesn't mention any specifics at all. Still no "women" or "girls".


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This isn't a new issue or one specific to cervical screening: there's been much discussion about phrases such as "menstruators" or "chest-feeding".

This is generally framed as women being "erased". That's a stretch, and hopefully more so with this week's appointment of Professor Anna Glasier as the new – albeit delayed – Women's Health Champion in Scotland.

It does, though, feel almost refreshing now to see female-specific guidance that mentions the word. The problem is that it is always women who are asked to make way. As in the example of the Government of Jersey tweet, the word "man" is fine but there's not a sniff of "woman". NHS Greater Glasgow and Clyde has no qualms about saying "man" when it talks of the need for prostate screening. There's no suggestion of, say, "penis-haver" entering the lexicon. Though I quite like testicle swingers, just because it sounds jaunty, and any health board reading is welcome to it.

The squeamishness only comes at the use of the word "woman", which leads to a guddle as with NHS Tayside studiously avoiding any mention of women but having that post advertising the fact it's the final winter vaccine drop-in clinic for "pregnant women" in Dundee this week. Some charities supporting those who are pregnant or who have just given birth prefer "pregnant people".


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It seems very little to say "pregnant women and people" but, of course, you then have pushback from those pointing out that women are people. Of course, women and people who can get pregnant are one specific type of person - female, a thing they all have in common. But saying "female" is reductive as well, given its often pejorative use. And female what? Koala? Spectacled bear?

Trans allies say it's dehumanising to reduce people to their body parts, and it is, which is why words like "menstruator" are so tough to stomach. It can be difficult in a medical setting - such as cervical screening – to avoid it.

A few years ago I had a letter exchange with the Scottish Trans Alliance about this and they said: "Trans people are not arguing that all language must be chosen with a specific focus on our issues, but just for us not to always be left out entirely." That's fair and it works both ways.

Inclusive language does not work for everyone if it excludes women.