Recent legal rulings, policy changes, and public debates have reshaped the working landscape in the UK have impacted on transgender and non binary healthcare workers. Dr Alys Einion, midwife and Senior Lecturer Student Support at the School of Health Sciences, University of Dundee discusses the issues and guides how midwives should respond professionally.
Transgender and non binary healthcare workers in the UK are facing increasing challenges within the current legal and political climate. Recent legal rulings, policy changes, and public debates have reshaped the working landscape, raising concerns around workplace safety, inclusion, and equal rights for all midwives, polarising people’s viewpoints. At the same time, professional bodies across the UK continue to emphasise the importance of equitable, person centred, and discrimination free care—both for patients and for healthcare staff. For many midwives, it can lead to difficulties in negotiating the legal parameters of their role and practice. Midwives practice woman centred care, and at the same time, person-centred care. As a traditionally ‘gendered’ profession, midwifery has already shown its willingness to open itself to the critical thinking and flexibility needed to adhere to legal requirements and best practice and support trans and non-binary colleagues to feel safe and included.
In April 2025, the UK Supreme Court ruled that “sex” within the Equality Act 2010 must be interpreted as biological sex, irrespective of whether an individual holds a Gender Recognition Certificate. This ruling has sparked significant public and professional debate, as it potentially affects access to single sex spaces, workplace policies, and legal protections for transgender employees. Human Rights Watch suggests that authorities’ interpretations of the ruling results in employers forcing trans people into facilities that correspond to their assigned sex at birth, which could impact their safety, dignity, and autonomy. The current situation does not negate the legal protections of the Equality Act, which protects individuals undergoing or having undergone gender reassignment from discrimination and harassment based on gender identity. It also does not change the professional obligations of midwives, and their employers, to provide supportive and inclusive workplaces.
For midwives and healthcare workers, the ambiguity created by the ruling and the delay in updated statutory guidance have generated substantial confusion within workplaces about what is permissible, what is required, and how best to uphold and adhere to legal obligations, EDI policies, and professional values. The NHS Confederation withdrew its previous trans inclusion guidance in May 2025, acknowledging that elements relating to single sex facilities had become outdated following the ruling. They reaffirmed, however, the commitment to addressing the “unacceptably high levels of bullying, abuse and discrimination” and inequalities in care experienced by trans and non binary staff and service users.
Midwifery as a profession often strongly associated with womanhood, could potentially be a source of additional barriers for trans men, non binary midwives, and trans women working in maternity services. TransActual’s 2025 Healthcare Professionals Report reflects wider systemic barriers, including insufficient training on trans inclusive care, heteronormative and cisnormative assumptions in workplaces, and discomfort or lack of confidence among some professionals in supporting or working alongside trans colleagues. Midwifery however prides itself on its inclusive principles and woman/person-centred philosophy, and it is therefore, surely, simply an extension of that philosophy to respect and uphold the dignity of diverse colleagues. The BMA has echoed the call for safe, respectful and inclusive workplaces and care settings, and the RCM has previously made it clear that it will reflect trans/nonbinary inclusion in the language of its publications.
Until there is clear policy guidance, however, the core response of midwives to these changes in law must be to uphold our professional values and adhere absolutely to the core tenets of the Nursing and Midwifery Council, who have stated in their review of the Code and Revalidation, that EDI issues, including inclusivity, will be prioritised so that the regulator can support professionals to uphold inclusive practice and address inequalities and discrimination. Despite the changes in the guidance that are still pending, and the heated debates that continue in the media, midwifery remains a profession rooted in respect for individual rights, autonomy and dignity, and as midwives, we can and perhaps should act as allies to ensure that we visibly protect those rights for all of our colleagues and service users.
Dr Alys Einion, FRCM, SFHEA
Senior Lecturer Student Support, Senior Adviser of Studies, EDI Lead, School of Health Sciences, University of Dundee
March 2026