How Anti-Fat Bias Shows Up in Reproductive Healthcare
by Isabelle (she/her)
Anti-fat bias shows up in many different areas of our society. “Victoria’s Secret models average in at size 4, while the average American population is wearing a size 16–18. Whether it’s the fat, funny sidekick friend, who somehow never finds love, or the straight-up portrayal of big bodies as disgusting, pop culture constantly shames and belittles plus-sized bodies. There is an institutional bias against bigger people that creates and perpetuates stigmas against anyone over a deemed “desirable size” This is an institutional bias born out of European colonialism and anti-Blackness. At every turn, the degradation of large bodies, and the romanticization of diet culture is shoved down the throats of consumers. This hate and obsession with devaluing bigger bodies does not end with low self-esteem for fat people, but it can actually affect the quality of the healthcare they receive.
It is well known that anti-fat bias has made a name for itself in healthcare. In the past, there has been a lack of medical attention and research focused on bigger people. Instead, being heavy has been written off as generally unhealthy. Many people considered “overweight” have found that their doctors don’t listen to their concerns about their health. Instead, they are met with oversimplified advice to “lose weight and it will get better,” dismissing potentially serious problems. Some people eventually avoid seeing a doctor due to the experience of feeling “so readily disregarded, so lazily misled, and still feeling so ashamed.” Anti-fat bias within healthcare institutions has led to dangerous situations, including undiagnosed or misdiagnosed medical conditions.
Possibly the most underrated threat to plus-size people is how anti-fat bias affects reproductive healthcare. The research needed to provide plus-sized people with the correct information they need has been pushed off for years and the little research available is often ignored. Either way, the little data that there is on reproductive care for people who are not considered thin or “normal” weight is not enough to provide accurate care. This is concerning considering that in the United States alone, “roughly two out of three U.S. adults are overweight or obese (69 percent) and one out of three are obese (36 percent)”, data also shows that “if U.S. trends continue unabated, by 2030, estimates predict that roughly half of all men and women will be obese”. All of these bigger people deserve to have access to reproductive healthcare. Fat people should be able to trust their doctors when it comes to their personal health.
When looking specifically at reproductive healthcare, it is easy to see that larger bodies are treated as an afterthought. Anti-fat bias in reproductive healthcare is most prevalent when it comes to birth control and emergency contraceptives, like Plan B. According to a study done on Obesity and hormonal contraceptive efficacy, oral contraceptives, and contraceptive patches have been shown to have increased failure rates in people with higher BMIs. This means bigger people taking contraceptives are at a higher risk of unplanned pregnancy compared to thin people. This is because these birth control methods were not designed with big bodies in mind. When it comes to emergency contraceptives, data has shown that there is a weight limit. It has been found that for women* who weigh over 155 pounds, Plan B may not work — even though the average weight for women is much higher than 155 pounds. This information, however, is not common knowledge among patients or prescribers and the FDA hasn’t made any changes to Plan B or its label prescription recommendations. There is also another emergency contraceptive called Ella but it has a 195-pound weight limit, which is similarly missing on the label, and you need a prescription for Ella emergency contraception, making it inaccessible for minors and those without health insurance. This means that heavier people are using contraceptives with the belief that they are equally protected. This explains why, the risk for unplanned pregnancy is 3 times higher for people who are heavier when compared to people who are thinner and that risk was even higher when it came to Plan B.
Unplanned pregnancy means a higher demand for abortions. This is why, yet again, the complete legalization of abortion is needed in the United States. Abortion is a reproductive health service that bigger-bodied birthing people, like all other birthing people, may have to rely on. Since the passage of Roe v Wade, anti-abortion lawmakers across the United States have attempted to pass restrictive abortions bans, like Texas’ recent six-week abortion ban. These bans perpetuate the stigma surrounding abortion, only adding to the shame that bigger people feel when they interact with reproductive healthcare. Abortion access is a crisis that affects too many people nationwide and bigger-bodied people are no exception. Anyone who is seeking an abortion should have complete autonomy over their body and be able to obtain an abortion with dignity and respect.
Anti-fat bias causes an enormous amount of issues for plus-sized people when it comes to reproductive rights. The rhetoric perpetuated by pop culture that bigger bodies are undesirable, unhealthy, and unworthy significantly contributes to the abuse of plus-size people. This leads to mistreatment, misdiagnosis, and misinformation when it comes to contraceptives and protecting against unplanned pregnancy for fat people. That, in turn, means more fat people turning to abortion and having to face many obstacles that restrictive abortion laws bring. Bigger people are habitually left feeling invisible and unheard in regards to their reproductive rights. This is due to a lack of attention, care, and research spent on anyone who is not considered a “healthy” weight. Anti-fat bias shows up in reproductive healthcare and it can no longer be ignored because so many plus-sized people are at risk.
*Not just women have the ability to get pregnant and need access to Plan B, but usually, only cis men and women are included in reproductive health studies, such as this one.
