research paper about photographer

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20 photography as a research method

Gunilla Holm, Institute of Behavioural Sciences, University of Helsinki

• Published: 02 September 2020
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This chapter discusses the development of photography as a research method in the social sciences. It describes the different types of photographs used, such as archival photographs and photographs taken by the researcher, and it focuses especially on photographs taken by participants. The uses of different approaches to obtain photographs and issues of interest concerning each approach are presented. The most common approaches to analyze photographs, such as content analysis, discourse analysis, and ethnographic analysis, are described. Interesting and challenging questions about the interpretation and presentation of photographs are raised, such as the impact of the researcher’s and participants’ habitus on the interpretation of photographs. Finally, ethical issues in research using photographs are considered, especially the meaning of informed consent, and confidentiality in photographic research is emphasized.

We encounter numerous photographs or visual pictures many times every day. They might range from photos on billboards to mug shots in a newspaper or photos of family members on a person’s work desk. We notice and process most of these images on a superficial level, but some impact us more. They affect us more profoundly, emotionally, or intellectually. Overall, our culture is becoming more and more visual, with images saturating our environment not only through the more traditional modes like television, newspapers, and magazines, but also through smartphones and social media, like Facebook. Despite living in a visual age (Gombrich, 1996 ) and the visual saturation of our culture, photographs are underutilized in social science research.

This chapter explores how photography has been used in social science research and what the current developments are. Commonly, we refer to visual methods and visual research, but here we can distinguish between two major kinds, namely, film/video research and research using photography. Within both fields are many ways of using videos and still photos. For example, with regard to video, the researcher can do the videotaping, but in recent research family members also act as co-researchers, videotaping another family member at home in the absence of the researcher (Holm, Sahlström, & Zilliacus, 2018 ; Sahlström, Pörn, & Slotte-Lüttge, 2008 ). Likewise, for photography, photos can be taken by the researcher or the research participants, or existing photographs can be used. Videos and photographs require different kinds of analyses and are reported in different ways. Although there is a considerable variety and complexity of work arising from the two methods, in this chapter I provide an in-depth discussion only of the use of photographs in social science research.

Even though some people thought that digital photography might bring about the end of photography, it simply changed photography and made it even more popular. For example, since 2010, when Instagram was launched, 40 billion photographs have been shared, and 95 million photographs are now shared every day ( https://www.hubspot.com/marketing-statistics ). On Facebook, on average 350 million photographs are shared on a daily basis ( https://www.brandwatch.com/blog/47-facebook-statistics/ ). Furthermore, there are 3.5 billion photos shared every day on Snapchat, one of the most popular social messaging/ photo-sharing apps in the world ( https://www.statista.com/statistics/257128/number-of-photo-messages-sent-by-snapchat-users-every-day/ ). In addition, the estimates for the number of advertisements we see every day range between 4,000 and 20,000, but on average we are exposed to about 5,000 advertisements per day ( https://stopad.io/blog/ads-seen-daily ).

The emphasis on visual images and visual culture is also evident in the numerous textbooks on visual culture produced since 2010. A classic text in social sciences first published in 1999 is Evans and Hall’s Visual Culture: The Reader (Evans & Hall, 2010 ). The book theorizes photography and provides theoretical perspectives, as well as a gender and race perspective on photographs. The difference between a visual and a textual research culture is well expressed by Kress and van Leeuwen ( 2006 ) in their statement,

But even when we can express what seem to be the same meanings in either image—form or writing or speech, they will be realized differently. For instance, what is expressed in language through the choice between different word classes and clause structures, may, in visual communication, be expressed through the choice between different uses of colour or different compositional structures. And this will affect meaning. Expressing something verbally or visually makes a difference. (p. 2)

This difference is important in visual research. Different data and different results are obtained through different ways of doing research. The search for a better understanding has led to a rapid increase in the use of photography in social science research. Visual culture research includes many kinds of visuals, such as art pictures, graphs, and maps (for a comprehensive overview of different kinds of visuals, see Margolis & Pauwels, 2011 ; Reavey, 2011 ).

There has been a proliferation of books on general visual research methods, including those by Emmison, Smith, and Mayall ( 2012 ), Margolis and Pauwels ( 2011 ), Mitchell ( 2011 ), Reavey ( 2011 ), Spencer ( 2011 ), and Stanczak ( 2007 ), as well as methodology books such those by Harper ( 2012 ), Pink ( 2012a ), and Rose ( 2016 ). Likewise, much has been published on specific aspects of visual research, such as visual ethnography (Holm, 2018 ; Pink, 2013 ) and the analysis of visual data (Ball & Smith, 1992 ; Banks, 2007 ). We also see the increasing popularity of visual research methods in social sciences; in addition to journals like Visual Anthropology, Visual Anthropology Review, Visual Communication, Visual Studies , and Forum: Qualitative Social Research , many other journals now also publish photographs. In addition, the Society for Visual Anthropology and the International Visual Sociology Association provide avenues and conferences for presenting visual research.

Across the social sciences, photography as a research method has a long history in fields such as anthropology and sociology (see Eberle, 2018 ), but it is fairly new to psychology and education. However, in sociology, photography continues to hold a marginal position, mainly because it is considered too subjective. In anthropology, film has been more important. Harper ( 2004 ) described gathering information as a function for photography in the social sciences. Here, he used Bateson and Mead’s book Balinese Character, A Photographic Essay (1942) as an example; these researchers “used 759 photographs (selected from more than 25 000 taken during their fieldwork) to support and develop their ethnographic analysis” (Harper, 2004 , p. 232). In his discussion of photography in sociology, Harper described photography as being used mostly with the researcher as the photographer. A similar tendency can be seen in anthropology. Although earlier anthropologists and sociologists like Collier and Collier ( 1986 ), Prosser ( 1996 ), and Grady ( 1996 ) wanted to make photography fit into a “scientific” framework by providing exact methods for how to use photographs in research, contemporary ethnographers like Pink ( 2013 ) rejected this approach. Pink argued for developing the way photography is used in research based on the questions and context of the study. The method can develop in the field, and she does not see the text as superior to the photographs, but as complementary and working together. Drew and Guillemin ( 2014 ) pointed out that by prioritizing the text over the visual data and using the photographs as illustrations, researchers do not see the importance of their visual data. However, more and more research uses photographs as primary data. For example, Bowles ( 2017 ) described how the photographs taken by women porters in Ghana were used for differential situational photonarratives about their marginalized social position. Likewise, Brigham, Abidi, and Zhang’s ( 2018 ) study of immigrant and refugee women’s immigration experiences in Canada was focused on the “photo-stories” produced to gain a deeper understanding of their multifaceted lives.

The field of psychology has engaged with photographs throughout its history, starting with Darwin’s use of photographs in his work. “A historical analysis of the role of the visual within psychology can reveal its instrumental effects in providing the context for ‘the psychological’ to become observable and therefore, measurable and more ‘scientific’ ” (Reavey, 2011 , p. 2). As Reavey ( 2011 ) pointed out in her book, Visual Methods in Psychology , qualitative research in psychology is a marginal field. The use of visual methods is thus at the margins of a marginal field of study. Contributing to this marginality, according to Reavey, is the notion that photography as a method has been considered more appropriate for “use with children and those deemed less ‘able’ to communicate thoughts and feelings.… In this sense, the ‘visual’ has traditionally been given the status of a naïve or more simplistic form of communication” (p. xxvii). Overall, qualitative research in psychology has focused on language- and text-based materials. In experimental psychology, photos are sometimes used as material for memorization or evaluation tasks (Mandal, Bryden, & Bulman-Fleming, 1996 ; Mavica & Barenholtz, 2012 ). In psychology related to health, education, and similar fields, there is some research using photography as a method (e.g., Brazg, Bekemeier, Spigner, & Huebner, 2011 ; Clements, 2012 ) and especially using photovoice in mental health research (e.g., Becker, Reiser, Lambert, & Covello, 2014 ; Sibeoni et al., 2017 ), but a search of psychology databases yields very few studies using photography.

In education, photos have been used in archival research related to, for example, school and space (Grosvenor, Lawn, Nóvoa, Rousmaniere, & Smaller, 2004 ) and schooling and the marginalized (Devlieger, Grosvenor, Simon, Van Hove, & Vanobbergen, 2008 ; Grosvenor, 2007a , 2007b ). Photography has also been used with preschool children to obtain an understanding of the children’s perceptions of their own surroundings and communities (Clark & Moss, 2001 ; Einarsdottir, 2005 ; Serriere, 2010 ). The photographs are helpful especially if the children’s language is not yet well developed (Clark, 2004 ; Prosser & Burke, 2008 ). Joanou ( 2009 ) pointed out that there are increased ethical considerations when working with marginalized groups of children, using as an example her study on children living and working on the streets in Lima.

The use of photography in research with children is the fastest growing application of its kind. Most of this research is done in relation to the school setting and preparation for school (Hilppö, Lipponen, Kumpulainen, & Rajala, 2017 ; Miller, 2016 ), but research is also done on children’s perspectives on, for example, their outdoor environment (Clark, 2007 ; White, 2015 ) and their city (Ho, Rochelle, & Yuen, 2011 ). Others discuss more generally the topic of using photography with children ranging from 2 years old to teenagers and children’s photographic behavior (Sharples, Davison, Thomas, & Rudman, 2003 ; Stephenson, 2009 ; Warming, 2011 ).

In this chapter, I discuss photography as a research method, review the types of photographs used in research (e.g., archival photographs, photographs taken by the researcher), and focus especially on photographs taken by participants. The uses of different approaches to obtain photographs and issues of interest concerning each approach will be presented. The most common approaches used to analyze photographs are briefly described, and interesting and challenging questions about the interpretation and presentation of photographs are raised. Finally, ethical issues in research using photographs are considered.

Photography as a Research Method in Qualitative Research

In this chapter, a distinction is made between images and photographs. As stated earlier with regard to visual culture, images can also include such things as artwork, cartoons, drawings, and maps. In research studies, children are often asked to draw pictures, on which interviews are then based (Ganesh, 2011 ). Drawings in combination with texts focused on schooling were also the focus of Holm’s ( 1994 ) analysis of the teen magazine Seventeen (1966–1989). In this study, the text and drawings placing an emphasis on how girls should behave and look made a strong counternarrative with regard to the importance of education for girls. The emphasis was on conforming to norms, on being stylish and pleasing, and on not challenging or upsetting male students. Skorapa ( 1994 ) analyzed how cartoons about schooling can either challenge or perpetuate stereotypes and the dominant ideology of schooling. Cartoons are not only amusing, but also often deal with cultural tensions, changes, and conflicts (Provenzo & Beonde, 1994 ).

In 1997, Jipson and Paley ( 1997b ) published an unusual book called Daredevil Research: Re-creating Analytic Practice , in which several of the chapters on postmodern research challenge our notions of how research should be reported. Many of the chapters incorporate or build on visual images. In Paley’s ( 1997 ) chapter “Neither Literal nor Conceptual,” the text blends with abstract black-and-white images. In another chapter by Jipson and Paley ( 1997c ), text blocks are imposed in the middle of the pages, which, in turn, are a map of the space. In yet another chapter, the text itself constitutes an image by being written in one to four interweaving curving columns (Jipson & Wilson, 1997 ). Although we rarely see this kind of experimenting with the use of visual images, these examples and other more arts-based visual research (see, e.g., Jipson & Paley, 1997a ; Knowles & Cole, 2008 ; Leavy, 2018 ) provide a sense of the endless possibilities of using images. Furthermore, photography itself provides many options; the kinds and uses of photographs are numerous. Because of the myriad of possibilities and the increasingly common use of photography, this chapter is limited to the use of photography in social science research.

One of the difficulties in using photography as a research method is the ambiguity that exists in photographs. Although photographs traditionally were thought of as portraying reality—the simple truth—this is no longer the case among researchers, even though many viewers still consider photographs as showing the truth. We acknowledge that photographs are constructed; they are made. Harper ( 2004 ) argued that this construction and subjectivity can be seen very clearly in photographs by early British anthropologists because they are all taken from the colonizers’ perspective. Interestingly, Chaplin ( 1996 ) argued that photographs are both taken and made, as opposed to just made or constructed. They are taken in the sense that they give researchers the information and details they need, more like a record or a document, but the researcher also makes decisions on what to photograph and how to set up and process the photograph.

The photographer always has a reason for taking the photograph. There is an intention behind the photograph. The photographer wants to see something specific or wants to send us a “message.” If the photographer is also a participant in the research, then the intended communication is connected to the researcher’s intentions as well. The researcher also influences the process by selecting a particular photo to be viewed by others. Consequently, there is also the intended audience: For whom is the photo taken? And, finally, there are the individual viewers. Photographers and researchers have their aims and intentions, but they cannot influence or control how the viewer interprets the photo. Sometimes the intended audience is only the researcher, and most of the photos will be seen and analyzed only by the researcher. These photographs are taken exclusively for the research and the researcher.

Whatever the case, without an accompanying text, many photographs can carry multiple meanings for the viewer (Evans & Hall, 2010 ; see also Grosvenor & Hall, 2012 ). The possibility of multiple meanings and the ambiguity attached to photographs has made many, especially positivist, researchers uncomfortable with using or accepting photographs in books and articles. A good example of this is the disappearance of photos from the American Journal of Sociology under the direction of positivist editor Albion Small, even though the journal earlier had published numerous articles with photographs (Stasz, 1979 ).

