Given their convenience, accessibility, and low cost, women of reproductive age are utilizing social media platforms to access health information that was previously provided by healthcare professionals, printed media or friends and family (1). One major platform is the photo and video sharing application, Instagram. It is estimated that 39% of Instagram's billion monthly active users are females of childbearing age, aged 18–44 years (2). Our recent survey study found that 92% of Australian postpartum women (with a child <2 years of age) had an Instagram account and 81% reported accessing Instagram more than once per day (3). Therefore, Instagram presents a potentially useful avenue for conveying relevant health information to women postnatally, such as information about nutrition, exercise, psychological wellbeing and breastfeeding.

However, evidence exists suggesting associations between social networking site use and increased body dissatisfaction and decreased mood in young women (4–7). Body dissatisfaction refers to negative subjective evaluations of one's own body size and shape, arising when there is a discrepancy between one's own body image and ideals (8). Reduced body satisfaction among Instagram users has been attributed to the carefully curated images uploaded to Instagram by users that may present an “ideal” rather than “real” version of themselves (9).

This potential impact of social networking site use on body image and body dissatisfaction may be particularly relevant for women in the postpartum period who, in comparison to women during pregnancy, are more likely to be experiencing body dissatisfaction that worsens over time (10). This increase in body dissatisfaction is likely due to women viewing their bodies less as a nurturing entity over time since childbirth, and an increase in the tendency to appraise their bodies in comparison to their pre-pregnancy size and shape (11). Hence, it is possible that exposure to imagery on platforms such as Instagram may exacerbate this vulnerability for psychological ill-health, leading to worsening body dissatisfaction and further problems including postnatal depression (12). Such negative impacts on the mental health of mothers may reduce engagement in practices, such as breastfeeding, exercise and healthy eating, that can assist in optimizing the physical and mental health of both the mother and the child (13).

If social networking sites are to be used for delivering health information to postpartum women, it is important to understand how encouraging women to engage more with social networking sites to access health information may impact their body satisfaction. Therefore, this study aimed to determine how exposure to typical body-focused imagery affects state body satisfaction and state body appreciation in postpartum women. Secondarily, we aimed to determine how the inclusion of health-information-focused imagery on social networking sites, in conjunction with body-focused imagery, affects state body satisfaction and state body appreciation, compared with body-focused imagery only. We hypothesized that exposure to body-focused imagery alone would reduce body satisfaction and appreciation, but that inclusion of health-information-focused imagery in conjunction with body-focused imagery would attenuate these reductions. This hypothesis is based on Objectification Theory which refers to the internalization of body image concerns of girls and women that depend largely on how they think others see and judge them (14).

Single (participant) blinded quasi-experimental study. Inclusion criteria were: Australian-residing adult (≥ 18 years) women who had given birth within the last 2 years and had access to a phone or computer with internet, including postpartum women who were once again pregnant. Women with low English proficiency were excluded due to the survey being in English and interpreter services not available for this study. This study was approved by The University of Sydney's Human Research Ethics Committee on 24 June 2022 (protocol number: 2022/148).

Recruitment occurred from 3 August to 7 November 2022 via advertisements on social networking sites (Facebook, Instagram, Twitter/X), Playgroup New South Wales (a not-for-profit Australian organization that helps connect families and children to people and services in the community to positively impact their quality of life) newsletters and paid text messaging advertisements to Playgroup New South Wales members. Snowball sampling was used, whereby participants who completed the questionnaire were asked to share study information with eligible friends/family/associates.

To prevent potential response bias, participants were not informed of the quasi-experimental nature of the study but were simply informed that they would answer questions including a set about body image before and after viewing a series of images taken from Instagram (i.e., participants were blinded to the experimental conditions). Survey responses were non-identifiable.

In total, 308 participants completed the image exposure and questionnaire including pre- and post- assessment of state body satisfaction and appreciation. Characteristics of study participants are displayed in Table 2. The majority were aged 26–35 years and had a university and/or postgraduate degree, and approximately three quarters identified as being Caucasian. Almost all were in a relationship, and approximately half had one child. Body mass index was in the overweight category for all groups. Most women experienced no self-reported health risk or pregnancy complication. The most common self-reported pregnancy complications were gestational diabetes (19%) and excessive gestational weight gain (14%). The only significant difference between groups was recruitment method, with more women in Group 1 being recruited from social media platforms, and more women from Groups 2 and 3 being recruited from the Playgroup New South Wales text message and Newsletter. In total, 95% of participants reported having a Facebook, 93% Instagram, 39% LinkedIn, 22% TikTok 18% Twitter account. This also did not differ between groups.

The majority of participants from Group 1 (no health information) correctly reported that all images were of women (92%), and that no images contained health information (81%). In Group 2, most participants correctly identified that about one quarter of the images contained health information (75%) while 47% and 42% reported that all or three quarters of the images were of women, respectively. In Group 3, 67% correctly reported that half of the images contained health information, whereas only 44% correctly reported that half the images were of women (31% reported that three quarters were of women, and 19% reported that all were of women).

