Body Dissatisfaction in Midlife Women

ABSTRACT

We examined the extent and correlates of body dissatisfaction among 1026 54-year-old women from the MRC National Survey of Health and Development. Weight dissatisfaction was reported by nearly 80% of the sample and by over 50% of ‘normal weight” women (BMI < 25). Women indicated being most dissatisfied with their bodies currently, relative to their younger years, including their forties. Adjusting for BMI, dissatisfaction was highest in higher social class women and in those who rated themselves in poorer health. Women with poor body esteem, regardless of body size, were likely to avoid various everyday situations because of how they felt about their bodies. Adjusting for BMI, women who were happy with their weight were more likely to report distress about other aspects of their appearance. We suggest that body dissatisfaction in women of this age group merits further attention.     

Effect of body image on gestational weight gain in overweight and obese women

Problem or backgroundThere is little information available describing how women who are overweight or obese in pregnancy perceive their bodies, and in particular the effect of body image dissatisfaction on gestational weight gain.QuestionTo describe how women who are overweight or obese in pregnancy perceive their body, and the effect of body image on gestational weight gain.MethodsThis prospective nested cohort study evaluated self estimation of body weight, preferred body shape, dieting behavior, satisfaction with body weight and shape, and gestational weight gain in pregnant women who were overweight or obese, through self-completed questionnaire in early pregnancy in South Australia from October 2010 to February 2012.FindingsOf the 442 women who completed the questionnaire, 25.8% correctly identified their BMI, with 70.1% under-estimating and 4.1% over-estimating their BMI. Women who were obese were significantly less likely to correctly identify their BMI, as were younger women. Women who incorrectly identified their BMI were significantly more likely to have higher gestational weight gain (P < 0.001). Approximately 45% of women indicated dissatisfaction with their weight or body shape, with this being more common in women of higher parity and higher BMI. Dissatisfaction was significantly related to gestational weight gain.ConclusionWomen who report increasing dissatisfaction with their body size and shape are more likely to gain excessive weight during pregnancy. Further research should explore insights about maternal body image and diet related behaviors.     

Hormonal Contraceptive Use and Discontinuation Because of Dissatisfaction: Differences by Race and Education

The unintended pregnancy rate in the United States remains high, and there are large race and education differences in unintended pregnancy and fertility. These differences make it important to study race and education differences in contraceptive behavior. Using nationally representative data from the 2002 National Survey of Family Growth, this study examines the effects of race and education on the likelihood that women have ever used particular types of hormonal contraception and have ever discontinued hormonal contraception because of dissatisfaction. The results show that blacks and Latinas were more likely to have used injectable contraceptives (??the shot??) and less likely to have used oral contraceptives (??the pill??) than were white women. Women with less education were more likely than college-educated women to have used the shot but there were no significant education differences in use of the pill. Among women who had ever used hormonal birth control, those with less than a college degree were more likely than college-educated women to discontinue the birth control because of dissatisfaction. However, net of education, this study found no significant racial/ethnic differences in discontinuation. The most commonly stated reason for discontinuation because of dissatisfaction was side effects.     

The validity of survey responses on abortion: Evidence from Estonia

This paper presents results of a validation survey of abortion conducted in Tallinn, Estonia in April and May 1992. The sample was drawn from patient records in a maternity hospital. Women who had an abortion in that hospital in 1991 were asked about recent abortions as part of a survey about women’s health. More than 80% of the respondents reported having a recent abortion. Some respondents misreported their abortion as a miscarriage. Moreover, some variation in reporting was associated with respondents’ characteristics. Ethnic Estonians were less likely to report their abortion than were Russians, women over age 40 were less likely to report the abortion than younger women, and women who had the abortion late in the first trimester were less likely to report that abortion. There was some evidence that unmarried women were less likely than married women to report their abortion, and that women who had borne three or more children were less likely to report their abortion than women who had borne fewer children. These differences probably stem from the extent to which pregnancy or abortion is considered stigmatizing for women in different situations.     

