The present study aimed to determine the predictors of body dissatisfaction at six months postpartum based on demographic and fertility characteristics. The results showed that body dissatisfaction had a significant relationship with variables such as BMI at six months postpartum, gestational age, receipt of information about body shape, spouse’s views on the shape of a woman’s body, and mode of delivery. Among these variables, the six-month postpartum BMI was the most effective predictor of postpartum body dissatisfaction. The higher the BMI, the greater the dissatisfaction. In this respect, the results of a study by Gjerdingen et al. indicated that an elevated BMI was the most important factor associated with body dissatisfaction [15]. Evidence suggests that increased attention to appearance, especially postpartum weight and obesity, results in increased body dissatisfaction among women [20]. The target weight of some women after childbirth is even lower than the pre-pregnancy weight, which results in increased body dissatisfaction [21]. Our study subjects weighed a mean of 4.600 kg more than their pre-pregnancy weights in the six months following delivery. Participants in the study by Gjerdingen et al. weighed 2.5 kg more in the nine months following delivery than before pregnancy [15]. Since the timing of these two studies is different, it is not possible to compare postpartum weight retention; however, in a study conducted by Rallis et al., it has been shown that dissatisfaction with body shape was most prevalent in the six months following delivery. In the study mentioned above, the mean BMI six months after delivery was 24.90; in the current study, it was 25.69, which could be attributed to the large sample size of the current study [5]. The results of another study showed that most participants described body changes during pregnancy with one objective and meaning. In their opinion, the unique event of becoming a mother enabled women to deal positively with changes in their bodies during pregnancy. Society also has a positive interpretation of pregnancy changes, but dissatisfaction and striving to reclaim the postpartum body dominated [22].
In the present study, there was no relationship between women’s age, the woman and her husband’s level of education, the woman and her husband’s job, and economic status with body dissatisfaction. Although body dissatisfaction in women whose husbands were workers was less than women whose husbands were employees, this difference was not statistically significant. In this respect, Gjerdingen et al. [15] reported that woman’s age, education, income, health insurance, and their employment status were not related to body shape dissatisfaction. It has also been noted that the relative importance of social factors regarding postpartum body dissatisfaction is uncertain and not well-studied. In another study, the results showed no relationship between age, job, and education with body shape dissatisfaction [23].
The results reported by Walker et al. on the relationship between dissatisfaction with body shape and race showed that black women were more satisfied with their body shape than white women [24]. In the current study, all subjects were of the same race; therefore, we compared body shape dissatisfaction between women in urban versus rural areas. In terms of socio-economic factors, just as blacks in most parts of the world are at a lower socioeconomic level than whites, village residents have a lower socioeconomic status than urban residents. Our findings showed that body dissatisfaction among women born in a village was lower than among those born in a city. This was not a statistically significant difference, as rural-born women made up a quarter of the subjects in our study. However, another explanation for decreased body dissatisfaction among rural women might be that they are less exposed to receipt of information, social pressures, and media publicity.
The results of the present study show that body dissatisfaction is related to the views of the spouse on the shape of the woman’s body. Women whose spouses were very satisfied with their body shape expressed higher body satisfaction. In this regard, the results of another study showed that a negative assessment by the spouse was strongly related to body dissatisfaction and, after the weight variable, the history of negative encounters in the family was of tremendous importance in terms of dissatisfaction with the shape of the body [25]. In the postpartum period, spouses play a major role in supporting women by providing positive feedback on the physical changes of the woman’s body [21]. Mickelson et al. concluded that maternal satisfaction with body shape after childbirth was accepted only with the consent of the spouse and it was indirectly related to the satisfaction of their private affairs. In other words, mothers understand that their spouses do not accept them in sexual relations, making them less satisfied with their private lives. Researchers in this study reported a clear link between body shape dissatisfaction and intimate relationships. Postpartum intimacy for a woman might be related to her husband’s satisfaction with the shape of her body [26].
Our study found that women with less information about body shape were more satisfied with their body shape. Information coupled with cultural and social pressures may make women feel unattractive, dissatisfied with their body, anxious, depressed, and stressed [4]. Most of the women’s self-consciousness with their bodies is rooted in the image of a beautiful body created by society. This self-consciousness and monitoring of the body as an item for assessment by others leads to increased body dissatisfaction [27]. By promoting a thin body as a beauty criterion, the media also causes women to experience unrealistic postpartum pressure on their body shape, and makes them want to quickly lose the weight they gained during pregnancy [21].
The present research showed a significant association between body dissatisfaction and the mode of delivery (NVD, cesarean section). In a qualitative study, Berry indicated that in women during five weeks after cesarean section, factors such as wound repair, therapeutic interventions such as injections and insertion of intravenous lines, digestive and nutritional problems, movements needed to breastfeed the baby, and reduced body function caused them to feel dissatisfied with their body image [28]. In our study, there was no association between body dissatisfaction with parity (multipara and primipara), abortion, infertility history, wanted and unwanted pregnancy, and baby’s gender. Gjerdingen et al. also reported that variables such as the baby’s gender were not related to body shape dissatisfaction after delivery [15]. In line with our study, there was no significant difference in body image between multiparous and primiparous women in other studies conducted in Iran [29]. The findings of the study by Rahmanian et al. also showed that there was no association between wanted and unwanted pregnancy and dissatisfaction with body shape; however, parity was related to body dissatisfaction. Because multiparous women have experienced pregnancy and are aware of changes in body shape during this period, they know which physical changes are reversible and which are permanent; therefore, multiparous women are more dissatisfied with their body shape than primiparous women who see pregnancy and its changes as a motherhood experience [23].
In our study, there was a statistically significant difference in the mean score of body dissatisfaction (p = 0.009), which depended on gestational age. Mothers who gave birth to preterm infants were more dissatisfied with their body shape. The researcher did not find a comparative study in this regard. In the current study, we observed no relationship between body satisfaction of mothers with different feeding conditions for infants (breast milk, bottle-feeding, both) and the duration of breastfeeding, which contradicted the results from other studies. The results of these studies have indicated that dissatisfaction with body shape affects breastfeeding self-efficacy, reduces the tendency to breast-feed, and causes women to stop breastfeeding earlier [8, 10, 20].
There were a number Strengths and limitations to this study. One of the strengths of this study is that we considered the variable of the spouse’s views on the shape of a woman’s body. According to Duncombe et al., women who had a positive attitude towards their bodies after childbirth often stated that their spouses also had a positive attitude about their body size [4]. Another strength is that in the present study, we examined the association of body dissatisfaction with receiving information about body shape. The results showed participants who received information were more dissatisfied about their body shape. We also examined the role of BMI as an intervening variable in this regard. T-test showed that there was no statistically significant difference in mean BMI in terms of receiving information about body shape.
The study had several limitations. Because the data were based on self-reported answers by the subjects, the response to some items might have been influenced by cultural factors and society values. A major difficulty we encountered in data analysis was how to score the BSQ-34. There was no difference between worry about body shape and its absence. Cooper et al. did not determine the cut-off point for the questionnaire. Although we observed no relationship between participants’ education and body shape dissatisfaction, education might have influenced the relationship between other variables and body shape dissatisfaction. Approximately 50% of the participants in our study had a college education; therefore, the generalization of the results of the present study might be less for studies where participants have lower educational levels. Finally, the assessment of body dissatisfaction was limited to just six months postpartum.