On this episode of Fat and Fertile, I describe the ethical dilemma many fat folks face when they start out on their fertility journey
We explore how the belief that it’s dangerous for us to get pregnant impacts our daily life and we dive into the research around the ethics of getting pregnant in a bigger body.
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Today we are going to be exploring the ethical dilemma around getting pregnant in a bigger body. We are going to be looking at it from two different perspectives.
The first is the belief that you might hold around getting pregnant in a bigger body. After that, we’ll dig into the ethical dilemma that doctors and fertility clinics will often mention when they try to justify denying fertility care and treatment to fat folks.
Let’s start with the belief that you might have around being a fat person who wants to get pregnant. You might think things like:
- “It’s wrong for me to get pregnant at my size.”
- “It’s irresponsible to try and get pregnant in a bigger body.”
- “It’s dangerous for you and baby to try and pregnant at your current size.”
- I’ll be a bad parent already if I get pregnant now.”
When so many people tell you it’s wrong for you to do something, it doesn’t take long for you to take on that belief yourself.
And all these thoughts ( and they are thoughts not facts) might:
- mean that you postpone trying to get pregnant until you’ve lost weight
- actively avoid getting pregnant even though you want to start your family now
- seek to terminate a wanted pregnancy for fear of the consequences of continuing in.
None of these actions are bad. They are all understandable in a world that tells us that fat people shouldn’t get pregnant.
Your brain and your body are protecting you from a perceived risk and it makes total sense. If you believe that it’s dangerous for you to get pregnant then, whether consciously or unconsciously, you will avoid taking action that will get you closer to your goal.
But where do these beliefs and thoughts come from? We aren’t born believing that fat people shouldn’t get pregnant. It’s something that we are conditioned to believe from the culture that we live in.
These ideas are based on the foundational belief that fat is bad and all fat people are unhealthy. But we know that this idea is outdated and not based on any robust science.
Unfortunately our understanding of the body and science is only as good as the people who are doing it. We all live in this soup of diet culture where we are told that thin is right and fat is wrong. That fat people can never be healthy which is why would people who are researching topics around fertility and pregnancy already start with this foundational belief that they will find something wrong.
We are going to dive deep into the perceived risks around pregnancy and fertility later in the season but it’s safe to say that
- The research is not black and white – it’s not the case that ALL the evidence shows that BMI increases the risk of complications occurring and there have been no biological mechanisms found to explain these proposed risks
- It never takes into account the lived experience of being a fat person and how our bodies respond to the anti-fat bias that we face from society and healthcare
- It’s your body, your choice. You get to decide what happens to your body, you get to weigh up the benefits vs the risks and make a decision about whether that benefit is worth the risk involved. A dr should be there to offer their knowledge and clinical experience, not make that decision for you. I know that that doesn’t always happen and our healthcare isn’t often framed in that way but ultimately they require your consent. I just want to recognise that having these conversations isn’t always easy. As much as it’s Technically right that you get to decide – in reality it doesn’t always work that way. Drs are used to having a power over their patients and we as patients have been conditioned to do what we are told. We have to consider our safety in those situations – especially for folks who are more marginalised, it may not feel safe to question your dr and that doesn’t mean that you don’t deserve the same level of healthcare, it’s a shitty situation and your safety must come first
So what can you do instead?
What if you believed that it was safe for you to get pregnant? What is you believed that you were worthy of choosing when you grew your family, just like folks in smaller bodies choose?
What would be different in your life if you allowed yourself to believe that getting pregnant was a possibility for you without having to diet and lose weight?
Let’s shift gears and think about the ethical dilemma that fertility clinics and drs use when they want to deny folks care based on their BMI. It’s based on similar assumptions around fat – unhealthy but there are also two other components sneaking in
- The first is money – For publically funded services such as the NHS in the UK, people in charge of spending often needs to decide where the money goes and fat people are the socially acceptable way to reduce access to treatment. This impacts about a third of people accessing treatment in the UK.
- The second is efficacy. For private companies, they will often use their success rates as a marketing strategy to attract more clients. There is a perception that fat folks have less success with fertility treatments (we’ll dig into this later in the season) so many clinics cherry pick their clients and decide not to offer treatment to fat folks.
There are a few great research papers out there that explore the ethics around denying fertility care to fat folks ( if you are interested in the studies, you can download the fully referenced research summary for free right here.)
In 2010 Pandey wrote a debate brief for Human Reproduction looking at the arguments for denying access to fertility treatment based on BMI. They concluded that all the arguments used for excluding women based on their BMI had a poor quality of evidence to back them up.
Brown of Oxford University wrote a great paper in 2019 entitled “Irresponsibly Infertile? Obesity, Efficiency and Exclusion from Treatment” Brown goes into great detail to look at the possible justifications for denying people with a higher BMI fertility treatment, coming up with the conclusion each time that it doesn’t make sense to deny folks care based on their body size.
The final words I’d like to leave you with come from a debate by Koning entitled “It is not justified to reject fertility treatment based on obesity”
When discussing risks for the woman, they highlight that there are no additional risks for women when undergoing IVF, they found higher risks associated with pregnancy complications. They argue that, although the risk is higher, “it does not mean that it is irresponsible to take that risk” and that “a competent and well-informed woman, in principle, has the right to her own deliberation when considering risk taken for herself”
There is no ethical dilemma when it comes to the rights of fat folks.