Our findings suggest that exposure to body-focused imagery, typical of what is commonly seen on Instagram targeting postpartum women (15), did not reduce state body satisfaction or appreciation. Furthermore, including postpartum health-information-focused images, in conjunction with body-focused images, did not influence state body satisfaction or appreciation compared with body-focused images alone.

We did not see expected reductions in state body satisfaction and appreciation following exposure to body-focused imagery. These findings contrast with the body of evidence demonstrating that Instagram use by young women, and viewing “idealized” imagery, is associated with worsening body satisfaction (4–7). However, some previous studies (4, 7) were conducted cross sectionally, and were not assessing differences in state levels of body satisfaction and appreciation. It is possible that changes in state body satisfaction and appreciation may have been detected in the present study if exposure to the images was longer, or if women were exposed to such imagery on multiple occasions.

Previous published studies showing negative impacts of body-focused imagery exposure were in young women (4–7), and not in postpartum women specifically, suggesting a potentially protective effect of the pregnancy experience and postpartum state on the effects of body-focused imagery on body satisfaction. Although we do not know whether images used in our experimental study were altered using filters or similar, it is possible that, due to their high social networking site use (2), postpartum women have become “desensitized” to the effects of photoshopped imagery on body image. Additionally, it is possible that their typical social networking site use has included exposure to, and increased awareness of, the body pride movement which may have empowered women to be less affected by exposure to this body-focused imagery (21). Regardless, our findings were unexpected, and would need confirming in future studies.

Women in our study were up to 2 years postpartum. This was to align with previous research which suggests that body dissatisfaction increases with time since child birth (10). Alternatively, other research suggests that body dissatisfaction may be heightened within 12 months of giving birth, when women may have expected to have lost weight gained during pregnancy, and hence may be more vulnerable to idealized imagery (13). This is in comparison to the potentially reduced vulnerability in late pregnancy, when women may be experiencing a new awareness of the functionality of their bodies (22). Nevertheless, our sensitivity analysis indicated that postpartum duration (0–12 months vs. 13–24 months) did not impact our findings.

Further research is required to investigate how delivering health information on social networking sites may impact women's physical and psychological health. A 2023 scoping review identified only three previous studies that have assessed the effectiveness of health information delivered on social networking sites to postpartum women,¹ highlighting the need for more research. Our preliminary findings are reassuring, suggesting that encouraging postpartum women to access health information via social networking sites may not negatively influence their body satisfaction and appreciation. However, there are several challenges in conducting an intervention via social networking sites, including encouraging women to increase their screen time use, which may not be good for their overall health (23, 24). Future interventions should include collaboration with consumers (i.e., postpartum women) and the health promotion sector, to design effective health promotion strategies that are acceptable, modifiable and safe for delivery via social networking sites.

In the 2023 scoping review,² none of the three studies assessing the effectiveness of health information delivered on social networking sites to postpartum women utilized Instagram for intervention delivery. However, 93% of participants in the present study report holding an Instagram account. Intervention designers need to consider that social media popularity and usage patterns are constantly evolving, and will need to monitor this and develop interventions that are able to be adapted to suit the most accessible sites.

There are several strengths of our research including recruitment of a sufficient sample size, participant blinding, and assessment of body satisfaction and body appreciation using validated tools appropriate for repeated measures. Limitations include the non-randomized, quasi-experimental nature of our study which, although groups were similar at baseline, limits the interpretation of our findings. We recognize that the images women see on Instagram vary greatly depending on the feed curation, therefore it is unlikely that the entirety of an individual's feed is aligned with #postpartumbody. We also recruited a highly educated, mostly Caucasian sample of women that had to hold at least one social media account, so may not be representative of the postpartum population. Our inclusion of pregnancy complication “excessive gestational weight gain” may have affected body image scores due to the shame inducing nature of this terminology. Future studies should use more appropriately worded terms and avoid stigmatizing language. Furthermore, image quality during the study may have been affected by internet connectivity or access to good quality technical devices, which we did not consider in our analysis. It is also possible that assessment of body satisfaction/appreciation over time (e.g., hours, day, few days, week), or exposure to more images, or multiple sets of image exposure over subsequent days, or exposure to images in a more “Instagram-like” set up may have led to different results, or indeed differences in state body satisfaction and appreciation between groups. It is also possible that this short-term exposure could impact initially on other aspects of mental health including mood and depression which we did not assess in our study. Health-information-focused images used in this study did not undergo content analysis or similar which should be conducted in future studies to better characterize these images.

Our preliminary findings suggest that short-term exposure to body-focused imagery typically seen on Instagram targeting postpartum women may not alter state body satisfaction or state body appreciation. A randomized trial with larger sample, longer follow-up, repeated image exposure and assessment of other aspects of mental health is needed to confirm a lack of effect. Nevertheless, further research investigating whether an intervention providing health information to postpartum women via social media platforms improves health outcomes may be warranted.