Applying Fat Liberation to Pregnancy Loss: A Personal Account with Shira Collings, LPC
October is Pregnancy Loss Awareness Month, which is a very common experience for many folks no matter their body size or health status. However, the medicalization of pregnancy and pregnancy loss can compound on the general medicalization/problematization of bodies, and fat bodies in particular. I wanted to spend time on this topic to show how a truly fat liberation lens (which includes disability justice and body autonomy) can help individuals and providers navigate pregnancy loss with more depth, care, and respect.
This is a tender topic, and we are not suggesting folks do not seek medical interventions for pregnancy loss or fertility struggles. Some bodies do indeed have underlying health conditions needing medical attention, and some pregnancy losses can be life threatening. Folks in larger bodies in particular can face barriers to seeking fertility care, such as BMI cutoffs for IVF, costly referrals to specialists, and generally being considered “high risk” due to weight. These experiences of medical gatekeeping and weight bias have similar impacts as we are mentioning below: viewing the body as a problem you are personally responsible for. While many aspects of fertility struggles share similar emotional experiences, and certainly experience the same anti-fatness, we chose to focus on pregnancy loss because it is overlooked even within fertility or fat liberation spaces.
One more caveat- below we are talking about the pregnancy loss that comes after intentional efforts to become pregnant. These experiences may be different from people who have terminated “unwanted” pregnancies. These experiences may also differ from people who have had to terminate “wanted” pregnancies as well. There are ways fat liberation overlaps with these issues as well (like the weight limit on emergency contraceptives for instance), and that will have to be for another blog. Both myself and Shira are staunch advocates for reproductive justice.
Below is a personal account of how anti-fatness can shape discussions of pregnancy loss and contribute to body disconnection.
Shira Collings LPC is a therapist focused on body liberation (https://www.rachelmillnertherapy.com/shiracollings), and below she shares her experience of pregnancy loss with this framework of how medicalization de-personalizes and problematizes bodies. While Shira is straight sized, she brings her fat liberation lens to her experiences.
Shira, can you share what you mean by the medicalization of pregnancy loss?
Through my own experiences of pregnancy loss, I have noticed that our culture tends to treat pregnancy loss as primarily a medical problem or moral failing rather than a loss. It seems that most people are quick to ask questions about potential medical or lifestyle causes and much less likely to check in about how a pregnancy loss parent is feeling emotionally. This can send a message that the parent’s body is the problem, that it is broken and in need of fixing.
The fat liberation community often talks about how anti-fatness shows up in their medical appointments, with most folks experiencing things like a focus on their weight instead of exploring the actual problem they are coming to the doctor for. How does this connect to pregnancy loss medicalization?
This can have a significant impact on relationships with food and body. We live in a culture where we are relentlessly bombarded by messages that our health is determined almost exclusively by our weight/shape, eating, and exercise, and that if we are experiencing a medical problem then it must be the result of poor habits. The medicalizing of pregnancy loss in combination with our culture’s healthism and anti-fatness can leave pregnancy loss parents scrutinizing our own bodies and eating as well as feeling scrutinized by others. It is all too common that we begin to blame our weight, shape, eating, or movement habits for our losses, which can quickly spiral into disordered eating. This is especially true for fat parents.
This is of course compounded by anti-fatness in medical care. Pregnancy loss is commonly attributed to fat people’s weight without exploring non weight related causes, and weight loss is frequently recommended as a first line of defense, or even required for people to access fertility treatments. Healthcare professionals rarely consider the impact this might have on someone who is already struggling with a high degree of grief and loss, and who may have a pre-existing eating disorder or complex relationship with food and body.
If you could speak directly to medical providers or mental health professionals on this issue, what would you recommend?
As providers, we need to make fat liberation a part of our conversations around reproductive loss. We need to be aware of how the cultural view of pregnancy loss as primarily a medical issue or failure of the body may reinforce loss parents’ already existing shame and mistrust of their body. We need to talk about the ways that anti-fatness in reproductive healthcare can put not only fat people but all people with challenging relationships with food and body (which is most likely everyone, considering we all grow up in a profoundly anti-fat culture) at risk of disordered eating.
I would recommend that both medical providers and mental health professionals check in with patients who have experienced pregnancy loss about how this may be impacting their relationship with food and their bodies. It is important to be able to recognize the signs of disordered eating and debilitating body image distress, and to understand the importance of providing support or offering a referral for this to people of all body sizes. This of course requires having an understanding of Health At Every Size and unpacking assumptions about fatness being unhealthy that are embedded in our culture but not based on scientific evidence.
If you could speak directly to folks going through pregnancy loss, no matter their body size, what would you recommend?
I would recommend having self-compassion around whatever feelings and needs are coming up for you around your loss. I think any way that you feel during and after pregnancy loss is so, so valid. In particular, I really just want to normalize struggling with body image and disordered eating after pregnancy loss. Even though this is not talked about, it is so common. If possible, I would recommend getting support from a therapist, loss/bereavement doula, grief counselor, clergy member, and/or another support person who is both fat affirming and knowledgeable about reproductive loss.
What would you recommend for folks that do have health conditions impacting their fertility, if they are in smaller or larger bodies?
I would recommend finding fat affirming fertility care if at all possible! Unfortunately, I think that is so rare - my own experiences have shown me that even though I live in a major U.S. city, it is nearly impossible to find a truly HAES aligned fertility medical provider. There needs to be radical change within the fertility field (as with all medical disciplines). But fat affirming medical care benefits people of all sizes, so I think it is worth it to seek this out if it is available.
