“We tell fat people they are infertile, when that is completely false”

When faced with the desire to have a child or during the follow-up of the pregnancy, pregnant women endure discriminatory words and gestures. “Violence in the medical environment pushes fat people to avoid healthcare. They are accused of being in poor health, but a major cause is likely to be a lack of access to compassionate care, as they wait until the last moment to consult.”analyzes Aline Thomas in her book Get on the scale first!. Of the 800 testimonies collected on medical fatphobia, half concerned gynecology.

He received ideas about fertility

“Fat bodies are considered non-functional. From adolescence onwards, fat people are told that they will not become mothers, that they are sterile, when this is completely false.reports Daria Marx, co-founder of the political association Gras.

For Maya⁽¹⁾midwife and member of the Pour une MEUF association, “Weight can impact fertility and cause ovulation disorders, but like many other things. » Sometimes amalgam is also performed with women suffering from polycystic ovary syndrome, which causes weight gain, but which is also the most common cause of infertility.

Exclusion from the PMA

Based on this preconception, the CECOS (Centres for the study and conservation of human ova and sperm) mainly refuse applications from women with a BMI above 30, preventing them from resorting to assisted reproduction. “We advise fat people to go on a diet or undergo bariatric surgery, we make them feel guilty” denounces Daria Marx, author of the book Ten questions about fatphobia. “It is easier for them to exclude us, because they are not trained in the technical insemination procedures intended for thin bodies and do not have adequate equipment”, points out. Another explanation for these reluctances: Health professionals think that fat people’s pregnancies will be more complicated to follow.

Anxious follow-up

When a fat woman gets pregnant, the fatphobia continues. A study by the Clinical Ethics Center of Cochin Hospital⁽²⁾published in 2018, proved it “the relationship with the gynecologist has deteriorated from a routine check-up following pregnancy, and from following pregnancy to an assisted reproduction process, as if motherhood allowed women to feel guilty, and the desire for motherhood even more so. » Sylvie Benkemoun, psychologist and president of GROS (think tank on obesity and overweight) which commissioned this study, deplores this observation: «During pregnancy there may be difficulties (gestational diabetes, etc.), but they can be accompanied, this does not justify the feeling of guilt. Especially since stress is not good for ovulation. »

For Maya, “We need to change the way we talk to patients about risks, but also stop weighing them systematically. Caregivers give them weight goals to achieve, although these recommendations are unreliable because they are based on observational studies. This weighing most of the time has the opposite effect and can reactivate eating disorders”warns. “Weight gain during pregnancy is a risk factor, but, among many others, this does not mean that the pregnancy will necessarily be complicated,” says Maya.

Actions during support can turn violent. “With a lot of adipose (fat) tissue present, healthcare workers have a harder time seeing the baby during the ultrasound because they use low waves. The sonographer then pushes a lot, and often with rude comments. This first consultation may discourage the expectant mother from returning.”observes Aline Thomas. “ Statistics show that fat women are more likely to have complications, but these figures do not show the incidence of poor care »he adds.

Fatphobia also impacts people who have undergone bariatric surgery (which changes the way food is absorbed by the digestive system), because they can sometimes remain silent, without knowing that this peculiarity requires adequate follow-up.

What solutions?

“Carers must be trained to take care of obese people, to support them rather than want to warn them,” believes Sylvie Benkemoun. And invest in appropriate equipment: armband, stretcher, armrests, sensors... Aline Thomas cites a positive example: “at the Delafontaine hospital in Saint-Denis (93), they invested in equipment and doctors were trained on the specifics of large bodies. But accommodating patients means accepting that they will remain fat, and most doctors still have difficulty doing that. »

That too is necessary for her “Medical research is interested in the complexity of different discriminations, fatphobia is often left aside. » Daria Marx adds: “The feminist movement must address fatphobia and anti-validism, these struggles must converge to achieve access to care for all. »

⁽¹⁾nickname used by the people of the Pour Une MEUF association

⁽²⁾Do the conditions of access to gynecology, obstetrics and antiretroviral therapy for “significantly overweight” women raise ethical questions? Exploratory survey among interested women and their gynecologists Perrine Galmiche, Cynthia Le Bon and Véronique Fournier – from the Center for Clinical Ethics of Cochin Hospital.