Photographs as Illustrations or for Documentary Purposes

Photography can be considered a data collection method, but not all photographs are used as data to be analyzed. The most common uses for photographs in social science research have been as illustrations and documentation. Documentary photography has a long history in fields like anthropology and sociology (see Eberle, 2018 ; and Harper, 2012 ), as discussed earlier, but also in fields like history, where archival photographs are often used. In cultural studies, a good example of historical analysis of documentary photographs is Steet’s ( 2000 ) study of the construction of the Arab world in the magazine National Geographic . Steet analyzed 100 years of photographs in the magazine, visually (and textually) constructing men and women as well as patriarchy and orientalism in the Arab world. In contrast to Steet’s extensive material, Magno and Kirk ( 2008 ) analyzed only three photographs when examining how development agencies use photos of girls to promote their agencies’ work concerning the education of girls. However, they used an elaborate analysis template with six categories: surface meaning, narrative, intended meaning, ideological meaning, oppositional reading, and coherency (coherency meaning, in this case, whether the photographs and the text argued for the same thing). Banks ( 2007 ) explained the difference between using photographs as illustrations and using them as anthropological visual research in that photographs as illustrations “are not subject to any particular analysis in the written text, nor does the author claim to have gained any particular insights as a result of taking or viewing the images” (p. 11).

Wang ( 1999 ) described a nontraditional approach to documentary photography as underpinning the photovoice method. She sees photovoice as theoretically grounded in critical consciousness and feminist theory and as an effort by “community photographers and participatory educators to challenge assumptions about representation and documentary authorship” (p. 185). Photovoice is an approach to using photography as a method for collecting data that is merged with social activism and political change, particularly with community involvement. The main goals of photovoice are, according to Wang, Cash, and Powers ( 2000 ),

(a) to enable people to record and reflect their community’s strengths and concerns, (b) to promote critical dialogue and knowledge about important community issues through large and small group discussion of photographs, and (c) to reach policy makers and people who can be mobilized for change. (p. 82)

Wang used this approach mostly for health-related research. Other researchers, like Duits ( 2010 ), claimed to use photovoice but without the community improvement goal; these kind of studies more closely resemble participatory photography research.

Archival Photos

Many archival photos were originally taken for documentary or illustrative purposes. The most frequent use of archival photos is in some form of historical research. Digital archives are becoming common, making it easier to search for particular kinds of photos. However, it is also very demanding to work with thousands of photos on a particular topic (Park, Mitchell, & de Lange, 2007 ). Photos are commonly of interest in newspaper or magazine research because they often are perceived as documenting or illustrating “objective” reality or providing evidence of historical events. For example, Martins ( 2009 ) included a couple of photographs in her study of deaf pupils in a boarding school, illustrating and providing “proof” of the kinds of exercises the pupils had to do. A similar use of photos can be seen in Amsing and de Beer’s ( 2009 ) article on the intelligence testing of children with mental disabilities. Photos of the test and a testing situation show the reader “how things were done” in the testing of these children. However, in contemporary historical research, photos are critically examined with regard to how they construct an argument in interaction with the text in a particular context. Grosvenor and Hall ( 2012 ) emphasized the importance of examining archival photos in relation to the text when creating meaning because “words when used with images can anchor meanings; change the words and the original meaning can be displaced, even though the image that it captures remain the same” (p. 26). A common problem with archival photos is that they are anonymous, in the sense that nothing is known about them: neither the photographer’s intentions nor the context in which they are taken (Martin & Martin, 2004 ). Hence, the use of these kinds of photos for research is limited.

Photo albums are also a form of private or family archives. Because family albums and photos are very familiar to us as researchers, it is important to be aware of one’s own notions and constructions of families, of what one sees as a “normal family.” A reflexive approach is necessary so that the researcher does not impose his or her own views of families on the interpretation of albums. These kind of albums also bring forth an ethical issue, since photos often contain images of family members and other people who have not given permission for their photos to be part of a research project (Allnutt, Mitchell, & Stuart, 2007 ).

Collier and Collier ( 1986 , p.10) described documentary photographs as “precise records of material reality.” Photographs document the world for further analysis at a later stage. However, Collier and Collier argued that many anthropologists have used photographs as illustrations but not as documentary data for research. Most anthropology and sociology researchers have themselves been photographers, and often these photographs have been taken as illustrations or for documentary purposes.

Photographs Taken by Researchers

Traditionally, photographic surveys (see Collier & Collier, 1986 ) of, for example, visual aspects of workplaces or institutions were used as a way to systematically document and produce material to analyze so that the researcher could draw conclusions about working conditions, types of work, and the like. As Pink ( 2012 ) pointed out, the photos taken in these kinds of surveys do not say anything about whether the objects or physical surroundings are meaningful to participants or what meaning they hold for participants. In this case, the researchers decide what they find interesting or potentially important enough to photograph. Photographs taken by researchers can also be used in photo-elicitation interviews, but still, it is the researcher who sets the tone for what is important to discuss. It becomes the researcher’s interpretation of “reality” that is considered important and analyzed. In a well-known context, the researcher can provide both descriptive meaning and stories about each object (see Riggins, 1994 ), and this can make researcher-produced photographs very valuable for understanding processes. For example, Mitchell and Allnutt ( 2008 ) described how it is possible in photo documentary research to follow “social transitions or change by identifying shifts in material objects, dress, and so on” (p. 267). Rieger ( 2011 ) called the study of social change rephotography and suggested it for studying social change with regard to places, participants, processes, or activities. Hence, in this way, detailed photographic surveys produce data to be analyzed rather than photographs for documentary and illustrative purposes.

There is no agreement on what the best approach is for researchers to take photos in the research setting. Some argue that by taking photographs immediately, at the beginning of the study when entering the scene, the camera can function as an opening device to create contact with the participants. Others argue that it is necessary for participants to get to know the researcher first, so they can feel comfortable with the camera and with being photographed.

Photographs Taken by Participants

Having participants take photographs, also called participatory photography , is the most frequently used photography method in the social sciences since 2010. It is also commonly used in visual ethnographies, especially with young people (Holm, 2018 ). Photographs taken by the participants for the purpose of, for example, photo-elicitation interviews encourage the participants to take a more active role in the research by indicating what is meaningful for them to discuss in the interview. It also gives participants more control over the interview (Clark-Ibáñez, 2004 ; Majumdar, 2011 ). Some researchers prefer to call this type of photography, in which participants construct and take the photos, photo production (Majumdar, 2011 ; Reavey, 2011 ). Radley ( 2011 ) pointed out that photos produced by participants also allow for interviewing about the circumstances of the production, which will give a more comprehensive insight into the participants’ intentions. However, even if the participants produce the photographs, the researcher’s presence is evident because the participants take the photos for the purpose of the research. In this chapter, I am not making a distinction between photographic interviews and photo-elicitation interviews. Most researchers less familiar with participatory photography tend to use the term photo-elicitation interviews as covering all kinds of participatory photography. The focus here is instead on the issues surfacing in participatory photography.

Clear instructions about the purpose of the research and the photographs must be given to participating photographers. Even so, participants often deviate from the instructions. In a study in England on young people’s constructions of self and the connection to consumer goods, participants were supposed to photograph goods they considered important. Instead, they all photographed mostly their friends. Hence, the participants redefined their task (Croghan, Griffin, Hunter, & Phoenix, 2008 ). Commonly, participants are asked to take photos during the study, but frequently they contribute photos that were taken previously, but which they think exemplify the topic. For example, in a study of language minority ninth graders’ perceptions of their identifications and belonging to the Swedish language minority group in Finland, we (Holm, Londen, & Mansikka, 2014 ) found this to be common. Because the study was done in the fall, the students found it difficult to photograph some things they thought were important for their identification. Therefore, they brought in many photos of, for example, flowers and parties taken in the summer that they believed exemplified being part of the language minority group (Figures 20.1 and 20.2 ).

The flowers portray the beautiful Swedish language.

Crayfish is something we eat with our friends. We always do it with Swedish-speaking Finns.

Likewise, participants most often are asked to be the photographers themselves, but it is also common for participants to ask others to take photos of them. In a study with doctoral students about what it means to be a doctoral student, several students asked others to photograph them instead or used previously taken photos in which they themselves were included (Holm, 2008a ). The photo in Figure 20.3 was taken by a friend of a student who is a participating doctoral student.

Photo of a doctoral student taken by a friend.

The time of the year influences the study in other ways as well. Especially in countries with dark, gloomy winter weather, wintertime photo projects will produce more indoor photos and dark, gray outdoor photos. In a study on elementary students’ perceptions of what community means to them and what their community consists of, the children took many outdoor photos of friends, their homes, and family cars, but the days when they happened to have a camera were overcast winter days. The indoor photos of their classrooms, schoolmates, and teachers are also quite gloomy, despite the smiling faces. Hence, looked at out of context, there is a somewhat downcast mood over the photos even though the neighborhood is very lush and green, with a vibrant street and porch life in the summer. Consequently, photos taken in summertime would have looked much more upbeat and cheery (Figures 20.4 and 20.5 ).

The time of year affects how photographs may look; this classroom photo was taken during the wintertime, which gives it a gloomy look.

Outdoor wintertime scenes may hide the true nature of an environment.

The importance of clearly communicating to the participants in multiple ways the purpose of the research and the participants’ task cannot be overemphasized. The study of students’ perceptions of the meaning of community and their own community was originally a comparative study between a school in the United States and a school in Finland. The students in Finland were Finnish speakers attending an English-language school, and the researcher was American. The students understood that their task was to photograph their school community instead of their community in general, which resulted in photographs mostly of their friends at school.

A weak common verbal language can also be overcome if participants express themselves through photographs. Veintie and Holm ( 2010 ) studied how indigenous teacher education students from three different tribes thought of knowledge and learning in an intercultural bilingual teacher education institute in Ecuadorian Amazonia. Spanish was the common language, but it was also the second or third language for everyone. To ease the limitations for the students to express indigenous thinking about these concepts in Spanish, the students took photographs that were then used as the basis for interviews. As researchers, we assumed that many photos about learning and knowledge would be related to schools and the teacher education institute because they were very prominent in the small community. Instead, the photographs portraying learning always involved people and actions and were mostly taken in the community (see Figure 20.6 ). In interviews, students also explained that learning is not given, but that learners are given the opportunities to observe and practice what is to be learned. Students also expressed knowledge as lived knowledge. Therefore, many students could not participate in the study because their families and homes were too far away to be photographed. Knowledge was grounded in their communities and their ancestors. The school-based photographs were only a small part of the pictures showing learning and knowledge. Instead, learning and knowledge were based on social interaction. Images of books, newspapers, Internet, and television were completely absent because they held no meaning and were not present in the students’ lives. These aspects of knowing and learning would have most likely not emerged if the students would have only been interviewed.

An Ecuadorian student’s photo of an object that represents community knowledge and learning.

Ethical Issues in Participatory Photography

Access to research sites for qualitative and especially ethnographic research can be difficult. Many institutional review boards and sites like workplaces, schools, and organizations are cautious about providing access, particularly to vulnerable populations like children and the ill. The very openness of the qualitative, ethnographic design may raise concerns. It is impossible to know in advance exactly what questions will be asked or what situations will be observed. Likewise, the analysis may be perceived as being too open and imprecise. These issues are often amplified with regard to including photography as a research method (see, e.g., Miller, 2015 ). The cautiousness is justified because the risks are higher when participants can be identified. There is no confidentiality if a photograph includes a person’s face. If the researcher is also the photographer, there is more control over what will be photographed, and the researcher can use his or her ethical judgment in each situation and refrain from taking photographs that could potentially harm or compromise participants or the research site. Conversely, if the participants are the photographers, very clear instructions can be given about what should be photographed, but there is no guarantee that participant photographers will keep to the topic or particular settings. It then becomes the responsibility of the researcher to exclude potentially harmful or compromising photographs from being published or publicly presented.

Getting official permission and access is a first step, but securing informed consent from participants or the people who participants include in their photographs can be complicated. It is difficult to know if participants fully understand how their own photographs or the photographs of others might be used later. The concept of publishing photographs in a book is easier to grasp, but the lack of control over photos appearing on websites or the fact that they might be shown and discussed in conferences across the world is more complicated. Institutional review boards seem to perceive the risks for taking advantage of children as lower if the children themselves take the pictures (Holm, 2008b ), which means that it is somewhat easier to receive institutional review board approval for these kinds of studies, even though institutional review boards tend to be concerned about children taking potentially risky photographs (Kia-Keating, Santacrose, & Liu, 2017 ). However, children taking photographs requires informed consent from guardians, beyond the informed assent of the children themselves. Involving children means more difficulties in gathering guardians’ consent and children’s assent forms. In most studies, some guardians will not give their consent although their children want to participate; conversely, some guardians will give their consent but their children will not want to participate. One way to avoid having to exclude children who want to participate is to make the photography assignment part of a school or organization project in which all children participate, but only the children who receive their guardian’s permission participate in the research.