Motherhood status and union formation in Moshi, Tanzania 2002-2003

Age at first union is increasing throughout much of sub-Saharan Africa at the same time that not all couples are waiting for marriage before their first sexual intercourse. We assessed the effect of a premarital first birth on entrance into a first union in an urban area in East Africa -- Moshi, Tanzania. The data come from the Moshi Infertility Survey of 2002-2003. Women who spent less than a year in single motherhood were significantly more likely than childless women to enter into a first union, although the magnitude of this relationship was weaker for more recent cohorts. Women who had been single mothers for 5 or more years (about two-thirds of women with a premarital birth) were significantly less likely than women without children to enter into a first union.     

Motherhood status and union formation in Moshi,Tanzania 2002–2003

Age at first union is increasing throughout much of sub-Saharan Africa at the same time that not all couples are waiting for marriage before their first sexual intercourse. We assessed the effect of a premarital first birth on entrance into a first union in an urban area in East Africa—Moshi, Tanzania. The data come from the Moshi Infertility Survey of 2002–2003. Women who spent less than a year in single motherhood were significantly more likely than childless women to enter into a first union, although the magnitude of this relationship was weaker for more recent cohorts. Women who had been single mothers for 5 or more years (about two-thirds of women with a premarital birth) were significantly less likely than women without children to enter into a first union.     

Honesty and comfort levels in mothers when screened for perinatal depression and anxiety

PurposeTo evaluate the degree of honesty and level of comfort reported by women when questioned about their emotional wellbeing during the perinatal period; to investigate if honesty and comfort are associated with perinatal depression or perinatal anxiety; and to examine the reasons why women may not always respond honestly.MethodsQualitative and quantitative data from 1597 women from the cross-sectional perinatal mental health substudy (part of the Australian Longitudinal Study on Women’s Health) were analysed using a mixed methods approach.ResultsWhen questioned by their health practitioner about their emotional wellbeing in the perinatal period, 20.7% of women indicated they had not always responded honestly. Reasons for not being honest reflected four main themes: normalizing of symptoms/coping; negative perceptions (self-and others); fear of adverse repercussions; and fear of involvement of health services (trust and confidentiality). The 38.9% of women who did not feel comfortable when questioned by their health practitioner about their emotional wellbeing were four times more likely to report perinatal depression (odds ratio = 4.09; 95% confidence interval = 2.55, 6.57) and nearly twice as likely to report perinatal anxiety (odds ratio = 1.90; 95% confidence interval = 1.24, 2.94) than other women.ConclusionsWomen who are most likely to need mental health care during the perinatal period are also those least likely to be honest about their mental health. A non-judgemental, open and reassuring approach by clinicians may help to reduce the stigma and fears contributing to lack of honest responses, and improve early diagnosis and treatment of mental health problems.     

Yummy Mummy — The ideal of not looking like a mother

BackgroundPregnancy and childbirth are important life experiences that entail major changes, both physically, psychologically, socially and existentially for women. Motherhood transition and the accompanying bodily changes involve expectations of body image that are simultaneously naturally and socially produced and culturally informed by public, private and professional discourses about motherhood transition.ProblemMuch focus is levelled at the antepartum body in maternity services whereas the postpartum body seems left alone, although bodily dissatisfaction is of concern for many mothers, whose expectations of bodily appearance postpartum are sharp and explicit.AimTo explore Danish first-time mothers’ experiences of their body postpartum, focusing on body image.MethodsEleven first-time mothers participated in semi-structured interviews related to the postpartum body image. Data was analysed thematically.FindingsFour themes: (1) Reverting the body: on bouncing back and losing weight; (2) Picturing me: on standards of beauty and ideal bodies; (3) Redefining earlier self-images: on meta-reproachment of the body; (4) Idealisation of not looking like a mother: on societal pressure to think positively. Findings were discussed through the theoretical concepts by Scheper-Hughes and Lock: the body as both individual, social and political.ConclusionDespite nuanced reflections over the body as subject and object, women identified beauty as a personal trait dependent on visual appearance. Bodily beauty was identified as something individual, yet standardised. Women felt strengthened through motherhood but looking like a mother was not considered worth pursuing. To allow for women’s contradictory perspectives, caregivers are advised to communicate reflexively about the postpartum body.     

