* Trigger warning: mentions of fatphobia in the medical community.
* We are using the term “fat” as a neutral term and adjective.
Reproductive freedom means that everyone can access quality, dignified reproductive healthcare that is free of judgment. But fatphobia in the reproductive healthcare community keeps many people from seeking the care they need, from abortion to IVF.
Fatphobia, or anti-fatness, occurs when fat* people are shamed and de-humanized simply because of their weight. Fatphobia supports the false notion that fat people are less “healthy” than thin people because of their weight, even though weight doesn’t determine health.
For centuries the medical community has defined health largely based on the perceived notions of what health is and isn’t–notions that are influenced by white supremacy, fatphobia, and Western ideas of beauty. Fatphobia is a product of white supremacy and racism, rooted in misogynistic modern and colonial notions that thinness reflects self-discipline and whiteness. Modern ways of measuring health like the Body Mass Index stem from these white supremacist notions. The BMI was created in the 20th century by a white man and has never been an accurate way of determining overall health.
Fat people have been discarded from medical and reproductive healthcare dialogues throughout history and continue to be left out of its narratives. Because of this, growing fatphobia and anti-fat stigma are challenges fat people face when they seek healthcare. And, when the average size in the US is a size 16-18, this means many people are facing stigma when they go to the doctor.
A barrier to healthcare emerges when fat people are discriminated against, shamed, and punished in doctor’s offices and avoid seeking healthcare they need because of fear of being mistreated by medical professionals. In healthcare settings, stigma can be perpetrated in many ways. It can be perpetuated when fat people’s pain and health concerns aren’t taken as seriously as thin people or when medical professionals fail to listen to the actual complaints of fat people and instead blame any health problems on their weight.
Access to reproductive care is also challenged when medical professionals refuse to treat fat people. When it comes to reproductive healthcare, fat people are often denied access to healthcare services or procedures based on their weight. Half of America’s 20 largest fertility clinics fail to provide IVF or other fertility services to people they deem “obese.” And when women with a specific BMI (usually over 35 or 50) come in to be treated, many doctors tell them to lose weight in order to receive treatments, even if they have no preexisting health conditions (and even if they did, they should still be able to have children if and when they want to). Furthermore, the idea that fat and pregnant people have high-risk pregnancies is false. There are more complicated factors that determine high-risk pregnancy, such as barriers to care like poverty, class, and race.
Even Plan B discriminates. It is less effective for people over 166 pounds and has a high failure rate for those over 176 pounds. Abortion care discriminates, too. Fat people have been denied abortions because of their body size. Many providers will refuse to perform an abortion on a fat body, limiting access to abortion for anyone above a certain weight threshold, even though the risk of complications for fat and thin people is relatively the same. Weight stigma does nothing but produces stress and shame for those seeking healthcare. Since fat stigma is a barrier to reproductive healthcare, it’s no wonder that fat people aren’t getting the care and treatments they need.
Reproductive freedom is for everybody–regardless of weight. Fat people deserve to feel safe in their bodies when seeking medical care. When fat people are denied medical care based solely on their weight, this is discriminatory and keeps them from accessing healthcare services like IVF or abortion.
Better healthcare outcomes and accessibility start with seeing fat people as human and combatting anti-fatness in our day-to-day lives. This means listening to fat people, educating yourself, ensuring everyone gets the care they need and supporting everyone along the way. Medical practitioners should be trained against fatphobia and learn about how health, weight, and other socio-economic factors come into play when seeking healthcare. More studies need to include the effects of reproductive medication on fat people, and more fat people’s voices need to be included in medical studies and policies related to healthcare.
Giving fat people equal access and dignified treatment to reproductive healthcare is reproductive freedom. Fatphobia and weight stigma (not weight itself) lead to worse outcomes for patients and pregnant people. Fat people deserve comprehensive, dignified, accessible healthcare free from judgement, period.