Barriers to weight‐related health behaviours: a qualitative comparison of the socioecological conditions between pregnant and post‐partum low‐income women

Abstract

The association between socio-ecological factors and poor health outcomes for low-income women and their children has been the focus of disparities research for several decades. This research compares the socio-ecological conditions among low-income women from pregnancy to postpartum and highlights the factors that make weight management increasingly difficult after delivery. As part of the formative research for an online health intervention, group and individual interviews were conducted with low-income pregnant and postpartum women. Five pregnancy group interviews (n=15 women), five postpartum group interviews (n=23 women) and seven individual interviews with a total of 45 participants were conducted in Rochester, NY. All interviews were audio-recorded. The constant comparative method was used to code interview notes and identify emergent themes. Subjects faced many challenges that affected their attitudes, beliefs and their ability to maintain or improve healthy-weight behaviors. These included unemployment, relationship issues, minimal social support, lack of education, limited healthcare access, pre-existing medical conditions and neighborhood disadvantage. Compared to pregnant women, postpartum women faced additional difficulties, such as child illnesses and custody issues. The most striking differences between pregnancy and postpartum related to the family’s medical problems and greater environmental constraints. Many factors detracted from women’s capacity to engage in healthy-weight behaviors postpartum, including challenges present prior to delivery, challenges present prior to delivery that worsen after delivery, and new challenges that begin after delivery. These additional postpartum challenges need to be considered in designing programs, policies and interventions that promote healthy weight.

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

“…Women often struggle with weight management at this stage in life and face many barriers to taking positive action, such as lack of time, tiredness and prioritising their children's needs. [33][34][35][36] Pregnancy and motherhood are major life events, and changes in lifestyle and maternal priorities may help explain postpartum weight retention and further weight gain trends. 19,37 Financial costs associated with pregnancy and postpartum overweight and obesity…”

Women’s perceived social support: associations with postpartum weight retention, health behaviors and depressive symptoms

“…Thus, it is not surprising that limited social support has been found to be related to depression in the postpartum period and that support from a partner, family or friends may help a new mother cope with stress and mental health issues [8, 9]. Social support may also help mothers engage in healthy behaviors, but the evidence is more sparse in postpartum period [10]. Very few studies of general populations have examined the relationships of PPWR, weight retention related health behaviors, and mood disorders with social support from partners and from family/friends concomitantly during the postpartum months [11, 12].…”

Women in the Workplace: Promoting Healthy Lifestyles and Mitigating Weight Gain during the Preconception, Pregnancy, and Postpartum Periods

“…However, general barriers include: heavy workloads, health promotion activity scheduling and location, work patterns such as part-time work or shift work, workplace location, limited availability of healthy lifestyle activities [28], and unsupportive management [29]. Additional obstacles impacting pregnant and postpartum women underscore the importance of tailored health promotion for this population, including health concerns such as gestational diabetes or morning sickness; short interconception periods, which may not be long enough to return to a healthy weight; and children's health problems [30]. Targeting women during pregnancy and postpartum alone may mean that preconception women are excluded from potential health protection and prevention measures, which could include teratogen exposure around the time of conception or during the early stages of pregnancy [31].…”