Pregnancy care and birth outcomes for women with moderate to super-extreme obesity

PurposeTo describe the health service utilisation and birth outcomes of pregnant women with moderate to super-extreme obesity.BackgroundMaternal obesity is increasingly recognised as a key risk factor for adverse outcomes for both women and their babies. Little is known about the service utilisation and perinatal outcomes of women with obesity beyond a body mass index of 40.MethodWomen with a self-reported pre-pregnancy BMI of 40 or more, who had received care and birthed a baby at the study site between 1 January 2009 and 31 December 2010. Clinical audit was used to identify the health service utilisation and birth outcomes of these women.Results153 women had a BMI of 40 or more. Women saw 6 different health professionals during pregnancy (1–16). Most of their visits were with a medical practitioner, often with limited experience, and almost all women only saw a midwife once at their booking visit (n = 150, 98.0%). While the majority of women experienced a normal pregnancy, free from any complications, almost half the women in this study experienced a caesarean section (n = 74, 48.4%).ConclusionClinical audit has been useful in providing additional information which suggests current maternity care provision is not meeting the needs of this group of women. The model of antenatal care provision may be a mediating factor in the birth outcomes experienced by obese women. The development of effective, targeted antenatal care, designed to meet the needs of these women is recommended.     

Who is holding the baby? Women's experiences of contact with their baby immediately after birth: An Australian population-based survey

BackgroundSeeing and holding their baby immediately after the birth is the pinnacle of the childbearing process for parents. Few studies have examined women's experiences of seeing and holding their baby immediately after birth. We investigated women's experiences of initial contact with their newborns using data from an Australian population-based survey.MethodsAll women who gave birth in September/October in 2007 in two Australian states were mailed questionnaires six months following the birth. Women were asked three questions about early newborn contact including where their baby was held in the first hour after birth and whether they were able to hold their baby as soon and for as long as they liked. We examined the association between model of maternity care and early newborn contact stratified by admission to SCN/NICU.ResultsThe majority (92%) of women whose babies remained with them reported holding their babies as soon and for as long as they liked in the first hour after birth. However, for women whose babies were admitted to SCN/NICU only a minority (47%) reported this. Women in public models of care (with the exception of primary midwifery care) whose babies remained with them were less likely to report holding their babies as soon and for as long as they liked compared to women in private care.ConclusionOur findings suggest that there is potential to increase the proportion of mothers and fathers who get to hold their baby immediately after the birth by modifying birth suite and operating room practices.     

Body image,satisfaction with sexual life,self-esteem,and anxiodepressive symptoms: A comparative study between premenopausal,perimenopausal, and postmenopausal women

Menopause is an important life transition in women, and it is associated with significant physical and psychological changes. This study aimed at examining how the menopausal transition influences body image and satisfaction with sexual life. To this aim, body image dissatisfaction, sexual dissatisfaction, and self-esteem were compared in three groups of women with distinct menopausal status (premenopausal n = 142, perimenopausal n = 66, or postmenopausal n = 149), while controlling for depressive and anxiety symptoms and BMI. Using ANOVA between these three groups, we observed that dissatisfaction with body image was significantly higher in the perimenopausal sample compared with its premenopausal counterpart. In the postmenopausal sample, body image improved, as this group displayed body image scores close to the premenopausal level. In addition, sexual dissatisfaction was significantly increased in the perimenopausal and postmenopausal samples, which is compatible with the concept that higher body appreciation positively predicted sexual function. We conclude that body image dissatisfaction reaches a maximum during the perimenopausal phase, before returning to a level nearly identical between the premenopausal and the postmenopausal phases.     

The need for improved emotional support: A pilot online survey of Australian women’s access to healthcare services and support at the time of miscarriage

ProblemWomen need improved emotional support from healthcare professionals following miscarriage.BackgroundSignificant psychological morbidity can result following miscarriage and may be exacerbated by poor support experiences. Women frequently report high levels of dissatisfaction with healthcare support at this time.AimThis study was developed to pilot a survey aimed at exploring women’s access to healthcare services and support at the time of miscarriage.MethodsWomen over 18 years, residing in Australia, who had experienced a miscarriage in the past two years completed a 29-item online survey.FindingsA total of 399 women completed the survey. Two key findings arose: 1) More than half of women (59%) were not offered any information about miscarriage or pregnancy loss support organisations or referral/access to counselling services at the time of miscarriage, despite almost all reporting they would have liked various forms of support from items listed 2) More than half (57%) did not receive follow up care, or emotional support at this time, beyond being asked how they were coping emotionally. Other findings showed 3) Women accessed various healthcare services at the time of miscarriage and 4) Women often saw a general practitioner at the time of miscarriage despite having a private obstetrician.ConclusionThere is clear mismatch between the support women want at the time of miscarriage and the care they receive from healthcare professionals. Despite considerable structural barriers, it seems likely there is scope within healthcare professionals’ usual practice for improved support care through simple measures such as increased acknowledgement, information provision and referral to existing support services.     

