Earlier this month, the federal government announced it would scrap questions about gender and sexuality from the 2026 census.1 However, within 48 hours, this decision was reversed.2 But why does this matter?
Firstly, it’s important to understand that sex, gender, and sexuality mean different things in this context. Sex is most simply understood as referring to sex characteristics – which can be physical, genetic, and hormonal. A person who is intersex has sex characteristics that do not conform to the common medical binary of ‘male’ or ‘female’. Gender can be understood as a social construction and refers to the ways a person identifies, experiences, or expresses their identity as a man, woman, or otherwise. Gender identities and gender expression vary across different societies and cultures. They do not necessarily correspond to a person’s sex and can change over time. For example, understandings of what a ‘girl’ or ‘boy’ is can mostly be explained as different from a ‘woman’ or ‘man’. Sexuality is not associated with sex or gender, it refers to a person’s sexual or romantic attraction to others; be they heterosexual, gay, lesbian, bisexual, pansexual, or asexual.
In the 2021 census, responses about non-binary sex were included in the sex question but were later criticised for not providing meaningful data.3 To improve and move forward, it’s essential to include more in-depth questions about gender and sexuality in the 2026 census. Understanding the size of communities like the gender and sexually diverse (GSD) community is essential for effectively supporting their health and well-being. Without accurate data, it becomes difficult to provide appropriate and effective resources and services, and there is a risk that vital funding could be allocated to services that are less relevant or important for specific communities.
“Diversity is having a seat at the table; inclusion is having a voice; and belonging is having that voice be heard.” Liz Fosslien
In nursing, accurate patient care starts with understanding the whole person, not just their physical symptoms – just as taking vital signs allows for personalised therapy, collecting data on GSD individuals ensures respectful and effective care. It is widely recognised that GSD people face inequitable access to healthcare, have poorer experiences of care, worse physical and mental health and wellbeing outcomes, and also more frequently delay or avoid care due to past negative experiences or concerns about discrimination and poor treatment.4 Substantial research suggests that GSD individuals continue to be at greater risk for cancer and may be more likely than cisgender people to develop certain cancers.5 These health and wellbeing disparities are a significant burden on GSD people, their families and loved ones, and are costly to health systems and the community at large.
Understanding a patient’s history and the factors that influence their care and treatment decisions are essential. This knowledge helps provide successful care and therapy. It ensures that care is individualised and appropriate to each person’s needs and preferences. Therefore, compiling and using information on gender and sexual diversity is crucial to delivering respectful, individualised care that responds to each individual’s particular needs. As person-centred care is a standard for practice for every nurse and midwife and the foundation for safe, high-quality healthcare, ensuring that data regarding sex, gender, and sexuality is collected and utilised to guide policy and practice is fundamental.6
By taking the first step, asking the right questions, and by ensuring that accurate information regarding sex, gender, and sexuality is sensitively collected and used in the context of clinical practice we can begin to both understand and account for diversity within our population. Normalising questions about sex, gender, and sexuality can give GSD people more confidence to self-identify and helps governments, organisations, and communities create genuinely inclusive spaces and services. This opens the door to meaningful engagement with communities like the GSD community. This helps us better understand their needs and improve healthcare delivery and outcomes. By collecting this data and responding to it, we are not just acknowledging these voices—we are ensuring they are heard, valued, and that they truly belong to the larger community.
Clinton Fildes is a Lecturer in Nursing based in Clinical and Health Sciences, and a member of the Rosemary Bryant AO Research Centre, University of South Australia.
Chantal Brown is a Registered Nurse based in the Lyell McEwin Hospital Emergency Department, Northern Adelaide Local Health Network.
Associate Professor Micah DJ Peters is the Director of the ANMF National Policy Research Unit (Federal Office) based in the Rosemary Bryant AO Research Centre, Clinical and Health Sciences, University of South Australia.
References
1. Tingle L. LGBTQI+ questions government scrapped from 2026 census revealed. ABC News [Internet]. 2024 Sep 6 [cited 2024 Sep 12]; Available from: https://www.abc.net.au/news/2024-09-06/2026-census-questions-revealed/104321662
2. Worthington B. Jim Chalmers confirms census will include questions on sexual orientation and gender. ABC News [Internet]. 2024 Sep 8 [cited 2024 Sep 10]; Available from: https://www.abc.net.au/news/2024-09-08/census-sexual-orientation-gender-to-be-included-jim-chalmers/104325074
3. Australian Bureau of Statistics. Analysis of non-binary sex responses [Internet]. Canberra: ABS; 2022 September 27 [cited 2024 September 12]. Available from: https://www.abs.gov.au/articles/analysis-non-binary-sex-responses
4. Kruse MI, Clarizio A, Karabelas-Pittman S, Bigham BL, Upadhye S. Systematic Review, Quality Assessment, and Synthesis of Guidelines for Emergency Department Care of Transgender and Gender-diverse People: Recommendations for Immediate Action to Improve Care. Western Journal of Emergency Medicine. 2024;25(1): 94.
5. Ziegler E, Slotnes-O’Brien T, Peters MDJ. Cancer Screening and Prevention in the Transgender and Gender Diverse Population: Considerations and Strategies for Advanced Practice Nurses. Seminars in Oncology Nursing. 2024;40(3):151630–0.
6. Australian Commission on Safety and Quality in Health Care. Person-centred Care [Internet]. Australian Commission on Safety and Quality in Health Care. 2024 [cited 2024 Sep 14]. Available from: https://www.safetyandquality.gov.au/our-work/partnering-consumers/person-centred-care