One thing I like to share that isn’t well-known is that there are fertility doulas who can serve as part of your support team and provide advocacy just like birth doulas. It may be worth considering working with a fertility doula, in particular if there are HAES aligned doulas in your area. Another resource that could be helpful is the work of fat positive fertility coach Nicola Salmon.
More broadly, I would recommend lots of self-compassion and surrounding yourself with support. You did not cause your health condition and experiencing barriers to fertility is not a failure. For people in larger bodies experiencing health conditions impacting fertility, I would recommend getting as much support as possible from fat affirming people in your life, as it can be difficult not to internalize messaging that your body is to blame.
Fat liberation and disability justice are inextricably linked in their fights against healthism and ableism and their fight to provide a more loving world for a wider diversity of bodies to live in with comfort and care.While some cases of pregnancy loss are not necessarily due to disability or medical conditions, the focus is often on problematizing the body and not honoring the grief. What are your thoughts on how pregnancy loss fits into this intersection of fat lib and disability justice?
I think that one way to define disability, very broadly, can be anything that does not fit into our society’s idea of what is “natural” and “normal.” Our cultural narrative around parenthood tends to be that what is a “natural” and “normal” path to parenthood is a pregnancy that results from heteronormative sex that requires minimal medical intervention. People whose paths differ from this in any way often face a lot of stigma and pathologization. Even if a pregnancy loss is not caused by a diagnosed medical condition or disability, and medical treatment is not required to be able to carry a subsequent pregnancy to term, experiencing a pregnancy loss is still a way that a person’s path to parenthood can differ from what is considered “normal” and “natural.”
Disability justice requires us to radically question what we consider “normal” and “natural.” We need to recognize the legitimacy and validity of all paths to parenthood, as well as the legitimacy and validity of not being a parent. Disability justice and fat liberation both require us to challenge the idea that our bodies exist to meet some kind of end goal, such as productivity, shrinking to make others comfortable, or meeting beauty standards. We also need to challenge the idea that our bodies exist for the purpose of reproduction, and that reproductive loss is a failure to attain this.
Another intersection is that many times, pregnancy loss is not framed as the loss of an actual life or child but a “potential” life. Pregnancy loss parents are told that they are grieving hopes, dreams, and visions for a future, but not an actual life. This may indeed be how some pregnancy loss parents feel, but for many of us, including myself personally, this feels dismissive. It is as if the pregnancies we lost were not important in and of themselves. I believe that at its core, disability justice and fat liberation are about celebrating and honoring who each of us is right now, in this very moment, rather than only valuing us based on our potential to be productive or shrink our bodies in the future. For me, what has been meaningful is recognizing that the lives I had a chance to carry inside of me were valuable in and of themselves, regardless of any future potential, and that I am grieving the relationships I had with them during the time I was pregnant. (I recognize this is a complicated thing to say during a time when people’s reproductive autonomy is being violently taken away on the basis of a fetus being viewed as a person/life, and I want to emphasize the importance of fighting for reproductive justice while also acknowledging the validity of however loss parents feel in their grief.)
I think disability justice also applies here more broadly because grief, especially reproductive grief, is disabling in our society. We live in a grief phobic culture that is often afraid to recognize or honor grief in general. Because there is so much stigma around perinatal loss, we tend to view it as “unnatural” or “abnormal” for people to be significantly affected by this kind of loss; pregnancy loss parents are generally encouraged not to talk about it and to keep this private. Pregnancy loss parents may not only face the pathologization of their bodies but also of the feelings and trauma responses they are having. It is not common for pregnancy loss parents to receive bereavement leave at work or for there to be memorial rituals or other forms of communal support around this. Disability justice necessitates providing support and accommodations to those who are grieving any loss rather than pathologizing them.
I hear you say that loss is normal, death is a part of life, and we need more comfort with this. I’ve seen fat lib folks talk too about how fear of death is sometimes at the core of anti-fatness, since fatness is assumed to be deadly (essentially). It seems like your focus would rather be on the emotional/psychological/spiritual aspect of pregnancy loss. What are other ways you’d like to see pregnancy loss recognized and honored?
I would love to live in a culture where it was common to check in about how loss parents are feeling in their grief rather than immediately jumping to problem solving, advice giving, and searching for an explanation. I think a major part of fat liberation is accepting that disability, illness, death, and loss are all part of life, and restricting our food, changing our bodies, exercising rigidly, eating the “perfect” combination of foods, etc. is not going to change that. We need to honor and show up for one another’s grief, as well as honor the ways in which our bodies support us in our grief, rather than striving in vain to eradicate loss.
Some ways that we could honor the grief of pregnancy loss include saying the baby’s name or nickname, asking loss parents about their babies, having memorial rituals or ceremonies to honor the loss, and recognizing loss parents on occasions like Mother’s Day, Father’s Day, and due date anniversaries. Most importantly we need to recognize that loss parents are parents and have a right to nurture their children through remembering them.
Thank you to Shira for sharing her experiences and perspectives! May your continued journey be filled with support and care.
If you or someone you know is dealing with the grief of pregnancy loss, you are not alone! You can utilize ASDAH’s Provider Listing to help find providers in your area that are HAES oriented. There are also several fertility and pregnancy resources for folks in larger bodies listed on my webpage. Please reach out if you’d like additional referrals and resources, and trust that you are not alone in this process.