Women’s experiences of infant feeding support: Findings from a cross-sectional survey in Victoria,Australia

ObjectiveTo evaluate new mothers’ experiences of infant feeding support.DesignA postal survey developed for this study was sent to all new mothers in ten local government areas in Victoria, Australia when their baby was six months of age. Questions explored infant feeding methods, feeding support services, and experiences of infant feeding support. This survey made up one component of the Supporting breastfeeding In Local Communities (SILC) cluster randomised controlled trial.Findings997/4127 women (24%) completed the survey between 15 April 2013 and 31 July 2013. Women received infant feeding support from multiple sources, including professionals, family members, and peers. Overall, 88% reported receiving adequate infant feeding support. Women who reported not receiving adequate infant feeding support were less likely to be giving any breast milk at six months compared to those reporting adequate support (OR = 0.59; 95% CI 0.40, 0.88). Adjusting for breastfeeding intention and parity did not alter the association (Adj. OR = 0.60; 95% CI 0.40, 0.90). Women were most satisfied when they received accessible, available, consistent professional infant feeding support provided in a non-judgemental and reassuring way. Women were dissatisfied when there were barriers restricting access to support, or when they received conflicting advice or support that made them feel guilty, pressured or judged.Key conclusionsRegardless of infant feeding method, women wanted accessible, non-judgemental support. Given that receiving adequate support was associated with more breast milk feeding at six months, care providers should ensure accessible infant feeding support is available to all new mothers.     

Body esteem and self-esteem in middle-aged women

The aims of the study were (a) to identify predictors of body esteem and (b) to expand on previous research by examining the link between global self-esteem and body esteem in a community-based sample of women in midlife. We found that body esteem in midlife women was predicted by body mass index (BMI), optimism, self-esteem, and menopausal symptoms. Although BMI was the main predictor of body esteem in middle-aged women, global self-esteem was more strongly related to feelings about appearance and physical condition than feelings about body size.     

Body Image and Quality of Life in a Group of African American Women

African American (AA) women’s preference for a larger body size and underestimation of their body weight may affect the relationship between their body weight and weight-related quality of life (QOL). We wanted to examine the relationship between weight-related QOL and body mass index (BMI) in a sample of overweight AA women. Thirty-three overweight AA women completed a clinic visit to measure height, weight, and complete surveys including the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and the Stunkard Figure Rating Scale. BMI was calculated using measured height and weight. Correlations and linear regression models were estimated using SAS v 9.1. In this sample, the mean total quality of life score was 78.00 ± 17.68 on a 100 point scale. There was a modest correlation between BMI and total weight-related QOL (r = −0.034, p = 0.053). Body image dissatisfaction was the strongest predictor of total quality of life score (p = 0.04). African American women’s unique cultural perception of body image may play a key role in weight-related QOL.     

Factors affecting adoption in China, 1950-87

Though adoption in China is known to have increased as more girls were abandoned and became available for adoption following the introduction of the country's one-child policy in the 1980s, little is known about Chinese adoption practices. This paper investigates the factors affecting adoption in China in the period 1950-87 using data from the National Two-Per-Thousand Sample Survey on Fertility and Contraception of 1988. The results show that the national adoption rate was 2.3 per cent. Childless women were more likely than women with children to adopt and did not show a sex preference. Women with children by birth used adoption to secure a child of the 'missing' sex. Women who had experienced the death of a child were more likely to adopt than those who had not. Women with children may have used adoption as a strategy to circumvent the strict family planning policies.     

