Better than nothing?

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NHS England has just released a new sexual orientation monitoring Information Standard. This means that there is now "a consistent mechanism for recording the sexual orientation of all patients/service users aged 16 years across all health services in England".

This is to be welcomed, isn't it? Well…

The proposed question for health care professionals to use is as follows:

Which of the following options best describes how you think of yourself?

    1. Heterosexual or Straight
    2. Gay or Lesbian
    3. Bisexual
    4. Other sexual orientation not listed
    U. Person asked and does not know or is not sure
    Z. Not stated (person asked but declined to provide a response)
    9. Not known (not recorded)

Somehow 'straight' has become a proper noun, but more important is that..

This isn't asking about sexual orientation, it's asking about sexual identity!

There are numerous issues with that.

Firstly, it's not what the specification defines as sexual orientation immediately before this:

In this standard, sexual orientation is defined as follows:
    The stated physical and emotional attraction a person feels towards one sex or another (or both).

.. which is all about attraction.

(And hideously binary: a trans status Information Standard is being prepared. The semi-official Good Practice Guide from the LGBT Foundation is, as you'd expect, much better in its definition, but is still all about the attraction: "SEXUAL ORIENTATION: describes who an individual is emotionally and sexually attracted to".)

Weirdly, it then says

The question has been worded so as to encompass more fully sexual orientation, sexual attraction and sexual behaviour

.. so just after saying that orientation is about attraction, it says it is something distinct from attraction. That something can only be identity, confirmed by the next phrase:

and to reinforce the fact that sexual orientation is about identity rather than sexual partners.

Yes, sexual orientation is not just about sexual behaviour, but it's not just about identity either and many, many people have attractions and/or behaviour that are not congruent with most people's definitions of identity.

Secondly, this is completely and utterly guaranteed to underestimate how many bisexual people there are.

Why? See here:

Venn diagram of bisexual feelings, behaviours and attractions

(Adapted from Rebecca Jones, as republished in The Bisexuality Report, by making it clear that some people have bisexual behaviour* or identity without having bisexual attraction.**)

There are plenty of things to get from that*** but some of the main ones are:

o Many more people have bisexual attraction than have bisexual behaviour

o Many more people have bisexual behaviour than have bisexual identity

o Many people have bisexual attraction and identity but not bisexual behaviour

o .. and they're all bisexual

I will have more to say about the BBC Newsbeat survey of over three thousand people which found that over a quarter of 16-22 year olds have bisexual attraction (ten times the number with only same gender attraction!) but as you can guess from that statement, they asked about attraction. Had they asked about identity, the number would have been much lower.

Thirdly, it gets even worse if you look at the LGBT Foundation's Good Practice Guide's definitions.

Being based purely on behaviour, the original Kinsey Scale has its issues but it's easier to image than some of the better ones like the Klein Sexual Orientation Grid, so I will use an adaptation of Kinsey for attraction:

0 Exclusively other gender attraction

1 Predominantly other gender attraction, only incidentally attracted to same gender

2 Predominantly other gender attraction, but more than incidentally attracted to same gender

3 Equally attraction to same and other gender

4 Predominantly same gender attraction, but more than incidentally attracted to other gender

5 Predominantly same gender attraction, only incidentally attracted to other gender

6 Exclusively same gender attraction

Those definitions:

LESBIAN: a woman who primarily experiences romantic love or sexual attraction to other women.

GAY: describes a person, usually a man, who primarily experiences romantic love or sexual attraction to other people of the same gender.

So this is the visual version:

As you'd hope, the LGBT Foundation uses what's basically the bi community's definition of bisexual:

BISEXUAL: a person who experiences sexual and/or romantic attraction to people of more than one gender, also referred to as “bi”.

.. or, visually:

HETEROSEXUAL / STRAIGHT: a person who experiences romantic love or sexual attraction to people of a gender other than their own.

.. and, visually:

They're good on gender, but…

everyone who is 'bisexual' is also, because of their other gender attraction, also 'straight'! WTF?

The same applies to two thirds of the lesbian / gay boxes. A lesbian who is attracted to one person of another gender? This 'good practice' guide includes you in the straight category too…

One reason for this is that all the definitions include people in Kinsey-attraction 4 and 5! Now yes, people there may well identify as any, all, or none of them, but having such overlapping definitions is confusing at best.

And this is a 'best practice' guide from an LGBT organisation which is is referenced by the official NHS documentation in an approving way?

TL;DR: If you're going to monitor sexual orientation, ask about attraction, not identity..

.. then get your definitions right.

To answer the original question, it's really a sexual identity monitoring Information Standard, and while that's much better than nothing, I can still say this is what erasure looks like because it pretends otherwise and this decision's completely predictable effect on bi numbers.

How did this happen? One factor may well be that activists care a lot about sexual identity. For most, having an LGBT identity will have been a big reason why they do LGBT activism. It can also suit the agenda of homo- and biphobes to talk about identity: self-identification is clearly a matter of choice rather than being innate and the numbers are lower!

(To save another afternoon writing furiously, this is why having the Office for National Statistics opine on the number of bisexual people in the UK on the basis of questions on sexual identity is Wrong.)

The definitions issue is linked to the way that an awful lot of people with lesbian / gay / straight identities have attractions (and sometimes behaviour) that could best be described as bisexual, because they are not all to one gender.

The bi community has always been happy with people who say they're, say, a 'lesbian-identified bisexual' (as well as people who don't have any bi in their identity) but there are far too many lesbian / gay / straight spaces where talking about bisexual attractions is taboo.

There shouldn't be a conflict between saying someone's identity is A and their attraction is B – or even that their behaviour is A or B or C – but it's one of the things that many monosexual spaces decide that they do not want to even address. And it's another example of what bi erasure looks like.

* One example is in male prostitution: virtually all clients are male, but a significant number of male escorts are not attracted to men. Most keep quiet about that, but as having sex with 'straight' men is a fetish especially for some gay-identified men, this is sometimes used as marketing.

** There will also be a tiny number with both bisexual behaviour and identity without the attraction, but the graphic becomes harder to draw while retaining its main messages.

*** The original is such a good diagram, I suggested that it should have been on the cover of the Bisexuality Report rather than the bottom of page 12…

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