Guardians are a form of gatekeepers; more unpredictable gatekeepers include institutions such as schools, day-care facilities, hospitals, and businesses or organizations. For example, in an ethnographic study of a school for pregnant and parenting teenage girls, the girls were going to photograph their lives as pregnant and/or parenting teenagers. However, after the study was set up, the school principal decided that the girls could not take photos of any males or of their children in diapers or taking baths. This restricted the girls so much that, in the end, they mostly took photos of each other posing at school. The restrictions were understandable, because there were several fights in school about the fathers of the babies (e.g., one man had fathered three children with three different girls) or the girls’ boyfriends, who sometimes switched from one girl to another. Likewise, the restriction about not taking nude pictures of babies was understandable because the principal wanted to protect the babies from potential abuse, especially in light of the fact that several girls had themselves been abused in different ways. However, the restrictions were imposed on the girls without an explanation of why the rules had suddenly changed. These kinds of rules imposed from above reinforced the general management and control attitude of the school with regard to the girls’ schooling (Holm, 1995 ).

Certain studies are difficult to do without the participants acting as co-researchers/photographers. Janhonen-Abruquah ( 2010 ) studied the daily transnational lives of immigrant women. The women kept photographic diaries of their everyday mundane activities, revealing the importance of cross-border communication between women in extended families living in different parts of the world. The women decided what and who they photographed. Because of the often fairly private family situations portrayed, Janhonen-Abruquah decided to blur the faces in the photographs to protect the participants’ identities (Figure 20.7 ). This approach allowed photos of people to be used without obtaining permission from everyone included, which would have been difficult for the women to do. However, if someone familiar with the women reads the study, it might be possible for that individual to recognize people in the photos based on surroundings or other features. Although this is a feasible way to deal with a difficult situation, it also objectifies the people in the photographs (Wiles et al., 2008 ) and makes them more remote and less interesting. Allen ( 2015 ) argued that blurring can be de-empowering and de-identifying as well as objectifying the person in the photograph.

Researcher (right) discussing with a research participant (left). Reprinted with permission from Janhonen-Abruquah, H. ( 2010 ). Gone with the Wind?: Immigrant Women and Transnational Everyday Life in Finland . University of Helsinki. http://urn.fi/URN:ISBN:978-952-10-6136-3

Conversely, the alternative is to not use photos, but merely describe them. In Newman, Woodcock, and Dunham’s ( 2006 ) study on bullying, it was also essential to blur or box out faces to protect children, but the photographs still give a sense of the bullying, which gives additional information and understanding compared to a mere written description.

A similar situation emerged in the study of elementary school students’ sense of community. The students had to take their own photos because much of their community was located at home, centered around their families, pets, toys, and bedrooms—places not accessible to the researcher. Young children also tend to focus on their immediate family and home environments because they are less mobile (Fassetta, 2016 ). Therefore, protecting the children’s and their families’ confidentiality often makes it difficult to publish young children’s photographs.

Preparations for Participatory Ethnography

Even though many people have some experience with cameras and photography, it is useful to have a session before the project to talk about the basics of photography. Even taking photographs for a research purpose requires some planning. For example, it might be useful to talk about how light and colors influence how a photograph is perceived (see Holm, 2008a ). Likewise, it is useful to talk about literal and metaphorical photos (Elliot, Reid, & Baumfield, 2017 ). How does one take photographs of abstract or missing things? Can the photographers manipulate their photos, now that manipulation is fairly easy to do if they have access to computers? Can the photographers bring an unlimited number of photographs, or do they have to pick a certain number of the most important ones? How will the participants deliver their photos to the researcher?

The issue of manipulation is no more important when using photography as a data collection method than in using other methods in qualitative research. Unethical researchers can always manipulate data. Interview and observation sections can be left out as easily as photographs can be left unanalyzed. However, all manipulation is not the same. If the participants manipulate/edit their own photographs, that could be considered part of the data. Unedited and edited photographs could, for example, be compared to study differences between the current and desired situations. The difference between posing for a photo, where clothing, pose, expression, and surroundings are arranged, and editing a photograph can be marginal. They are both ways of arranging the photo to convey an intended message. A researcher manipulating photos for the purpose of misrepresentation is a very different issue, however. With digital photography, the total number of photos can become unmanageable. In a study in four countries on consumer behaviors of poor people, the group of researchers took 10,400 photos but analyzed only 612. In these kinds of cases, the question arises of why exactly these 612 photos were selected for analysis (Lindeman et al., 2010 ). A detailed description of the elimination process would help dispel thoughts of manipulation resulting from the selection of certain photos.

If a group of people are to take photographs, a brainstorming session is useful at the beginning of the project in which participants generate ideas about what kinds of things might be possible to photograph. This session is not intended to tell participants what to photograph, but rather to encourage them to explore as a group possibilities for constructing and producing photos related to the research theme (Holm et al., 2014 ). In the study on doctoral students’ perceptions of their studies mentioned earlier, we did not have a brainstorming session. When students as a group viewed everyone’s photos, there was real disappointment that some students had not thought about photographing certain themes they considered very important. They also discovered that, as a group, they had forgotten certain themes altogether, such as the importance of fellow doctoral students, seminars, and professors. In other words, they were so overwhelmed by life outside the university that, in most cases, they forgot to photograph the university scene (Holm, 2008a ).

Photography works well as a method for research and advocacy using the kind of concrete portrayal/documentation of problems used in photovoice. Many researchers argue that young people are especially comfortable with and knowledgeable about photography. Many also argue that it is easier for young people and children to photograph and then discuss difficult and complicated issues. Especially when dealing with less verbal students or students with another first language, photography might be a good method (Cremin, Mason, & Busher, 2011 ; Lodge, 2009 ; Sensoy, 2011 ; Wilson et al., 2007 ).

Habitus and Metaphorical Photographs

Bourdieu ( 1990a , 1990b ) and Sweetman ( 2009 ) argued that photography can be used for exploring abstract and difficult-to-grasp concepts like habitus. Following their claims that photography is a possible way to explore habitus, we (Holm et al., 2014 ) set out to study the habitus of Swedish language minority–speaking teenagers in Finland. How do these teenagers see themselves as being a member of a language minority group, and how do they perceive the entire group? The photos they took can be divided into two categories. One category included literal depictions of Swedish-speaking theaters, newspapers, street signs, and the like (Figure 20.8 ).

A literal photograph. One can understand both languages; street signs are in both Finnish and Swedish.

The other category included metaphorical photos (see also Elliot et al., 2017 ) showing, for example, being a minority group member, community, togetherness, feeling threatened, and being worried about the future of the language group (Figures 20.9 – 20.11 ).

A metaphorical photograph showing the proportion of Swedes to Finns in Finland.

A metaphorical photograph; Finland-Swedes are melting away slowly in Finland.

Finland-Swedes are like trees in a storm. Often we just bend, but if it is storming too hard we will break.

Interestingly, in interviews, students had difficulty explaining what it means to belong to a language minority group. In the interviews, students focused mostly on the language, whereas with the photos, they brought forth a variety of aspects. In the photos, the language was just one aspect among many. The students also tended to use photographs of nature for their metaphorical visual statements. They often said in interviews that language minority members stick together and that they have a sense of belonging. In the photos, this was expressed through nature, as in Figures 20.12 and 20.13 .

I think this little path is like the Finland-Swedes, all the rest around are the others in Finland.

A lone swan in the big sea like a Finland-Swede.

The students photographed more deep-seated thoughts about the group’s future and stereotypes about the group, as well as their attachment to nature and the archipelago where many of their families originated. Likewise, Croghan et al. ( 2008 ) found that young people took photographs of sensitive issues related to their identity positions such as religion and race, issues that were not brought forth in interviews.

This kind of literal and metaphorical division can also be seen in photos taken by Palestinian children and youth living in refugee camps in Lebanon (Mikander, 2010 ). They took photos to show what their lives are like. In this case, too, the children and the researcher had no common language. Here, too, there were many photos portraying the children’s thinking, habits, and ways of being. An example of a literal photo is one of a living room wall (Figure 20.14 ). The viewer’s eye is drawn to the picture of Yasser Arafat, but the child took the photo to show the hole in the wall. She wanted to show how they continue to live without permanent wiring, as if their housing was temporary.

A Palestinian child’s photograph of a wall in her home; although the viewer’s eye is drawn to the picture of Yasser Arafat, the child’s focus is the hole in the wall.

In Palestine, young people’s ways of thinking about their future can best be told through a series of photographs of a burning cigarette (Figure 20.15 ). They begin with full lives, with seemingly a lot of possibilities and hope. Their lives shrink with age, and in a metaphorical way their development stops when they finish school because they do not have opportunities for further education. Dreams about future families are also hampered by the severe housing shortage. Hence, their life prospects are very limited.

The life opportunities of a youth in Palestine are metaphorically depicted as a burning cigarette.

Other abstract aspects of life, like absence, seem to be more difficult to photograph. In a study in which doctoral students photographed their lives as doctoral students, four photos of four students’ families were similar, but depicted different things. One photo was of a Chinese wedding; the second depicted a Korean mother, father, and child; the third showed a Ugandan mother with four children; and the fourth was of an American father with two children. In all photos, the people looked happy. Without accompanying text, it was impossible to know how different the intended messages were. The American photo indicated that, for this doctoral student, her husband and children were her first priority, even if the doctoral studies required much of her time. However, all the other photos indicated that the international students were studying alone in the United States and were missing their families, who had remained in their home countries. The question for them had been, “How do you photograph the absence of someone?” Many of the issues, like ethical questions and habitus, brought up here in relation to participatory photography are also important for other kinds of photography in the social sciences. However, they are often brought to the forefront in participatory photography because the participants take the photographs.

Analysis and Interpretation

No one “best” specific method exists for analyzing or interpreting photographs. In social science studies, most researchers use the same methods for photographs as for text. Early books on visual research methods (see, e.g., Collier & Collier, 1986 ) tended to give fairly precise instructions on how to organize, categorize, and compare photos to be able to conduct a good analysis. All researchers must organize and group their photographs in some way, especially when we talk about hundreds and thousands of digital photos. However, researchers develop their own styles, often in connection with how they analyze their textual data. Many researchers use software programs to organize photos; others group them by hand. However, categorizing or grouping photos is just a beginning, as with textual data. According to Harper ( 2003 ), taking and analyzing photographs is aided by theory, just as when collecting and analyzing any other kind of material. He also sees photographs as helping to build theory by forcing us to look at specific things in the field or to confirm theory. Harper ( 2003 , p. 195) states “Indeed, the power of the photo lies in its ability to unlock the subjectivity of those who see the image differently from the researcher.” Theory, the researcher’s own and the participants’ previous knowledge and experiences, previous research, and the participants’ descriptions of the photographs all contribute to an understanding of the photographs.

How the analysis of photographs is done is not discussed much, if at all, in most research reports and visual research books, even though Ball and Smith wrote about analyzing visual data in 1992. However, literature does exist on various kinds of content analysis, semiotic analyses, and interpretive and other methods (see, e.g., Margolis & Pawels, 2011 ; Rose, 2016 ). As Spencer ( 2011 ) pointed out, how a research study is designed, how data are collected, and how results are understood depend on the underlying paradigm. Therefore, some researchers simply state that a study was analyzed based on a particular paradigm.

Content Analysis

A mostly quantitative content analysis is used for large numbers of photographs because it yields basic information about the frequencies of certain types of photos, on the basis of which various comparisons can be made. Rose ( 2016 ) presented detailed steps to be followed to conduct a reliable content analysis. She emphasized a careful selection of images and rigorous coding. However, Rose cautioned that a high frequency count does not mean that the occurrence is important. In addition, frequencies do not indicate how strongly a photo exemplifies a category or anything about the mood of photos. The intentions of the photographer are also excluded from content analysis. Even though the analysis is quantitative, there is also a qualitative element in the interpretation of the frequencies and the presentation of the results.

Margolis and Rowe ( 2011 ) described their use of a grounded theory approach to content analysis, which differs substantially from the approach discussed by Rose ( 2016 ). In Margolis and Rowe’s approach, the coding is theoretically based, which also allows them to pay attention to absent categories. Their categories overlapped, as opposed to the usual requirement of mutual exclusivity, and they also expanded the number of categories and merged categories during the analysis.

Discourse Analysis

In popular culture studies, as well as in other social science research, various forms of discourse analyses are used in the analysis of photographs in relation to text. There is no specific visual discourse analysis, but Spencer analyzed specific images as examples of the use of discourse analysis. Rose ( 2016 ) made a distinction between discourse analysis I and discourse analysis II, describing discourse analysis I as paying “rather more attention to the notion of discourse as articulated through various kinds of visual images and verbal texts than it does to the practices entailed by specific discourses” (p. 192). She described discourse analysis II as working “with similar sorts of material, but … much more concerned with their production by, and their reiteration of, particular institutions and their practices, and their production of particular human subjects” (p. 220). Rose presented highly detailed and in-depth descriptions, with examples of how to conduct these kinds of discourse analyses. However, it can be useful to remember that there are many ways of doing discourse analysis (e.g., see Laclau & Mouffe, 1985 ).