Estimating the impact of change in pre-pregnancy body mass index on development of Gestational Diabetes Mellitus: An Australian population-based cohort

BackgroundInternational studies examining maternal overweight and obesity have found GDM risk increases with increasing weight gain between pregnancies.AimThe study aimed to estimate the association between pre-pregnancy maternal body mass index (BMI), change in BMI between pregnancies and Gestational Diabetes Mellitus (GDM) amongst women with consecutive births in an Australian cohort.MethodsWe used a population cohort of women who had at least two consecutive singleton births between 2010 and 2017 in one NSW health district to investigate the risk of GDM in the pregnancy after the index pregnancy, BMI change between pregnancies and the impact of BMI change on risk of GDM.FindingsOf 10,074 women 1987 (16.7%) had no GDM in the index pregnancy but GDM in the subsequent one while 823 (8.2%) had GDM in both pregnancies. No change in BMI between pregnancies occurred in 47% of women, while 12% had a decrease and 41% an increase. After adjusting for socio-demographic characteristics and selected maternal and perinatal confounders, a reduction in BMI between births in women without GDM in the index pregnancy was associated with a 36% lower risk in GDM (aRR: 0.64; 95% CI: 0.49?0.85), while an increase in BMI was associated with increased risk of GDM with the greatest risk amongst those who gained 4+ kg/m² (aRR 2.27; 95%CI: 1.88–2.75).ConclusionInterpregnancy weight change is an important modifiable risk factor for the risk of GDM in a subsequent pregnancy. Clinical guidelines and health messages about interpregnancy weight change are important for all women.     

Intensive Parenting: Fertility and Breastfeeding Duration in the United States

Using 30 years of longitudinal data from a nationally representative cohort of women, we study the association between breastfeeding duration and completed fertility, fertility expectations, and birth spacing. We find that women who breastfeed their first child for five months or longer are a distinct group. They have more children overall and higher odds of having three or more children rather than two, compared with women who breastfeed for shorter durations or not at all. Expected fertility is associated with initiating breastfeeding but not with how long mothers breastfeed. Thus, women who breastfeed longer do not differ significantly from other breastfeeding women in their early fertility expectations. Rather, across the life course, these women achieve and even exceed their earlier fertility expectations. Women who breastfeed for shorter durations (1–21 weeks) are more likely to fall short of their expected fertility than to achieve or exceed their expectations, and they are significantly less likely than women who breastfeed for longer durations (≥22 weeks) to exceed their expected fertility. In contrast, women who breastfeed longer are as likely to exceed as to achieve their earlier expectations, and the difference between their probability of falling short versus exceeding their fertility expectations is relatively small and at the boundary of statistical significance (p = .096). These differences in fertility are not explained by differences in personal and family resources, including family income or labor market attachment. Our findings suggest that breastfeeding duration may serve as a proxy for identifying a distinct approach to parenting. Women who breastfeed longer have reproductive patterns quite different than their socioeconomic position would predict. They both have more children and invest more time in those children.     

Effect of Conflict on Age at Marriage and Age at First Birth in Rwanda

Using Rwanda Demographic and Health Survey 2005 data, we estimate a Cox proportional hazard model to identify the determinants of age at marriage and age at first birth and whether these decisions were affected by conflict. We find that women living in clusters accounting for a larger proportion of sibling deaths in 1994, the year of the genocide, were more likely to marry later and have children later compared with those living in clusters accounting for a lower proportion of sibling deaths. Women living in regions with higher levels of under-five mortality were more likely to have their first child earlier compared with women living in regions with lower infant mortality. The age at marriage was probably affected by two reasons: the change in age structure and sex ratio of the population following the genocide, and the breakdown of kinship in the case of women who lost their siblings.     

Characteristics of Women with Body Size Satisfaction at Midlife: Results of the Gender and Body Image (GABI) Study

This study characterizes the profile of women (N?=?1,789) ages 50 and over who report body size satisfaction on a figure rating scale. Satisfied women (12.2%) had a lower body mass index and reported fewer eating disorder symptoms, dieting behaviors, and weight and appearance dissatisfaction. Interestingly, satisfied women exercised more than dissatisfied women, and weight and shape still played a primary role in their self-evaluation. Weight monitoring and appearance-altering behaviors did not differ between groups. Body satisfaction was associated with better overall functioning. This end point appears to represent effortful body satisfaction rather than passive contentment.