“Just a number” – larger-bodied women’s experiences of weight-centric and weight-inclusive maternity care: a national online photovoice study

Abstract Background Weight stigma is a pervasive issue in healthcare, including maternity care, characterised by bias, discrimination, and exclusion. Experiencing weight stigma can negatively impact health outcomes, self-esteem, and engagement with care. While existing literature documents the nature and consequences of weight stigma in maternity care, few studies have explored solutions or involved women with lived experience. This study aimed to investigate larger-bodied women’s experiences of weight-centric and weight-inclusive maternity care across the preconception, antenatal, intrapartum, and postnatal periods, as part of a broader program to co-create Best Practice Principles for Weight-Inclusive Maternity Care. Methods A consumer-led, national online photovoice study was co-designed and co-facilitated by a multidisciplinary team of lived experience experts and academic researchers. Qualitative data—including transcripts, images, and discussions—were analysed using reflexive thematic analysis. Participant demographics were analysed descriptively. Synthesised member checking was used to enhance trustworthiness. Results Sixty-five women from across Australia took part in the photovoice activity, attending virtual workshops and engaging in asynchronous online discussions that yielded 261 shared images and 899 comments. Thematic analysis generated seven themes: (1) BMI dictates care, (2) larger-bodied women feel excluded, (3) weight-centric care creates burdens, (4) stigmatising experiences leave lasting impacts, (5) women have embodied knowledge of their own health and wellbeing, (6) women hope for weight-inclusive care, and (7) individual maternity care providers can make a difference. Participants described weight-centric care as stigmatising, exclusionary, and emotionally burdensome, often undermining their autonomy and birthing confidence and leaving lasting impacts. Encounters with weight-inclusive care providers were described as empowering and healing. Women articulated a clear vision for respectful, individualised, and holistic maternity care. Conclusion Larger-bodied women experience maternity care as weight-centric and stigmatising. Conversely, encounters with weight-inclusive providers contributed to positive care experiences, and shaped women’s vision for more respectful, strengths-based care. Larger-bodied women’s experiences inform the need for respectful, strengths-based care and informed choice. Findings will inform the co-development of national care guidelines to address weight stigma and improve maternity care for women in larger bodies.