Ethnographic Analysis

Many researchers use some kind of interpretivist analysis without being specific about it. Pink ( 2012b ) summarized the ethnographic approach very well:

The academic meanings that ethnographers give to visual images are also arbitrary and are constructed in relation to particular methodological and theoretical agendas. Individual researchers classify and give meanings to ethnographic images in relation to the academic culture or discipline with which they identify their work. Moreover, ethnographers are themselves subjective readers of ethnographic images and their personal experiences and aspirations also inform the meanings they invest in photographs and videos. A reflexive approach to classifying, analyzing and interpreting visual research materials recognizes both the constructedness of social science categories and the politics of researchers’ personal and academic agendas. (p. 117)

Hence, an ethnographic approach entails using one’s already established or newly developed ways of organizing data. This organization and categorizing or beginning analysis might be quite intuitive and begin in the field. In many cases, the field and academic work intersect on a weekly basis, which influences how the researcher sees the data. In the academic setting, photographs are interpreted more closely from particular paradigms and theoretical frameworks and thus receive different meanings than they would in the field. In this kind of ethnographic approach, text and photographs are equally important and interact and inform the understanding of each other, as well as the relations between the two. The categorization in this approach differs from that of earlier approaches (see Collier & Collier, 1986 ) in that photos might be grouped in several ways. For example, they could be grouped according to the content, symbolic meaning, or origins of the photographers. The sequential order in which the photographs are taken is not necessarily important for the analysis because the photographers’ or participants’ thinking might not be linear. Rather, the way participants think about the way the photographs connect to themselves and their worlds might be more important.

At times, text and photographs might produce different but connected stories. Harper ( 2004 ) described, with regard to Agee and Evan’s ( 1941 ) work on sharecroppers during the Depression, how the text and photos are juxtaposed and where “neither form repeats or replaces each other. Rather they develop in tandem” (p. 232). In my research on the schooling of teenage mothers, the photos, on the one hand, told the story of happy, playful girls posing alone or with other girls, but always without children. This was the story they wanted to show outsiders. The text, on the other hand, told the story of the girls’ more private thoughts about their unhappy childhoods of abuse and abandonment, as well as their worries about being young mothers, often without any support network. Together, the two stories give a much fuller view of the girls than either one does separately (Holm, 1995 ).

Issues in Interpretation

The context of the production of the photos can be important. In our study of minority-language teenagers’ perceptions of their own identifications, the geographical region in which they lived and produced their photos was closely tied to their identifications. Likewise, the larger societal context with regard to the general standing of the language minority group influenced how worried the teenagers were about the future of the entire group. The academic context in which the photos are interpreted produces interpretations different from the interpretations produced in the field.

The interpretation of the photos will always vary somewhat from person to person depending on previous experience. An interesting question concerns how much the researcher needs to know about and understand the context in which the photo is taken. How much of the historical context do we need to understand to interpret archival photos? On one level, we can make some sense of photos of people living in difficult circumstances (as, for instance, during the Depression), but without the knowledge of this historical context, our interpretation will be superficial. Likewise, how much of the context do we need to know and understand of the participants who took the photographs?

As researchers, we found in our study of the Swedish-speaking students’ photographs (see the earlier description of the study; Holm et al., 2014 ) that having a habitus similar to that of the participating photographers facilitated understanding of their photographs. Metaphorical photographs were especially easier to interpret. For example, photographs of the feeling of being harassed or that the future is somewhat insecure for the minority group immediately rang a bell for us. We had all had that feeling or experience at one point, although in different settings. Figure 20.16 shows the sun disappearing like the Swedish language is doing, according to the student; this feeling of doom is familiar to all Finland-Swedes, like the participants and the researchers in this case, who live in areas where the Finnish language is dominant. Without the text (or without an interview about the photos), this photo would simply be a photo of a beautiful sunset. Outsiders would get some sense of the situation from the text, but for the researchers living in the same societal context, the photo immediately brings to mind the larger debates about abolishing compulsory Swedish-language instruction from schools, hostile comments by members of an anti-Swedish (and anti-immigration) party, personal comments that Swedish speakers should emigrate to Sweden, and the like. Hence, knowing the societal context helps the researchers to more fully understand the deep thinking of the student taking the photo.

Swedish is disappearing from Finland (photo taken by Eva, a student participant).

In analyzing and interpreting photographs taken by participants, it is important to pay attention to photographs not taken as well, since they can be important (Drew & Guillemin, 2014 ). They can be missing because it is too difficult or painful to find ways of showing one’s thoughts, as Frith ( 2011 ) found in her study of women in chemotherapy who did not have enough energy to take photographs when they were feeling most ill. Other issues might be too intimate or sensitive. Missing photos can also be a result of restrictions placed on the participating photographers by gatekeepers (Holm, 1997 ).

There are numerous books about different kinds of analyses of photographs and visual data in general. However, most researchers do not recount in their articles what kind of analysis has been used. In the methods section of articles, researchers discuss what kinds of data were collected and how they were collected, but few proceed to discuss what was done with the data after collection. Most indicate that the data were “analyzed.” Some use phrases such as photographs “can be read,” “in line with the social constructionist paradigm,” “we looked for salient patterns/images/issues,” and the like. The reason for this lack of discussion about the actual analysis might be that there is not one specific approach and that the field is relatively new for many researchers. Many researchers treat photos in the same way as verbal texts, but often do not provide even basic information about the method used. Some researchers mention that photographs were categorized, but usually there is nothing more explicitly said about the analysis or interpretation. However, more recently some researchers have provided closer accounts of the process of analysis and interpretation (e.g., Holm, 2018 ; Velasco, Beckmans, O’Driscoll, & Loots, 2014 ).

Presentation of Research Using Photography as a Research Method

In social science studies, the most common way to present research using photography is still to translate most of the photographs into text, although more journals are willing to publish a few photographs as part of an article. However, only journals like Visual Studies, Critique of Anthropology , and Visual Communication will publish photo essays in which most of the article consists of photos accompanied by short texts or captions and the participants’ story (Banks, 2007 ). There also tend to be more photos in books and book chapters than in journals. One reason for this might be, as Miller ( 2015 ) pointed out, that reviewers for refereed journals tend to give unreasonable or nonrelevant critique by asking, for example, about the frequency of photographs or if they are staged. E-journals are ideal venues because some of them, like Forum: Qualitative Social Research , are open-access journals and publish photography-based articles. Hypermedia online journal articles, like a special issue of Sociological Research Online , go a step further than regular online publishing by including, for example, live video clips. Online journals could also link directly to interactive websites where data sets of photographs and interview transcripts as well as the results, including the photographs, could be available. Rose, in her book Visual Methodologies (2016), provided examples of such websites. Although some researchers publish their work using photographs on websites, this is not a realistic option—at least not as the only venue—because most academic researchers still work in institutions requiring publishing in refereed journals.

Ethical Issues in Photography as a Method

Ethical issues have emerged throughout the chapter with regard to gaining access, securing informed consent, and promising confidentiality. Of foremost concern in photographic research is whether participants understand what informed consent means and for what purposes the photographs can be used. Institutional review boards are especially strict with regard to protecting participants from harmful or compromising photographs. However, many argue that it is not possible to foresee all possible situations in advance, and hence giving consent should be ongoing throughout the study (Pauwels, 2008 ; Wiles, Coffey, Robison, & Prosser, 2012 ). It is possible to produce consent forms in which participants specify what kind of uses they consent to. For example, some participants may allow their photographs to be used for analysis but not for publication. Other participants might not want anonymity; rather, they want viewers to know who they are and/or that they have taken a particular photograph (Grinyer, 2002 ; Wiles et al., 2008 ), although this is not always possible if others are involved in the study. Conversely, there can be difficulties with photo release forms if someone is suspicious of signing forms (Banks, 2007 ) or does not understand the language or meaning of the form.

Ultimately, the researcher must make judgments about ethical issues surfacing over the course of the study. Participants’ rights to refuse to be photographed or to photograph certain things must be respected at all times. Likewise, it must be possible to withdraw from the study at any time. In describing the difficulties of taking photos of very poor consumers in four different countries, Lindeman et al. ( 2010 ) described how the fieldworkers were torn between doing what the study required with just a couple of weeks of fieldwork and respecting people’s right to not to want to be photographed or have their poor homes photographed. They noted,

The issue of interfering in peoples’ lives was also present when we wanted to take photos and videos. In principle we always asked for permission before filming or taking pictures, but in some instances we also had to take sneak picture of things of high importance to the research. (Lindeman et al. 2010 , p. 9)

In the pressure to collect data quickly, the researchers made poor ethical decisions.

Researchers using previously taken photos as well as researchers working with new photos face questions of ownership and copyright (Rose, 2016 ). With regard to new photos, some researchers try to prevent potential problems by clarifying photo ownership on the forms used for permission to conduct research. This might be a good idea, especially if the participants take the photos and think of them as their own.

Overall, collaborative research in which the photographs are more of a coproduction might be a more ethical approach to visual research. Giving copies to and discussing photos with the participants whenever possible is also a way to give participants a better sense of which photos will be used and how they will be used. In using photography as a research method, the one aspect present in all studies and throughout all studies, from beginning to end, is the responsibility of the researcher to make good ethical judgments to produce research that does not harm participants in any way.

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Photography as a Research Method with Learners in Compulsory Education: A Research Review

This article offers a review of thirty-one research articles from 2001–2019 on the use of photography as a research method with learners in compulsory education. Understood within the scope of ‘visual’, ‘participatory’ and ‘arts-based’ research methods, many scholars have linked the increased use of the photographic method to greater awareness of the rights of the child and changing understandings of children as full ‘human beings’ with agency rather than simply vulnerable ‘human becomings’. Nevertheless, photography is still a relatively under-utilised approach in research with learners in school-based compulsory education and its use is not widespread globally. Against the background of the history of visual and photographic methods in general and in education in particular, this article highlights two key themes in the empirical research literature: why the photographic method is used (dealing with representation, participation and emancipation); and how the photographic method and the photos themselves are used (pre-generated and participant-generated photographs). It closes with a reflection on what may be holding back its expansion, including key ethical concerns, and a proposal for encouraging its use in education.

• 1 Introduction

It has been argued that the research methods that social researchers use should be applied creatively so that they can be made ‘fit for purpose’ ( Kara, 2015 ). With this responsibility in mind, a plethora of visual ( Banks, 2001 ; Pink, 2001 ; Rose, 2001 ), arts-based ( Leavy, 2008 ; Knowles & Cole, 2008 ) and participatory ( Reason & Bradbury, 2008 ; Chevalier & Buckles, 2013 ) methods have been evolving, particularly over the last four decades. Scholars have linked this development to a number of shifts, two of which can be related to children and young people and school-based research. The first shift is in understandings of children and young people that came around the time of the United Nations Convention on the Rights of the Child in 1989, and particularly the legal obligation for the ‘best interests’ of children to be taken into consideration, and the views of children to be taken into account on anything that affects them ( Lundy, 2007 ; Lansdowne, 2011 ; Hanna, 2019 ). The second shift relates to the movement within the sociology of childhood that began to more vocally advocate the appreciation of different childhoods where children were increasingly seen not as a vulnerable collective who needed protection, but as individuals holding agency to act on their world and the capacity for independent thought: as fully-fledged ‘human beings’ rather than simply ‘human becomings’ ( James & James, 2004 ). These two shifts, it may be argued, lead to the conclusion that children and young people should be allowed to ‘represent’ themselves to the world ( Prout, 2001 ). Therefore, it is sometimes argued that these, more creative methods hold the potential to offer a more holistic, inclusive and flexible approach to exploring social realities – and a more enjoyable and engaging research experience – particularly with children and young people as research participants ( Thomson, 2008 ; Stirling & Yamada-Rice, 2015).

One method that may be included within this shifting methodological landscape is photography. Used widely within anthropology from the late 19th century, it now holds a firm place in 21st century research methods literature ( Banks, 2001 ). However, while photography has been used fairly frequently as a method in some other fields, as will become clear from the limited number of research articles that were available for this review, it is still a relatively under-utilised approach in school-based compulsory education. This is despite the enduring and perhaps growing salience of visual culture due to the widespread use of social media among younger people in particular ( Woodfield, 2014 ), a conundrum that this Special Issue seeks to take some steps towards addressing.

Against such a background, this article offers a review of thirty-one empirical research articles from the past eighteen years (2001–2019) on the use of photography as a research method with learners in compulsory education. It considers the development of visual and photographic methods in research in general and within educational research in particular. Then it presents the scope of this research review and the search strategy employed to find the articles included within it. Following this, it moves on to the two main themes that emerged from reviewing the research papers, namely: why the photographic method is used (dealing with the key motivations of representation, participation and emancipation); and how the photographic method and the photographs themselves are used (distinguishing between pre-generated and participant-generated photographs). It closes with a reflection on what may be holding back its expansion, including key ethical concerns, and a proposal for encouraging its use in education.

• 2 Visual and Photographic Methods in Social Research

Photography has variously been described as a ‘visual’, ‘visual ethnographic’, ‘participatory’ and ‘arts-based’ method, depending on how and with whom it is used. Photography first began to be used as a research method within anthropology and ethnography in the early 20th century, when photographic equipment became accessible to researchers ( Banks, 2001 ). In this sense the camera was usually used by the researcher-photographer as a way of capturing an aspect of a community: as ‘photo-documentation’ ( Rose, 2001 ). Since then, the method has seen various evolutions, and particularly a significant movement towards being used as a way of involving participants in the research process itself, either through using ‘found’, researcher-produced or pre-existing photographs, or through participants producing photographs themselves.

