The sexual and reproductive health of overweight and obese women in low and middle-income countries

The project focuses on the challenges and barriers faced by women who have been categorised as overweight and/or obese when seeking sexual and reproductive health (SRH) in low- and middle-income countries (LMIC). While the "obesity epidemic" is gradually receiving more and more attention, most studies focus on the negative impacts of obesity on SRH or the discrimination faced by women who are considered fat in the healthcare sector, but the bulk of this literature originates from and concentrates on high-income countries.

However, the obesity rates are increasing in the vast majority of LMIC, with very little attention to the barriers and obstacles faced by women in these countries.

Those women are likely to experience different challenges, as fatness can be viewed differently depending on the context; moreover, as depicted in the obesity transition, while obesity is associated with low economic status in high-income settings, it is not necessarily the case in LMIC. Scholars have argued that weight stigma (defined by the World Obesity Federation as "the discriminatory acts and ideologies targeted towards individuals because of their weight and size") is likely to have a sizeable impact on women's SRH, with some claiming that it might actually have a worse impact on SRH than obesity itself.

Hence, studying the SRH of overweight and obese women in settings where the stigma might be less pronounced, as obesity is seen as a sign of wealth and good health, is crucial. Therefore, this project intends to fill this gap in the literature, to better understand the causes and consequences of fatness on access to SRH.

The project can be decomposed in four sub-projects, each focusing on a different yet complementary research question. The first sub-project consists of a quantitative analysis of Demographic and Health Survey data in LMIC, ranging from the early 2010s to 2024. Using data on weight and height, it compares different SRH outcomes for women with a body and mass index (BMI) that put them in the overweight or obese categories.

Considering the impact of other variables on SRH, this sub-project analyses the complex relationship between BMI, place of residence (rural or urban), education and wealth. It delves into the shift from obesity linked to high socioeconomic status to obesity linked to low socioeconomic status, as many LMIC have gone through that shift in the recent years.

The second sub-project focuses on the explanatory pathways from obesity to poor SRH, using longitudinal data. Using a latent variable model, it aims at unpacking the ways through which high weight has an impact on SRH. Indeed, cross-sectional DHS data does not allow for a causal explanation and can only present correlations. While have this first descriptive and comparative approach is essential, it is also interesting to go further and get causal explanations.

The third sub-project consists of an analysis of the framing of obesity and SRH policies in LMIC, focusing on Latin America. Much attention has been given to the framing of obesity policies in high-income countries, with obesity being mainly framed as a disease that is costly to society and caused by individual shortcomings. Less attention has been given to policies relating to SRH.

However, little attention has been given to how those same policies have a direct or indirect influence on policies implemented in LMIC. The purpose of this project is to analyse how obesity and SRH are framed, and how/if different frames are competing within the political sphere.

The fourth sub-project focuses on the lived experience of women who self-identify as fat and who have been/are currently seeking sexual and reproductive healthcare. While this kind of study has been led in high-income countries, to my knowledge, very few studies have been led in LMIC, implying that nothing is known about how such women are treated, if they encounter weight stigma, and in what ways.