At the Intersection of Fatness & Reproductive Justice

I am fat and I have been fat for a very long time. According to some people, the word “fat” is the very worst thing we could be. I admit, sometimes I have thought that, too. In an extremely fatphobic society, who would want to submit themselves to additional marginalization? I am fat, but sometimes I don’t want to be called fat, because to be called fat feels as if I’m accepting the very real negative outcomes that infiltrate nearly every aspect of our society. 

We often think about “fat” only in terms of appearance, relationships, sex, or food. We have ideas about who is fat and why they are fat. We question what they could, should, and would do about not being fat if they really tried, if they only had as much willpower as thin people. We know these things because many of us (even fat people) believe them to be true. These beliefs hurt, of course. They reduce us to a body, pass judgements of our willpower and capabilities upon first glance, and inflict feelings of shame and guilt upon us. All of that is difficult to cope with. 

What many non-fat people don’t realize is that the fat experience is so much more than people making fun of us or telling us to lose weight. It’s employers discriminating against us. It’s getting sexually assaulted but people not believing us. It’s negative experiences with health care providers, even reproductive health care providers.

As a fat person, I can personally attest to doctors hyper-focusing on my weight versus the issue at hand. Instead of digging deeper or offering other solutions, doctors often hit me and my fat friends with their cure-all: “lose weight.” Being dismissed and judged so many times makes going to the doctor challenging. As a result, we might avoid going altogether: fat people are less likely than thin people to receive preventative health care or cancer screenings, including pap smears and mammograms. Despite being more likely than thin people to develop and die from cancer, embarrassment, anxiety, and fear of weight bias can keep us from caring for our health. 

Beyond just interactions with medical professionals that might keep us from seeking vital gynecological care, important services like emergency contraceptives or birth control appear to be researched, designed, and provided with thin individuals in mind. For example, emergency contraceptives like Plan B, Take Action, and My Way won’t work as well for people over 165 lbs. And even though there’s an alternative called ella that works for people up to 195 lbs., this weight is nowhere near inclusive of fat people looking to protect themselves from unplanned pregnancy. As a fat person who feels the effects of fatphobia every day, I can’t help but wonder if this is by design: There’s this notion that “thin” is the default, that thinness is a possibility for everyone. That notion already informs clothing and seat size, for example. Is it too much to ask that fatphobia be left out of medicine?

 (NOTE: Most forms of birth control are thankfully not impacted by weight. However, the birth control patch might also be less effective for people weighing more than 198 lbs.)

 For my friend considered “obese” by BMI (a largely over relied upon and inaccurate measurement of health) who was seeking fertility treatment, the first thing they told her to do was lose weight. I remember how much grief, shame, and fear she felt already; how infertility blame so often falls on the birth giver, and how much those feelings were exacerbated by doctors who added yet another reason why infertility was “her fault.” She did lose weight, and yet, her fertility treatments continued on for over a year. My friend’s experience, sadly, was not a singular one: For those struggling to conceive, over half of the 20 largest clinics in the US have a policy against providing in-vitro fertilization on individuals deemed “obese” according to BMI. If someone turns to a fertility clinic and happens to be fat, it’s possible doctors will prescribe weight loss at first glance, even when other forces could be at play. 

Doctors also push pregnant fat people toward C-sections and warn them of dangerous conditions like blood clotting, preeclampsia, or gestational diabetes. Many doctors even encourage them to lose weight during pregnancy despite the majority of fat pregnant people who give birth complication-free. The belief that fat people can’t sustain healthy pregnancies, or even simpler, that fat people can’t be healthy interferes with adequate health care free of assumptions about someone’s health at face value. Fat people deserve to have pregnancies and births without medical professionals evaluating their fitness to carry a pregnancy, give birth, and parent without adequate warrant. 

Fatphobia has its roots in racism, and yet, we’ve found a way to spin anti-fatness to be innocently “caring about people’s health.” If we really cared about people’s health, we’d realize that experiencing weight-based discrimination is inherently unhealthy: Studies have found that the harmful effects of weight-based discrimination resulted in a 60% increased rate of death, even when BMI was controlled for. It’s exhausting, and frankly, ableist, to inundate fat people (and everyone) about “health above all,” when health isn’t always a choice. Health does not equal discipline or look a certain way, and it most certainly isn’t a prerequisite for people, especially medical providers, to treat us with respect. 

Ultimately, my fight for reproductive justice and fat liberation are based on the same premise; that people deserve bodily autonomy. In a society where we are constantly expected and shamed into wanting to change our bodies, and where there are real, tangible repercussions to simply existing in a fat body, how much bodily autonomy can we really have? 

I urge my non-fat friends to think about their bodily privilege, to think before they complain of “feeling fat,” and to challenge their beliefs about fatness when they see a fat person in front of them. This is work that I, a long-time fat person, am still doing. It will be hard. But here’s what I believe to be true. There can be no reproductive justice until all bodies are deemed worthy of reproductive care, until all bodies are provided with equal opportunities to protect themselves from unwanted pregnancy, and until all bodies can visit the doctor’s office without fear of their fat being the first and only thing their doctor sees.