Key scholars who have been active in the field of visual ethnography over the past two decades include Sarah Pink (2001) , Gillian Rose (2001) , and Marcus Banks (2001) , who have explored the various debates and dilemmas that have arisen as the method has evolved. For example, in her monograph, Pink (2001) proposes that images are everywhere, ‘inextricably interwoven with our personal identities, narratives, lifestyle, cultures and societies, as well as with definitions of history, space and truth.’ (p. 17) She therefore concludes that visual ethnographic researchers must appreciate the interlinkage between the oral/aural and the visual, for ‘[j]ust as images inspire conversations, conversations may invoke images…images are as inevitable as sounds, words or any other aspect of culture or society.’ (p. 17) Rose (2001) highlights issues of representation in terms of the extent to which an image can represent an object, person, place, time or concept; related to this is the issue of ‘audiencing’ which can influence how a particular image is understood and interpreted, a huge challenge for researchers in any qualitative research but perhaps particularly in visual research. Banks (2001) proposes that visual research is a ‘collaborative project between image maker and image subjects’ and so, social researchers ‘[can]not pretend that they can somehow transcend their humanity and stand outside, merely observing’. (p. 112) There have also been notable contributions from Claudia Mitchell (2011) in her monograph Doing Visual Research and Pat Thomson’s (2008) edited collection Doing Visual Research with Children and Young People . Many of the key debates explored in these monographs and volumes emerge also from the articles selected for this research review and will be returned to later.

In terms of photography in particular, it may be said that its use as a research method has expanded significantly, being used in very different ways to cover different topics and work with different groups of people, to serve different ends and to address or challenge some ethical issues. There have been notable edited collections published from the 1960s onward, such as John Collier’s collaboration with Malcolm Collier in their book Visual Anthropology: Photography as a Research Method . ( Collier & Collier, 1967 ) One of the best-known pioneers in this area has been Caroline Wang (along with Burris in the early days) who from 1997 began to publish on ‘photo-voice’ or ‘participatory photography’ in health and community contexts (see, for example, Wang, 1999 ). ‘Photo-voice’ is a method that involves participants documenting their experiences through photography and then discussing them, with a view to bringing about criticality, empowerment and change, all within a participant-led environment. ( Wang, 1999 ) It is an approach that has been used quite extensively within community settings, where a research participant will often have the use of a disposable camera and will therefore be able to take photographs within their daily lives. In this way, Wang has inspired a whole generation of researchers who wish to use a participatory approach to research, where participant-researchers are fully informed and leading and moulding the research in some way. It is also strongly associated with ‘photo-elicitation’ (Collier & Collier, 1986; Harper, 2002 ) whereby participants describe the photographs and sometimes write short inscriptions for them, that may or may not be shared publicly. However, ‘found’ or researcher-generated photographs have also been used as a way of sparking discussion or debate or tapping into a memory. Both of these approaches will feature in the themes of this research review below.

What may be apparent so far is that the best-known scholars in photography as a research method appear to be located outside of the field of education. While its use within social science research in general may be traced to the 1960s, as Kaplan, Lewis and Mumba (2007) noted, it is very difficult to trace the origin of the photographic method within compulsory education; in 1998 Wetton and McWhirter wrote on health education, in the same year, Prosser (1998) discussed the fact that text is normally more highly valued than images in educational research, and the earliest research paper that could be found for inclusion in this review was from 2001, which investigated sociability and cooperation among 4–5 year olds in England, using researcher-generated photographs ( Broadhead, 2001 ). There are some notable, more recent contributions specific to education that will interest the reader. There is extensive treatment of photographic methods in Miles and Howes’ (2015) edited collection Photography in Educational Research: Critical Reflections from Diverse Contexts . There is also the Wylie Handbook of Ethnography in Education from 2018 which includes a chapter on visual ethnography in education that refers to photography and covers such aspects as ‘participatory photography’ and ‘photo-elicitation’ interviews as well as the challenges of getting access to research sites due to institutional review boards ( Holm, 2018 ). However, while compiling this research review, what became clear was that, although photography as a research method is quite common within the early years of education, as well as in community (non-school) settings and other anthropological or sociological research ( Barker and Smith, 2012 ), it appears to be used less often with learners within compulsory education. Returning to Kaplan et al., they noted this in their work over a decade ago (2007) but it could be argued that the field has not expanded significantly since then. This is despite the fact that the method is clearly and continually being developed in other fields, while appreciation and understanding of visual culture grows. This is a curious point that will be explored more fully in the concluding section of this article, where ethical concerns and understandings of children will feature.

• 3 Scope of this Review and Search Strategy

This research review is a qualitative, narrative review (Efrat et al., 2019) focused solely on the use of photography as a research method with learners in compulsory education. This type of review aims to ‘survey the state of knowledge in a particular subject area and offers a comprehensive background for understanding that topic.’ (p. 21) It is based on articles in English language journals that report empirical research as this is the only language in which I am fluent. Therefore, it is unsurprising that many of the articles have been written by English native speakers in English-speaking countries.

In terms of search strategy, I followed Reed’s stages (2017). I did an initial general search based on Google and Google Scholar, looking for ‘photography as research method’ to check on terminology. After reading generally about visual and photographic methods, I then turned to academic databases, beginning with Scopus. I did a Boolean search of titles, key words and abstracts, with my search terms refined to ‘photography’, ‘education’/’school’/’learning’ and ‘research’ and ‘method’. I limited the disciplines to ‘arts and humanities’ and ‘social sciences.’ I also limited the search to research articles and excluded books and book chapters. I did not limit the time period at this stage, although I was aware from my initial reading that very little was available from before the early 2000s. I also did not limit the country focus. This brought up 135 research articles. I also used the references in the selected relevant papers that were more broadly on ‘children’ and ‘photography’ to plug gaps, particularly of papers that did not appear on Scopus. Some of these used the term ‘participant photography’ or ‘photovoice’ or ‘visual’ or ‘arts-based’. Finally, I searched the Taylor and Francis journal website to fill in any remaining gaps. After a brief review of titles and abstracts, I excluded papers that did not relate to compulsory education (a significant number). Once I had briefly scanned these articles, I also excluded those that did not focus on the use of the method with learners specifically.

In total the review is based on 31 articles that report empirical research studies. The findings focus on key themes that emerge from this research review. The list of papers included in this review can be found in Table 1 and in list form at the end of this article.

• 4.1 Why Photography is Used: Representation, Participation and Emancipation
• 4.2 How Photography and Photographs are Used: Pre-generated, Researcher-generated and Participant-generated Photographs
• 5 Summary and Reflecting on the Prospects for Photography as a Research Method in Education
• Review Articles

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Six Contemporary Photographers on Paper as a Source of Inspiration

Why artists thomas demand, christiane feser, daniel gordon, soo kim, matt lipps, and christopher russell fold, cut, layer and shape paper in different ways as part of their photographic practice.

Laura Hubber | May 22, 2018 | 14 min read

Partition 31 , 2015, Christiane Feser. Pigment print, cut, folded, and layered, 55 1/4 × 39 1/2 in. Collection of Trish and Jan de Bont. © Christiane Feser

Within a world of digital photography, the artists in the exhibition Cut! Paper Play in Contemporary Photography have turned to paper as a source of inspiration. All appreciate the physicality of paper, and each brings his or her own sense of wonder, precision, and playfulness to its transformation into something more complex.

In these brief slices of conversation, excerpted from interviews I conducted for the audio tour that accompanies the exhibition, they share what they love about working with paper.

Christiane Feser

Christiane Feser makes photographs of paper she has folded. Then she makes photographs of those photographs, and so on, until it becomes impossible to distinguish the photograph from the photographed.

Christiane Feser: I got more interested in the piece of paper you can touch because digital images don’t alter or age with time. They cannot be torn, they cannot be bent, they cannot be cut, so they are kind of a distant. I’m more interested now in dealing with the materiality and really touching this thing. There’s a German word, begreifen . This word means understand, but to touch something means to understand it.

Laura Hubber: How do you want your photographs to be received by the viewer?

Christiane Feser : When I was still shooting flat, normal photographs, I was always kind of disappointed when I saw how fast people were looking at these works. They look at them and after a few seconds they decide, “Okay, it’s a house, it’s a street,” next picture.

But if you really look closely at something, you get lost in the picture. It is important that people are a little bit like detectives, trying to find out, “What is the thing? What is the representation?” and this is very satisfying for me to see. But I am most happy if they can’t find out in the end all the secrets that are in this.

Hear more from Feser about her relationship with paper in the audio stop below.

(piano music with a sense of uncertainty)

Female narrator: Christiane Feser’s photographs are like visual puzzles that invite the viewer to try to solve them. What is the photograph? What is the shadow? Each invites the viewer to look and look some more.

Christiane Feser: I was thinking about how photography could be more complicated. I wanted to have an image that’s not so much related to the outer world anymore, so I started with paper constructions that I photographed. Then I took this print of the photograph and cut it up again. And then I re-photographed this second construction. And then I print it out again and returned to the first step, so it’s a photograph of a photograph of a photograph and this direct relationship got lost so people could no longer find an easy answer on this question. What is this photograph showing?

Female narrator: Feser began making images this way when she became frustrated by how people consume images.

(music ends)

Christiane Feser: When I was still shooting flat, normal photographs, I was always kind of disappointed when I saw how fast people were looking at these works, and after a few seconds, they decide to continue with the next picture.

Female narrator: She was also tired of experiencing images through the distance of screens and displays and smartphones.

(music resumes)

Christiane Feser: I got more interested in the piece of paper because, digital images, they don’t alter or age with time. They cannot be torn, they cannot be bent, they cannot be cut, so they are kind of distant. I’m more interested now in dealing with the materiality. There’s a German word, “begreifen”: to touch something means to understand it.

We tend to take the photograph for the thing itself. It is important that people are a little bit like detectives to try to find out, “What is the thing? What is the representation?” They spend often a very long time in front of the pieces and they start to talk and they go closer and far away and they look from the side and they speak with each other about what it is, and so this is very satisfying for me to see. But I am most happy if they can’t find out in the end all the secrets that are in this.

Models , 2016, from the series Looking Through Pictures , Matt Lipps. Pigment print, 72 × 54 in. Promised Gift of Sharyn and Bruce Charnas to the J. Paul Getty Museum. © Matt Lipps

Matt Lipps began cutting out photographs from Vogue and Harper’s Bazaar and pasting them onto cardboard when he was in high school.

Matt Lipps: That I’m still here twenty years later making paper doll cutouts is a crazy, fortunate thing.

Laura Hubber: Why do you love paper?

Matt Lipps: It doesn’t go away. You can always keep it and hold on to it. Digital pictures get deleted and they are just gone. They go back into the World Wide Web, wherever they go. There is something about that piece of paper that you can rely on, that will be with you, that you need to take care of. Especially if you think about an actual photograph, which has a surface that will expand and contract with heat and moisture, and needs to be protected from light. You need to care for it, like a body almost. The nurturing of that sort of appeals to me.

Paper also crumbles, is torn. I like the wear and tear and wrinkles that happen at the corners of the cutouts when they fall over and get bent. I appreciate the history that is embedded in that object. I’m left cold with a digital image.

Hear Matt Lipps say more about his cutouts:

Female narrator: Artist Matt Lipps has been collecting images since high school. Some of them he saved in binders. Others he cut out and stood up on cardboard stands.

Matt Lipps: That I am still here twenty years later making paper doll cutouts is a crazy, fortunate thing.

(piano music evoking technology)

This picture is from the book called The Great Photographers . It goes through about 30 different photographers and profiles the greats. Each one of those cutouts represents a different idea of what a great photographer looks like, or how they practice. They’re all standing up on these glass shelves and then behind that is a poster print from my own personal archive of negatives from my high school and undergrad.

Female narrator: Even though his photographs aren’t digitally manipulated, Lipps says his practice is informed by the world of technology that encourages quick looking.

Matt Lipps: We absorb images so quickly we think that we know them, but it’s when you really slow down, really examine what’s happening in the foreground, the background and it all starts to come together. I think being an active viewer, it’s something that’s kind of lost in the digital swiping. Swipe left, swipe right.

When I sit at my desk with my cutting mat and my x-acto blade and I’m really sort of tracing the contours and peeling apart the foreground, background, or whatever it is that I’m doing to get to the object, I’m seeing it for the first time in such a different way, a very slow, analog way, where I discover things constantly.

Female narrator: Lipps says his work is inspired by collage, but is more flexible.

Matt Lipps: I have thousands of cutouts in boxes in my studio. I like the idea that I can remix these parts up and I could make a new picture out of it, if I ever wanted to.

Female narrator: For Lipps, paper is an integral part of his photographic process.

Matt Lipps: Paper doesn’t go away. You can always keep it and hold onto it. Digital pictures get deleted and they are just gone. There is something about that piece of paper you can rely on that will be with you. You need to care for it, like a body almost. The nurturing of that, sort of appeals to me. I actually like the wear and tear and wrinkles that happen at the corners of the cutouts when they fall over and they get bent. I appreciate the history that is embedded in that object.

Thomas Demand

Thomas Demand is a sculptor who makes large models of cardboard and paper and then photographs them. After he takes the photograph, he discards the model itself.

