Unjust treatment, unfamiliar body, and unrealistic body standards: A qualitative investigation of body image, racism, and eating during pregnancy and postpartum among Black, African American, and Afro-Caribbean individuals

Abstract

The perinatal period, which includes pregnancy and postpartum, is associated with body-image disturbance and increased risk of eating disorder (ED) onset or relapse. ED diagnoses that are most common in the perinatal period are also more prevalent among Black individuals compared to other races. However, existing ED screening tools may miss important cultural nuances within the Black population. There is little data on whether ED screening tools are effective at detecting body-image or eating issues among Black individuals, perinatal individuals, or the intersections between these groups. The purpose of this study was to conduct qualitative interviews with Black, African American, and Afro-Caribbean pregnant or postpartum individuals (N = 21, M_age=32.81) about their experiences with body-image and ED concerns during the perinatal period and to obtain their feedback on two existing ED screening measures. The overarching goal of the study was to gather participant input to inform the development of a culturally congruent perinatal ED screening tool. Transcribed interviews were analyzed using an iterative, multi-phased inductive approach based on constructivist grounded theory. Data were organized into two themes: 1) “Baby Runs the Body,” and 2) "Too small, too big, and don’t start me on my nose!” Feedback on existing ED screening tools was organized into a Cultural Congruence theme. Eating and body-image concerns were widely endorsed by participants, and participants expressed a desire for culturally informed support for eating and body-image concerns. Results demonstrated the need for perinatal ED screening. Future perinatal ED screening should incorporate feedback from participants to promote cultural inclusivity.