When Ahlia* was waiting to check in for a routine pregnancy appointment, she says a receptionist walked by calling out directions to gestational diabetes education – then looked at her, waiting for Ahlia to follow.
“I’m not here for that,” Ahlia recalls saying in front of the waiting room full of people.
It was not the first time she’d faced assumptions about her and her baby’s health based on her body size alone.
Ahlia has had three healthy pregnancies with normal blood pressure and glucose levels, no pre-existing conditions and a nutritious diet – yet she has consistently come up against weight stigma.
At her GP appointment after she became pregnant with her second child, she expressed an interest in a water birth. “The GP just laughed in my face and told me that would never happen.”
Health guidelines for a water birth mention “excessive” weight as a risk only because of the need to ensure a woman in labour can be moved out of the water in an emergency.
Ahlia worked on a care plan with her midwife, including safety planning for her partner to be able to lift her out if needed, which was signed off by the consultant doctor.
But when she arrived at the hospital in labour and asked for the bath to be put on, Ahlia says the midwife on duty looked at her and said they would have to “just see about that”.
This delay initiating Ahlia’s labour plan led to what she describes as “a bit of a traumatic birth”.
The fear for her baby’s safety was “horrible”, as was her feeling none of this had needed to happen the way it did – and that her needs had been “ignored” based on judgments about her body size.
Weight stigma is already more prevalent towards women. Women during preconception, pregnancy and postpartum are particularly vulnerable – and weight stigma has been shown to have negative health outcomes for mother and child.
But a study published in the journal Health Psychology Review earlier this year proposes a new model for reducing weight stigma around pregnancy.
Dr Briony Hill and PhD candidate Haimanot Hailu, from Monash University’s School of Public Health and Preventive Medicine, led the study. Hill says society’s punishing beauty and behaviour standards for women extend directly to this form of “mum shaming” – “blaming mothers for their weight and their body size, thinking that it’s making them better by shaming them”.
“In reality, we are not 100% individually responsible for our weight, our body size, our body shape, because it’s mostly genetically determined,” Hill says. “Eliminating weight stigma is about looking at the person as a whole, rather than just making assumptions about them purely based on their looks or their body size.”
The authors noted stigmatisation begins with labelling women at a higher risk of infertility or pregnancy-related complications due to their body size.
Negative impacts of weight stigma around pregnancy include avoiding engaging with healthcare, psychological stress, reduced motivation to engage in healthy behaviours and disordered eating – which themselves can contribute towards maternal obesity.
Other examples discussed in the study were societal expectations around “ideal” weight before becoming pregnant, negative remarks about gestational weight gain, and pressure to “bounce back” to pre-pregnancy body weight.
Dr Gillian Gibson, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Ranzcog), says while there are pregnancy risks associated with both a low or high BMI, “Ranzcog acknowledges the importance of providing all women with care that is free of stigma and prejudice/discrimination”.
“An assessment of a woman’s overall health and wellbeing, including factors such as weight, is more complex than determination by a single indicator such as BMI,” Gibson says.
While healthcare is one of the biggest areas where weight stigma presents, Hill says clinicians’ behaviours stem from societal norms – which are the root cause that need to be tackled.
Beyond increasing public awareness about obesity factors, the study’s model proposes several interventions. These include tackling the normalising of weight stigma such as “over-medicalisation of obesity”, as well as equipping professionals to improve communication skills around the issue, and ultimately targeting structural stigma through strategies such as inclusive healthcare policies.
Dr Fiona Willer, the vice-president of Dieticians Australia and lecturer at the Queensland University of Technology, praises the Monash researchers’ model for addressing of the broad scope of precursors to weight stigma for this demographic in particular. She says the study addressed the prejudicial and stereotypical ideas health professionals hold: “That is how they end up delivering the care that they deliver, that’s subpar for large-bodied women.”
“I do agree with [the study’s] position that in trying to ‘help’, there are all of these unintended consequences, and it’s actually those consequences that we need to pay very close attention to if we’re wanting to do care better,” Willer says.
Willer says campaigns that simply say “stigma is bad” can have the opposite effect, opening the door to further stigmatising attitudes and beliefs.
“The kind of intervention that is effective for reducing stigma is making visibility of the people who have got these stigmatised characteristics, making those people much more visible in positions of power, making decisions, fully integrated into the system.”
*First name only used for privacy reasons.