Thomas Demand: I decided at some point that I wanted to be able to make sculpture[s], but not live with them. A cheap material, which wouldn’t bind me financially and space-wise, is paper and cardboard, which is also quite good because everybody knows it very well. The cup of coffee, the dollar note, maybe the newspaper. People have a feeling for paper.

The artificiality of the paper is important to me. It’s a different way to render the world, and it’s nearly as good as the real one. This “nearly as good,” this little gap between what you see there looks a little bit artificial, but is obviously a plant, makes you hopefully think about what we see, and how we see, and how we recognize, and how we communicate about what we recognize.

Hear Thomas Demand discuss his process and his work Landscape :

Thomas Demand: Trust your eyes, and try to figure out how it’s made.

(ambient enigmatic music)

If you look at it long enough you just realize that it’s actually nothing else than a cardboard model. It’s just a stand-in. It stands for our idea of reality.

My name is Thomas Demand, and I am a sculptor, predominantly. I make life-size models of cardboard and paper, which I then photograph, and after the photograph is done, I discard the model itself.

I wanted to make sculptures which are cheap and don’t get into my way. As an artist, you always have a space problem, especially when you do sculptures. I decided at some point that I want to be able to make sculptures, but not live with them.

Female narrator: Demand also likes the way paper is a common medium.

Thomas Demand: Everybody knows it very well. The cup of coffee, the dollar note, maybe the newspaper.

Female narrator: In his photographs, however, the paper almost becomes invisible as it masquerades as what it represents.

Thomas Demand: Landscape is basically the greenery, the cactuses you see when you go up the street. This is actually at the entrance hall of a UCLA building. I always liked the fact that it’s just so banal, but also it’s so beautiful and so complex.

My work is much about filling the frame. Usually, if you make a photograph of your uncle, you also photograph the fence behind him, the sky, the bird which happens to fly through so you get so much more than you actually focus on. My work, I always try to control everything on the picture. Much more like a painter does, because a painter has to paint every corner of his canvas. I don’t have anything coincidental on the photograph. Everything you look at is intentional and is done to be looked at by the viewer, and that kind of connects me a little bit more to a painter in the painting tradition than a photographer.

The artificiality of the paper is important to me. It is a different way of rendering the world and it’s nearly as good as the real one. This little gap between what you see there looks a little bit artificial but is obviously a plant, makes you hopefully think about what we’ll see and how we see and how we recognize and how we communicate about what we recognize.

Midnight Reykjavík #5 , negatives 2005; prints 2007, Soo Kim. Chromogenic print, 39 3/8 × 39 3/8 in. The J. Paul Getty Museum, 2009.36. © Soo Kim

Soo Kim’s photographs are an exercise of subtraction. She layers two photographs she has made, and takes away volume with a knife to create a more subjective portrait of what she has photographed.

Soo Kim: When I make a piece like the Reykjavik series, it’s showing me a picture of Reykjavik, but I’m subtracting parts of the picture plane away in order to make a depiction of Reykjavik that I’m interested in seeing.

They look less like buildings, less like houses, less like architecture, and more like sketches or an idea of a house, or an idea of a built environment, an idea of a city, rather than what you might picture as Reykjavik or a capital city of the world.

My practice comes from collage; it’s just a subtractive method rather than an additive method. It’s something that the viewer doesn’t see, but in a way, is just as meaningful and important to the photograph itself as what remains intact.

I am interested in the objecthood of photography. There is a certain kind of materiality, a certain kind of objecthood that is in the work. It comes from the paper itself.

Soo Kim talks more about her process and the Reykyavik series:

Female narrator: Soo Kim’s photographs are as much about what she has cut out of them as what they depict.

Soo Kim: I would define my work as photographs that I cut into to remove parts of the picture plane in order to reinterpret the photographic image and change the reading of the photograph itself.

Female narrator: In her series Midnight Reykjavik , she pictured the northern capital city during the summer solstice. Each piece in the series is made up of two photographs that she has cut into and layered.

Soo Kim: They become almost like drawings on the landscape rather than the kind of houses full of volume and space in the way that we would understand an urban panorama, less like buildings, less like houses, less like architecture, and more like sketches or an idea of a house, or an idea of a city.

Female narrator: In these personal portraits of the city, glimpses of the photograph underneath peep out: the sea, or a green spray of bushes. To Kim, a straight photograph is almost too full.

Soo Kim: One of the things that I love about photography is that it’s so generous. It just gives so much information. It’s almost too much information for me to understand. When I make a piece like the Reykyavik series, it is a real photograph and it’s a truthful document of what Reykjavik looked like, but I’m subtracting parts of the picture plane away in order to make a depiction of Reykjavik that I’m interested in seeing, that’s informed by, for example, ’60s architects who were exploring ideas of the Utopic City. I was trying to kind of picture a different version of what I might understand as a picture of a capital city.

People tend to look at photographs very quickly, and I think we might have the idea that we understand how to read photographs. And so, I think that I try to make photographs that you have to kind of take pause to understand what is happening.

Daniel Gordon

Clementines , 2011, Daniel Gordon. Chromogenic print, 29 3/4 × 37 1/2 in. Collection of Allison Bryant Crowell. Image courtesy Daniel Gordon and M+B Gallery, Los Angeles. © Daniel Gordon

Artist Daniel Gordon makes still lifes from photographs he’s printed on his inkjet printer and crumpled into balls and other shapes.

Daniel Gordon: I was interested in making a hybrid digital/analog image based on a traditional still life. The clementines are made of crumpled up pieces of paper with photographs of clementines glued on top of balls. The materials that I’m using to make these photographs are glue, paper and scissors.

I’m interested in inkjet printing, and the mistakes a printer could make when one color is jammed, and I get streaky lines, or there’s an ink splotch, or certain technical issues come up. I try to embrace those imperfections as a way to signal the tools that I’m using.

My training is as a photographer, but there’s a sculptural element, a collage element, a photographic element, and then more and more a painterly element that has come into my photographs.

Daniel Gordon discusses his photograph Clementines :

(ambient music evoking wonder)

Female narrator: As they cut, layer, fold, and shape paper in different ways, the artists in this exhibition explore how paper can be transformed into something more complex. Each artist brings his or her own sense of wonder, precision and playfulness that is an essential part of the photograph and a medium in and of itself.

In this vibrant still life, the three-dimensional clementines that artist Daniel Gordon has printed in his studio almost roll off the table.

Daniel Gordon: The inspiration was a bowl of clementines…in real life… I was interested in making a hybrid digital/analog image based on a traditional still life. The clementines are made of just crumpled up pieces of paper with photographs of clementines glued on top of those balls. Generally, the materials that I’m using are glue, paper and scissors to make these photographs, and film, of course.

My training is as a photographer. But I was always interested in other mediums, painting, sculpture, even design. There’s a sculptural element, a collage element, a photographic element, and then more and more a painterly element that has come into my photographs.

Female narrator: After photographing his sculptures, he scans the negatives, and creates prints that introduce imperfections.

Daniel Gordon: I’m more interested in photographs that live on paper. I’m interested in the mistakes that a printer could make when one color is jammed, and I get streaky lines, or there’s an ink splotch, or certain technical issues come up. I try to embrace those imperfections as a way to signal the tools that I’m using.

I think it always comes back to the idea of transformation. There is a kind of magic that happens when you snap the shutter, and the photograph is something entirely different than what was in front of the lens. That’s true for every photograph always. There’s just something kind of magical about it.

Christopher Russell

Explosion #31 , 2014, Christopher Russell. Pigment print and Plexiglas, 39 × 57 in. The J. Paul Getty Museum, Gift of The Mark & Hilarie Moore Collection in memory of the Orlando shooting victims of 6/12/2016, 2016.84. © Christopher Russell

Christopher Russell often cuts into his photographs. Sometimes, he uses a meat cleaver to hack at an image; in Explosion , he uses a razor blade to delicately carve into the surface of the photographic paper.

Christopher Russell: I think beauty is a lure. I’m interested in subversion and if you can sort of infiltrate, find a way into somebody’s space, then they’re more likely to understand what you have to say. So, I think beauty is sort of the hook that gets people in to think more about other issues in the work.

Laura Hubber: What’s your relationship between paper and the photographic process?

Christopher Russell: I mean, if we’re doing it SAT style, “Paper is to photo what spirituality is to daily life.” I mean, you’re releasing this bright white from within. It’s like ghost pictures of the visions of Mary with the glowing heart. That’s kind of what paper is to me.

Christopher Russell says more about his series Budget Decadence :

Female narrator: Artist Christopher Russell says his work is about dark places, but he is careful not to repel the viewer.

Christopher Russell: I think beauty is a lure. I’m interested in subversion, and if you can sort of infiltrate, find a way into somebody’s space, then they’re more likely to understand what you have to say. So, I think beauty is sort of the hook that gets people in to think more about other issues in the work.

(poignant piano music)

This image was from the house that I lived in when I was in L.A. I made five copies of that image and tried to manipulate each one differently. That house, it was the saddest place in the world.

Female narrator: Russell says the owner’s son had lived his whole life in this room.

Christopher Russell: I was only the second person to live there. When I got it, the walls hadn’t been painted. They were dyed plaster and had never been touched and there were marks on the wall, where his wall hangings had been. The child’s bed that he lived in, into his 40s, and so there were just these ghost imprints of his life.

Female narrator: In one of the images, Russell hacks into the image with a butcher knife.

Christopher Russell: It’s just this violent release on the physical space of the home. It gets this sort of bright light, illuminating from the interior of the photo.

Female narrator: In another image, he delicately scratches into the image creating the illusion of wallpaper on the walls and an intricately patterned rug on the floor.

Christopher Russell: The one with the wallpaper is definitely more about sort of wanting something better.

Female narrator: For Russell, paper is paramount to his practice.

Christopher Russell: If we’re doing it SAT style, “paper is to photo what spirituality is to daily life.” I mean, you’re releasing this bright white from within. It’s like those pictures of the visions of Mary with the glowing heart. I mean, that’s kind of what paper is to me.

• Cut! Paper Play
• exhibitions
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• J. Paul Getty Museum
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About The Author

Laura hubber.

I’m a content producer in the Interpretive Content Department of the J. Paul Getty Museum. Before coming to the Getty, I was a longtime producer and reporter for the BBC World Service.

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The visual vernacular: embracing photographs in research

Jennifer cleland.

1 Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore

Anna MacLeod

2 Division of Medical Education, Dalhousie University, Halifax, NS Canada

Associated Data

The increasing use of digital images for communication and interaction in everyday life can give a new lease of life to photographs in research. In contexts where smartphones are ubiquitous and many people are “digital natives”, asking participants to share and engage with photographs aligns with their everyday activities and norms more than textual or analogue approaches to data collection. Thus, it is time to consider fully the opportunities afforded by digital images and photographs for research purposes. This paper joins a long-standing conversation in the social science literature to move beyond the “linguistic imperialism” of text and embrace visual methodologies. Our aim is to explain the photograph as qualitative data and introduce different ways of using still images/photographs for qualitative research purposes in health professions education (HPE) research: photo-documentation, photo-elicitation and photovoice, as well as use of existing images. We discuss the strengths of photographs in research, particularly in participatory research inquiry. We consider ethical and philosophical challenges associated with photography research, specifically issues of power, informed consent, confidentiality, dignity, ambiguity and censorship. We outline approaches to analysing photographs. We propose some applications and opportunities for photographs in HPE, before concluding that using photographs opens up new vistas of research possibilities.

Supplementary Information

The online version of this article (10.1007/s40037-021-00672-x) contains supplementary material, which is available to authorized users.

A Qualitative Space highlights research approaches that push readers and scholars deeper into qualitative methods and methodologies. Contributors to A Qualitative Space may: advance new ideas about qualitative methodologies, methods, and/or techniques; debate current and historical trends in qualitative research; craft and share nuanced reflections on how data collection methods should be revised or modified; reflect on the epistemological bases of qualitative research; or argue that some qualitative practices should end. Share your thoughts on Twitter using the hashtag: #aqualspace

Introduction

Smartphones, tablets, and other devices are increasingly embedded in everyday life, influencing how many people interact, think, behave and connect with other people [ 1 , 2 ]. Many people Whatsapp, tweet and text, and/or use Facebook, Instagram and Twitter for professional, social, educational and entertainment purposes. Images are increasingly accessed and used where words would have been used in the past. Indeed, more than 10 years ago, van Dijck [ 3 ] suggested that “digital cameras, camera phones, photoblogs and other multipurpose devices are used to promote the use of images as the preferred idiom of a new generation of users.”

The increasing use of digital images for communication and interaction in everyday life has given a new lease of life to a source of research data long embraced by sociology and anthropology [ 4 , 5 ]. In contexts where smartphones are ubiquitous and with groups of “digital natives” asking participants to share and engage with photographs, this aligns with their everyday activities and norms more than textual or analogue approaches to data collection. Thus, it is time to consider fully the opportunities afforded by digital images and photographs for research purposes [ 6 , 7 ].

