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Key points
- Fat people can get pregnant relatively quickly and have healthy babies.
- Fat phobia is one of the main hurdles for fat people seeking respectful, adequate fertility and pregnancy care.
- Every additional year that fat people are denied appropriate tests and treatment, the probability that they’ll get pregnant decreases by 3.5%.
We have been interested in fat-shaming that happens to primarily cis-females in medicine but especially from pre-conception through postpartum stages. Bethany and Maggie have been interested in the history of fat-shaming and how it frames most bodies as “wrong” despite no proven causal links between fatness and health status.
Erin and Maggie have been researching patient-practitioner communication related to fat-shaming, especially memorable messages women experience. In an article under review based on a survey of 237 women, we found four themes: fat mothers are bad mothers, denial of competent treatment, weight normative commentary on fat bodies, and weight-inclusive counternarratives. Our findings illuminate the significance of patient-practitioner communication across the pregnancy trajectory. We highlight how medical providers and researchers can use our findings to inform practice.
Nicola Salmon and fat fertility
Erin and Maggie had the amazing opportunity to connect with Nicola Salmon, whose fat fertility activism has inspired us. Our conversation inspired a follow-up interview. Nicola is a fat-positive fertility coach and author of Fat and Fertile: How to Get Pregnant in a Bigger Body. She helps fat folks navigate getting pregnant in a weight-obsessed world and she advocates for change in how fat people are treated while accessing help with their fertility.
As a person with polycystic ovary syndrome (PCOS), she was told that she wouldn’t be able to have children. She said, “When I got pregnant, I spent my whole pregnancy anxious that everything would go wrong because that’s what our culture conditions us to believe about fat pregnant bodies.”
Her advocacy began when she was determined to have a water birth and was rejected by her midwife. From then on, she felt more comfortable disagreeing with practitioners and advocating for better, less fat-phobic care.
We asked Salmon if she initially pursued a water birth at home because of previous negative experiences with the medical system. “Not on a conscious level, but looking back now I can see that I was definitely trying to avoid being stigmatized during my births. Unfortunately, that's what happened during both my births with birth choices being ultimately denied.”
Myths and misconceptions about conception in a fat body
She discussed some myths and misconceptions about conceiving in a fat body. She said, “Our culture tells us that it’s harder for fat folks to get pregnant, and it’s irresponsible for us to do it! The research actually shows that it takes about a month longer for folks with a higher BMI (Body Mass Index) to conceive. Folks of all body sizes need support with their fertility and sometimes conditions like PCOS and hypothyroidism can lead to folks gaining weight alongside their other symptoms. Increased weight can be a symptom but is not a cause of these conditions. Fat folks can have higher incidences of complications during pregnancy. However, the risk is still relatively low (for example, 90% of folks with high BMIs don't get gestational diabetes) and can be well managed. This should not be used as a reason to deny folks fertility care. People who want to get pregnant should be given all the information about the potential risks and then they should be able to decide what they want to do. The decision around their own healthcare should not be taken away by doctors.”
How does fat-phobic medical education make fat fertility such a struggle?
We were interested in how medical providers are also peddling bad science and not staying updated on the research. Fertility practitioners with no training in HAES (Health at Every Size) and similar modalities are not equipped to support fat patients.
Based on her research and advocacy work, Salmon provided some advice for medical providers (e.g., infertility and REI providers, OBGYNs, and primary care). She explained: “I wish they knew that they are actively causing harm to people with the way that they treat fat people who are navigating fertility spaces. They are not ‘being cruel to be kind,’ they are not ‘motivating’ people with their words. They are traumatizing people with their care and denying them their human right to be supported in growing their family.”
Salmon argues: “The lived experience of fat folks must be the center of how we talk about fat fertility, but the science also backs us up. Weight stigma (the bias that fat folks face about their weight) not only creeps into conversations that doctors have with their patients but into how doctors are trained (or not trained on fat folks), and how scientists perform and share their research (even something as basic as a pregnancy test) is not designed with a fat person in mind. Pregnancy tests tend to work less effectively in fat folks, likely because we have a higher total volume, leading to a lower concentration of hormones in our blood. Whilst this sounds like a small thing, it can have huge implications for folks, especially for folks navigating fertility treatment and abortion care.”
We wanted to end with a powerful story from her advocacy work: “I worked with one client who had been denied fertility treatment for over 10 years. She wanted to try and access private care one last time but struggled to find a clinic that would support her. We created research-backed arguments for every reason they had to deny her care. She and her partner went to their local fertility clinic, armed with the research, and influenced them to reverse their BMI policy and offer them access to treatment for the first time.”
If you are interested in finding fat-positive healthcare clinics and practitioners, Salmon is continuing to research them. She said, “It’s the systems that we need to fix, not the fat folks, and it’s not fair that fat people must seek out people like me to support them in navigating fertility care. I want to put myself out of business, so every fat person has all the choice and support they need to grow their family in a non-stigmatizing way.”
Perhaps the biggest hurdle to folks with higher BMIs is that being told to lose weight before trying to conceive contributes to infertility because weight loss (while almost never successful in the medium or long-term) takes time, and as time progresses, the likelihood of infertility does as well. As the below studies suggest, “for every additional year that fat people are denied appropriate tests and treatment, the probability that they’ll get pregnant decreases by 3.5%.”
Dr. Erin Basinger is a guest author on this column. She studies stress, coping, and health at the University of North Carolina at Charlotte, and she had a successful fat pregnancy, giving birth to a baby boy in June 2021.
References
Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost A.T., & Gulliford, M.C. (2014). "Probability of an obese person attaining normal body weight: Cohort study using electronic health records.” American Journal of Public Health, 105(9), e54-9.
van Noord-Zaadstra, B.M., Looman, C.W., Alsbach, H., Habbema, J.D., te Velde, E.R., & Karbaat, J. (1991). “Delaying childbearing: Effect of age on fecundity and outcome of pregnancy.” British Medical Journal, 302(6789), 1361-1365.
