How do BMI-restrictive policies impact women seeking NHS-funded IVF in the United Kingdom? A qualitative analysis of online forum discussions.

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Reproductive Health Pub Date : 2024-10-28 DOI:10.1186/s12978-024-01891-1

Rebecca Muir, Meredith K D Hawking

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Abstract

Background: Across the United Kingdom's National Health Service (NHS), women with a Body Mass Index (BMI) of > 30 face restrictions accessing In Vitro Fertilisation (IVF) treatment. This study asks: what are the (un)expected and (un)intended harms and consequences experienced by women restricted from accessing NHS-funded IVF due to BMI threshold criteria?

Methods: Posts from a popular infertility online forum were collected and reflexively thematically analysed.

Results: On the forum, users discussed how they struggled to lose weight, how they faced time pressures to meet BMI thresholds, and they shared knowledge on how to comply or appear compliant with BMI cut-offs. Our study found widespread moral discourses around body weight were reproduced in the forum, particularly commonplace narratives that body weight is under personal control, that people with a high BMI should 'work' to change their bodies, and that this work helps demonstrate deservingness for IVF treatment. Moralising discourses around weight were linked to the responsibilities of a hoped-for future of motherhood, as users performed deservingness through emphasising their commitment to meeting the BMI threshold.

Conclusion: We conclude that NHS-IVF policies in the United Kingdom do not consider the burdensome emotional and moral work placed on people seeking treatment due to inflexible upper-limit BMI criteria.

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在英国，限制体重指数的政策对寻求英国国家医疗服务体系（NHS）资助的试管婴儿的妇女有何影响？在线论坛讨论的定性分析。

背景：在英国国民医疗服务体系（NHS）中，体重指数（BMI）大于 30 的女性在接受体外受精（IVF）治疗时会受到限制。本研究提出的问题是：由于 BMI 临界值标准而被限制接受 NHS 资助的体外受精治疗的女性会经历哪些（非）预期和（非）预期的伤害和后果？收集了一个流行的不孕不育在线论坛的帖子，并对其进行了反思性主题分析：在论坛上，用户讨论了她们如何努力减肥、如何面对时间压力以达到 BMI 临界值，并分享了如何遵守或看起来遵守 BMI 临界值的知识。我们的研究发现，围绕体重的道德论述在论坛中得到了广泛的复制，尤其是关于体重受个人控制、体重指数高的人应该 "努力 "改变自己的身体，以及这种努力有助于证明自己值得接受试管婴儿治疗的普遍论述。围绕体重的道德化论述与希望未来成为母亲的责任相关联，因为使用者通过强调他们对达到体重指数阈值的承诺来证明他们是值得的：我们得出的结论是，英国国家医疗服务体系的试管婴儿政策没有考虑到由于缺乏灵活性的体重指数上限标准而给寻求治疗者带来的沉重的情感和道德负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reproductive Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.00

自引率

5.90%

发文量

220

审稿时长

>12 weeks

期刊介绍： Reproductive Health focuses on all aspects of human reproduction. The journal includes sections dedicated to adolescent health, female fertility and midwifery and all content is open access. Reproductive health is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. Good reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.