This paper joins a long-standing conversation in the social science literature which advocates moving beyond the “linguistic imperialism” of text [ 8 ] to embrace visual methodologies. This conversation has relatively recently made its way into health professions education (HPE): for example, various authors have proposed video [ 9 ], video-reflexivity [ 10 ] and drawings [ 11 ] for research purposes. However, the use of still images or photographs in research remains niche to some areas of inquiry (e.g., exploring patient experiences, particularly mental health and experiences of serious illness (e.g., [ 12 – 14 ]) and some healthcare professions disciplines (e.g., nursing: [ 15 ])), and is an under-exploited approach in HPE research (see below for notable exceptions). Yet it is a method which offers many possibilities, particularly in respect to giving research participants more agency and power in the research process than is the case in traditional qualitative data collection approaches such as interviews.

In this paper, we discuss ways of using photographs in research, focusing on the use of photography within participatory research inquiry. We consider ethical and philosophical challenges associated with photography research, as well as its unique strengths. We outline some popular approaches to analysing photographic data. We finish with a brief consideration of how photographs could be used more in HPE research.

The photograph as data

Photography has been described as a silent voice, another language to communicate with and understand others, and a way of accessing complexities which may not be captured by text or oral language [ 16 ]. As instances of Latour’s “immutable, combinable mobiles” [ 17 ]—literally things which do not change but which carry action and meaning across time and place, as objects of memory and of relationship—photographs allow us to see what was “happening” at a particular point in time.

Photographs can be a source of data (photo-documentation and existing images) and a tool for eliciting data (photo-elicitation and photovoice). Each of these approaches are explained below.

Photo-documentation

Photo-documentation has been used in clinical medicine for nearly two centuries [ 18 ] Clinical photographs and images are vital for training purposes, to illustrate a clinical finding, steps in a process or procedure, or for comparative (“before” and “after”) purposes. They are an integral part of patient’s clinical notes in numerous specialties and are also used to offer the patient insight into realized or expected treatment results [ 19 ].

This way of using photographs—as objective records documenting an objective something—is quite different from how photographs are used in social science research. In fields such as sociology and social anthropology, photography has been used as a tool for the exploration of society [ 4 , 5 ]. Photographs help others understand how societies are culturally and socially constructed, to critically uncover the meaning people place on certain activities, places, things and rituals and to record and analyse important social events and problems. It is on this second use of photographs in research that we focus from this point onwards.

Existing images

A second way of using photographs in research is analysis of publicly available images: in other words, analysis of secondary (photographic) data. There are examples of this approach in medical education in relation to the messages given by images on public-facing documents and webpages, and how these might influence student choice of medical school [ 20 , 21 ]. Visual data is also used in research examining the relationships between architecture/space and learning [ 22 , 23 ]. Photographs can show us how people and things relate to each other. For example, what can we learn from a photo illustrating how staff are distributed around a coffee room, or around the table during a morbidity and mortality (M&M) meeting? Documenting the materials of a research space in a photograph serves as a mechanism for tracing the complexity of the field (see Fig.  1 and its accompanying explanation).

A photograph as an elicitation tool. Collected as part of a sociomaterial study to document the material complexity of simulation led by MacLeod. This photograph of a manikin in a typical simulation suite could serve as a useful elicitation tool in a study of simulation. Rather than asking research participants to use their memories to imagine a simulation suite, the photograph provides concrete detail, helping to reorient participants to the space. Rather than using a phrase like “simulation is complex”, the photograph serves as “evidence” of the complexity, documenting multiple non-human elements involved in a simulation at a particular time and place. This clarity can provide a jumping-off point for more detailed and specific conversations about the topic being studied

Photo-elicitation

In photo-elicitation (sometimes called photo production [ 24 ] or auto-photography), the specific area of focus is typically decided by the researcher. The photos are either taken by the researcher or participants.

In researcher-driven photo-elicitation the researcher decides on what people, objects, settings and/or scenes they find interesting or potentially important enough for a picture. These photographs are then used as prompts for discussion within an interview with the researcher. The photo(s) is a prompt to elicit data, akin to an open question in a semi-structured interview. Unlike interview or focus group questions however, participants not only respond to photographs with extended narratives but also supply interpretations of the images, drawing from and reflecting their experiences.

In participant-driven photo-elicitation, control of data collection is handed over to participants who have the freedom to pick and choose the representation(s) which is most salient to them in relation to the question under study. For example, to explore children’s experiences of hospital, Adams and colleagues [ 25 ] asked children to photograph architectural or design features that most interested them in a vast hospital atrium (the hospital’s primary non-medical space, full of shops, restaurants and so on). The children’s photographs were then used as the anchor to dialogue [ 26 ].

Participant-driven photo-elicitation empowers the participant to both choose the image and drive the dialogue about the image. Consider a picture of an alarm clock set to an early hour. This becomes meaningful only when the photographer explains that this image signifies their transition from student to first trained job. While the participant’s perspective on the transition to practice could potentially be accessed using traditional words-alone methodologies, photographs are different because they present what the participant felt was worthy to record, help capture the immediacy of the experience and stimulate memories and feelings. In other words, one of photo-elicitation’s strengths, and how it differs from interviews and focus groups, is its potential to collect data that not only taps into the perspective of the participant but does so at the time of the experience.

Images seem to prompt a different kind of reflection on lived experiences. Harper [ 26 ] suggests that images prompt emotions and thoughts in ways that narrative alone cannot. By seeing what they did, informants may help the researcher to better understand their behaviour. Moreover, by viewing and discussing photos together, the researcher and participant actively co-construct meaning. In this way photo-elicitation offers a way to potentially enrich and extend existing interview methodologies and give a combination of visual and verbal data for analysis purposes [ 27 ]. Furthermore, the act of interpreting an image creates a critically reflective space within the research process which is lacking in interview methods. Leibenberg suggests that “collectively then, images introduced into narrative research create important links that participants can use to more critically reflect on their lived experiences and to more accurately discuss and share these experiences with others” [ 28 , p. 4].

Arguably however, if the main source of data is not the photographs themselves but the transcripts from photo-elicited discussions, this may still privilege participants who are more skilled verbally—maintaining the “linguistic imperialism” of text, or, more accurately, of transcribed responses [ 8 ]. While this criticism cannot be wholly dismissed, the many empirical studies referred to in this paper suggest that photographs help make abstract ideas accessible and encourage reflection in groups which are less literate and who do not routinely engage in reflection. Moreover, there are approaches to data analysis which privilege the image, not the accompanying text (see below).

A specific research method within the bracket of photo-elicitation is photovoice. Developed by Wang and Buriss in 1997, photovoice involves asking community members to identify and represent their community through specific photographs and tell the stories of what these pictures mean, promoting critical dialogue and potentially catalysing social action and change [ 29 ]. Photovoice allows people to see the viewpoint of the people who live the lives, and as such is considered an example of participatory research [ 30 ]. For example, MacLeod et al. [ 31 ] asked adolescent youth to take photographs pertaining to the health of their community. The adolescents created a platform for discussion, and helped the researchers, who were medical students, learn about the community they were serving. Photovoice is often used to access and explore patient experiences, particularly mental health and experiences of serious and/or life-threatening illness [ 12 – 14 ].

The ease of taking photographs with a mobile phone has opened up new ways to utilise the photovoice methodology, particularly the method of “time-space diaries” [ 32 ] or digital journals. Participants record what is meaningful to them across time and activities, such as what and where they ate over a full day, or salient events in the first few weeks of medical school. Just like non-research social media activity, a series of images can provide insight into real, lived experiences and give participants a voice to reflect on their everyday lives on issues relevant to the research topic. Consider a resident taking pictures of things and people who were significant to their first experience of a full weekend shift. The nature of the images may change over time, reflecting exposure to different patients, working with different colleagues, task demands and fatigue.

In summary, the nature of photographs as data varies according to who produces them, whether they are independent of the research or created specifically for the research, how they are used in the research process and whether they are used in conjunction with narrative (verbal) data. These key decisions can be synthesised, according to Epstein et al. [ 33 ], into three basic questions:

• Who is going to make or select the images to be used in the interviews?
• What is the content of the images going to be?
• Where are the images going to be used, and how?

How photographs and accompanying narratives can be analysed is discussed next.

Data analysis

There are two main ways of approaching photographic data analysis. The first, the dialogic approach, focuses on analysing the verbal or written reflection on the content of photographs and what they symbolise. This approach is fundamentally constructivist, “locating visual meaning as foundational in the social construction of reality” [ 34 , p. 492]. Traditional ways of analysing verbal/transcribed data such as thematic analysis [ 35 ], content analysis [ 36 ], grounded theory [ 37 ] and various forms of discourse analyses [ 38 ] are appropriate for analysis of photograph-prompted dialogue. In this approach, the photographs themselves are usually used merely for illustration purposes, if at all [ 38 ].

Alternatively, the data can be within the photograph itself, separate from its capacity to generate dialogue and independent of any explanation. Photographs can provide new ways of seeing the phenomena under study from their visual features. For example, in their analysis of existing images on medical school websites and prospectuses in 2019, MacArthur, Eaton and Marrick [ 21 ] recorded information including gender, ethnicity, assumed role and setting, of each person on each image. They found a predominance of hospital-themed images, compared to few community-themed images. They concluded that these images signalled to students a strong preference for hospital-based settings, despite a strong national drive to recruit more general practitioners.

This approach to analysis is referred to as “archaeological” because images inherently reflect the social norms of a point in time. Consider your graduating class photograph. Clothes and hairstyles which were chic at the time may look old-fashioned and incongruous when viewed many years later. In this way, photographs contain “sedimented social knowledge” [ 34 , p. 502], manifest through the photographer’s choices of scenes, subjects, styles, compositions and so on. An educational example of this is presented in Photograph S1, found in the Electronic Supplementary Material (ESM).

Grounded, visual pattern analysis (GVPA) combines both approaches [ 39 ]. Via a structured, multi-step process of analysis, GVPA investigates the meanings individual photographs have for their photographers and also attends to the broader field (sample) level meanings interpreted from analysis of collections of photographs. Paying attention to absence (what is not photographed) is also important [ 40 ]. The analysis process ends by building conceptual contributions rather than purely empirical ones from the photographic data (see Photograph S2 in ESM).

Whichever analysis approach is taken, as with any qualitative research, it is important to consider quality and rigour in respect to the credibility, dependability, confirmability and transferability of the data [ 41 ]. Providing details of the sampling strategy, the depth and volume of data, and the analytical steps taken helps ensure credibility and transferability. Photo-elicitation allows participants to work with and direct the researcher to generate data that is salient to them, thereby increasing the confirmability of research outcomes. Allowing participants to clarify what they meant to convey in their photographs is inherently a form of member checking. As for all research, ethical considerations should be considered and addressed, as well as a clear statement made on formal research ethics committee approval or waiver. Thought must be given to the power relationship between researcher and participants and how this might affect recruitment, the nature of the data and so on. Reflexivity, reflecting on the extent to which similarities or differences between researcher and researched may have influenced the process of research, is particularly critical in photo-elicitation studies [ 42 ]. Keeping written field and methodological notes as well as a reflexive diary is important for dependability and confirmability.

Finally, in terms of data presentation, in our discipline most journals have a limit on the number of tables, figures and/or images allowed per paper, and most do not publish colour photographs. This limits the visual data which can be presented in an article. However, journals also offer the option of supplementary e‑files. We suggest that one or two pictures in an article can support key evidential points, with additional data made available electronically.

Ethical considerations associated with photographs in research

As with any method, care must be taken to ensure the proper use of photographs for research purposes. Here we briefly consider the main ethical issues of power, informed consent, anonymity, dignity and image manipulation. We direct readers to Langmann and Pick [ 43 ] for more in-depth discussion.

In any researcher/participant situation, there is a power dynamic that privileges the “expert” researcher over the object of study, the participant. Certain ways of using photographs in research, specifically photo-elicitation, can change this dynamic and empower participants by giving them an active role in the research process, making them the experts, and allowing the researcher greater insight into participant perspectives [ 29 , 30 ]. Photo-elicitation also gives those who are not verbally fluent another way to express themselves effectively, avoids the use of survey questionnaires and other research instruments that might be culturally biased, and places participants as equals—able to reflect and decide how they want to represent themselves visually [ 43 ]. Photo-elicitation is thus firmly rooted in an approach to inquiry that draws on Paulo Freire’s (1970) critical pedagogy [ 44 ] and fits within the broader participatory action research method [ 29 , 30 , 37 – 40 , 45 ].

The use of mobile phones for data collection is considered a way of connecting younger groups with research [ 46 ], connecting with populations in more remote and rural communities across the globe [ 47 ] and with “difficult to reach” populations (e.g., [ 14 ]). However, it is important to again acknowledge the “digital divide” and the associated power differential: marginalised populations and certain societal groups may not have access to equipment to take and share photographs. Where this is the case, the researcher must consider whether to supply the necessary equipment or whether an alternative method of data collection is more feasible.

Informed consent

Informed consent is particularly challenging with photographs. It is difficult to ensure that every person in an image has given their consent to the photo being taken and used for research purposes. Where images are participant-generated, clear instructions about the purpose of the research and the photographs, and the processes of ethical consent, are essential [ 48 ].

Confidentiality

Confidentiality is an issue, particularly if a photograph includes a person’s face. Faces can be pixelated or blurred to protect participants’ identities, but these approaches may objectify the people in the photo and make the photographs less powerful [ 48 ].

Our third point relates to dignity. Langmann and Pick [ 43 ] suggest three ways of considering dignity in research photography: being sensitive to the social and cultural norms of the communities being researched, being aware that those who are the focus of the research will benefit by the presentation of an authentic view of the situation and considering the impression the photograph will give if and when it is published. In all cases, it is the researcher’s responsibility to exclude photographs which are not covered by ethical approvals, as well as any potentially harmful or compromising photographs.

Photographs can mean different things to different people [ 24 , 49 ] and meanings may change over time, depending on context and how they are associated in terms of text and other images (for example, one’s interpretation of a photograph taken as a teenager is likely to differ when viewing it as an adult). This ambiguity makes some researchers uncomfortable. However, if one takes a social constructivist stance, that we live in a multi-reality world, then this possibility of multiple meanings from a photograph adds to the data.

Conscious and unconscious “self-censorship”, including when, where or what to photograph, or editing a photo to convey an intended message, is inherent in photo-elicitation [ 45 ]. However, self-censorship is not an issue if one accepts that the purpose of photo-elicitation is to access the social reality of another individual.

Strengths of using photographs in research

Participation and co-construction.

As mentioned earlier, photo-elicitation and photovoice maximise opportunities for participant agency and engagement in the research process, allowing participants to work with and direct the researcher. Furthermore, in dialogic approaches, research involves a joint process of knowledge-production where narratives are co-constructed between participant and researcher through discussion. By using participant-driven photographs, the researcher gains an understanding of what the content of the photos means to the participants without imposing their own framework or perception of a topic on the process.

Participatory research requires trust, a safe space between participant and researcher, so people can express their thoughts and views. Wicks and Reason [ 50 ] suggest that establishing this safe space must be considered throughout the research process: empowering participants in the earlier stage of the research process can also build the connection and trust between researcher and participant—and reduce participant inhibition later on. This may be particularly useful where the topic is sensitive or taboo. For example, Meo [ 51 ] reported photo-elicitation was useful in tapping “class and gendered practices” (p. 152) in greater depth than with interviews alone.

Giving power to participants within the research process can be challenging for researchers. Adjusting to participants as co-researchers may be new and unfamiliar. Continuous flexibility and reflexivity on a personal (e.g., personal assumptions, values, experiences, etc. that shape the research) and epistemological (e.g., the limits of the research that are determined by the research question, methodology and method of analysis) considerations are critical [ 52 ].

Photographs provide structure to an interview, giving the researcher something to return to, to elicit more detailed discussions and/or trigger memories and reflection [ 53 ]. In addition, participants often give information about people or things outside of the photo (the invisible) as well as on who and what are visible [ 52 ]. Similarly, the researcher may be able to access parts of participants’ lives that would be difficult to see into otherwise. For example, Bourdieu argues that visual methods of research may be particularly helpful in investigating habitus, ways of being, acting and operating in the social environment that are “beyond the grasp of consciousness” [ 54 , 55 ].

Snapshots in time and of space

As mentioned earlier, photographs are inherently snapshots in time. They also provide snapshots of space, a means of examining the material assemblages of space, of how things are ordered and used [ 56 ]. For example, a photo of students in a learning space would illustrate who sits with whom, the spatial relationships between humans (e.g., student and student, students and teachers) and the non-human (e.g., bags, laptops, phones, snacks) (see Fig.  2 as an example).

An example of a photograph representing the assemblage of time and space: Students distributed in the space of a contemporary learning suite. Photograph from a publicly facing webpage on a medical school website. This photograph provides an example of how a photograph captures space and time. It provides a glimpse at a contemporary medical school. The photograph serves to document the complexity of modern medical schools, making clear the digitized learning environment. Such a photograph might evoke emotion and a sense of progress, in particular, when contrasted with more traditional images of students learning in a stadium-style lecture theatre

Applications and opportunities

Looking forward, we encourage researchers to consider the use of photographs as a source of data, as a way of accessing data that might otherwise have been obscured or overlooked if we had relied solely on language-based data. We encourage readers to consider what might be learned were we to augment current understanding by incorporating photographic data sources into healthcare professions research. In Table S1, found in ESM, we suggest some outstanding research questions and topics that could be explored. The list found there is by no means exhaustive. Rather it reflects our own interests and observations and should be regarded as a springboard to help readers consider diverse ways in which photographs may add richness in research endeavours.

There are many ways of conducting qualitative research in health professions education research (HPER). All have their affordances and limitations. In this article, we have offered a critical examination of how photographs can be used to generate rich and potentially different data to that generated through talk-only data collection. Using photographs in HPER research opens up new vistas of research possibilities, whether as a means of accessing snapshots of people and situations in time and space and/or as a means of engaging participants collaboratively, to explore taken-for-granted lived experiences which may not otherwise be accessible. This is a fertile area for future research and the empirical potential is vast, ranging from reflective practice to widening participation to questions which are as yet unknown.

Acknowledgements

This paper was inspired by JC’s move to Singapore, a society which uses photographs rather than text in all spheres of life—as proof of payment or parcel delivery, to illustrate a point, to share information, to advertise an event, etc.

The authors neither sought nor received any funding for this project.

Author Contribution

JC suggested and coordinated this collaborative effort, initiated the writing outlines and drafts. AM helped create and revise outlines and drafts. Both authors contributed significantly to the intellectual contents, gave approval of the version to be published and agree to be accountable for the work.

Declarations

J. Cleland and A. MacLeod declarethat they have no competing interests.

This is not applicable as no human or animal subjects were involved in the creation of this paper.

The families risking everything to keep Ukraine’s trains running – photo essay

Dutch photographer Jelle Krings has been documenting the workers of the Ukrainian railway since the war began. Here, he revisits the families that have kept a war-torn country moving, often to great personal sacrifice

• Words and pictures by Jelle Krings

I n the early hours of 24 February 2022, when Russian bombs and rockets struck Ukrainian cities and infrastructure throughout the country, railway workers boarded trains heading east. Determined to get as many people as possible to safety , they would end up evacuating millions to Ukraine’s borders in the west.

Ukraine’s new railway chief Yevhen Liashchenko was in the team that guided the network through the first stages of the war. He says his people acted not because they were instructed to but because “they didn’t know any other way”. There was no time for bureaucracy, “decisions were made by the people on the ground, and they love the railway, not as a business but as a family”.

It takes more than 230,000 people to keep the trains running in Ukraine.

The railway station in Lyman, Donbas, destroyed by shelling

Yevhen Liashchenko, chief executive of Ukrainian railways, has been leading Ukraine’s 230,000 railway workers through the war

Together they run a vast railway network of more than 15,000 miles (24,000km) of track, one that has been invaluable for Ukraine’s ability to withstand the invasion. Despite continual bombing, the network has largely remained operational. Damage to the tracks is swiftly repaired, and shell-hit critical infrastructure is promptly restored.

Over two years, we followed families and workers living by the tracks near the frontlines to find out how the war and the struggle to keep the trains running is shaping their lives.

The Neschcheryakovas

Nadiya Neschcheryakova works as an attendant at a railway crossing in Bucha, about 10 miles from Kyiv. She works in shifts, sharing her post with her mother and two other women. On the morning of the invasion, the sound of explosions pierced the sky above the thick pine forests surrounding her home. She went to work anyway. A few days later, her post at the railway crossing was occupied by Russian troops. Her home in the next village along the track was now at the frontline of the war.

Nadiya Neschcheryakova operates her railway crossing in Bucha, near Kyiv . A freight train passes transporting materials such as wood for possible use in Ukraine’s defensive efforts along the frontline

Remnants of the Neschcheryakovas’ family house, destroyed by shelling, lie in the yard at Spartak, Kyiv oblast

Nadiya Neschcheryakova with her husband, Yuriy, their daughter Kateryna and grandson Andriy. Yuriy built a new house after their home was destroyed by shelling early in the war

With her husband, daughter and grandson, Nadiya managed to flee to the west where they stayed for a month waiting for the Russian withdrawal from Kyiv. When they returned home, they found their home had been reduced to rubble.

The Petrovs

When the city of Kherson was liberated after nine months of Russian occupation in November 2022, Oleksandr Petrov was sent on a mission to repair the tracks leading to the city. When he set out in a van with a team of repairmen in the morning, he knew the risks: the fields along the tracks were heavily mined in an attempt to slow the Ukrainian advance.

Railway workers wash their wounds after driving over a mine in the Kherson region, 13 November 2022. They were carrying out repair works just days after Kherson was liberated. Oleksandr Petrov lost a leg in the incident

Oleksandr shows his prosthetic leg to workers in a railway repair team in Voznesensk, Mykolaiv oblast. Since his injury, Oleksandr has been given a desk job

Oleksandr Petrov at his parents’ house in Voznesensk. Family members spend a day at the cemetery to maintain their relatives’ graves and pay their respects

Russian troops were expected to start shelling the city once they’d had a chance to regroup on the other side of the Dnipro River. The civilians left in the city would have to be evacuated by train, so Oleksandr went anyway. Later that day, Oleksandr lost his leg after they drove over a Russian anti-vehicle mine.

The Lyman community

When Ukrainian troops recaptured the railway hub of Lyman from Russian troops in November 2022, it had been under Russian occupation for six months. Since then, it has been on the frontline of the war in Ukraine’s Donbas region. Yet, a small community of railway families continues to live in the basements of their battered apartment buildings on the outskirts of the city.

The Rosokha family mourn the death of Nina Rosokha, who was killed by a Russian artillery strike on Lyman. Nina had worked in a railway service department, her husband was a train driver for 36 years. During the funeral, sounds of fighting could be heard in the nearby Kreminna forest

A forest on the outskirts of Lyman smoulders after shelling. Firefighters do not go into the forests for fear of mines

Fedya, 13, plays his accordion outside the apartment building where he lives with his mother and grandmother, both of whom work for the railway. Evelyna, 12, with one of her cats

The families in the community stay underground most of the time. The frontline is too close for the air raid alert system to be effective, and artillery and missiles can strike at any moment. The community have paid a heavy price in the war . Railway worker Nina Rosokha was killed on her way to the post office in a Russian artillery strike on a market. During another attack, Lyubov Surzhan’s top-floor apartment was obliterated. A piece of shrapnel skimmed Fedya’s head during a strike on a nearby railway depot. Yet the railway is their home and, despite the danger, they don’t want to leave.

The Mykolaychuks

The Mykolaychuk brothers live in an apartment building in the centre of Podilsk. Both are fifth generation locomotive drivers. Before the invasion, their jobs were mostly local, transporting grain from the region to the port of Odesa. Now, they go farther east towards the frontlines of the war, driving evacuation trains and weapons transports.

Alla Valeriyivna Mykolaychuk in Podilsk with her daughter and niece, both aged one

They don’t get paid if they don’t work, and jobs have become less frequent since the war. With money hard to come by, they have had to sell their family car to make ends meet.

The Tereshchenkos

Olha Tereshchenko survived a Russian attack on a convoy of civilians fleeing the then occupied city of Kupiansk. Her husband and five-year-old son were killed. Consumed with grief, she now works at a railway office in Kharkiv and gets support from her fellow workers there. Urns containing the ashes of her husband and son still sit on a shelf in a nearby crematorium. She hopes to bury them near their home in Kupiansk one day, when the frontline is further away.

Olha Tereshchenko in Saltivka, the area of Kharkiv where she now lives

Olha’s husband and son, photographed as a baby, were killed in a Russian attack on a civilian convoy. Olha is overcome when she visits their remains in a nearby crematorium: she hopes one day to bury her husband and son near their home in Kupiansk

• Rights and freedom
• Rail transport

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Research Photography Is…

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This chapter introduces the utility of photography in social research and outlines different data collection methods that researchers can employ. The power of the photograph is discussed and then questions about representation are examined. The idea of the photograph as a ‘fold’ is proposed as one way of helping to integrate varying perspectives on the issue of representation. An examination of commonly used photographic research methods is presented that explains their uses and relative strengths and weaknesses. A new approach is proposed called the ‘snapshot’ that provides opportunities for gaining new and unique insights into people’s lives. The chapter concludes with an examination of the emic and etic qualities of research photography and why this matters.

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2023 summer warmth unparalleled over the past 2,000 years

• Jan Esper   ORCID: orcid.org/0000-0003-3919-014X 1 , 2 ,
• Max Torbenson   ORCID: orcid.org/0000-0003-2720-2238 1 &
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Including an exceptionally warm Northern Hemisphere (NH) summer 1 ,2 , 2023 has been reported as the hottest year on record 3-5 . Contextualizing recent anthropogenic warming against past natural variability is nontrivial, however, because the sparse 19 th century meteorological records tend to be too warm 6 . Here, we combine observed and reconstructed June-August (JJA) surface air temperatures to show that 2023 was the warmest NH extra-tropical summer over the past 2000 years exceeding the 95% confidence range of natural climate variability by more than half a degree Celsius. Comparison of the 2023 JJA warming against the coldest reconstructed summer in 536 CE reveals a maximum range of pre-Anthropocene-to-2023 temperatures of 3.93°C. Although 2023 is consistent with a greenhouse gases-induced warming trend 7 that is amplified by an unfolding El Niño event 8 , this extreme emphasizes the urgency to implement international agreements for carbon emission reduction.

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Cities as Engines of Opportunities: Evidence from Brazil

Are developing-world cities engines of opportunities for low-wage earners? In this study, we track a cohort of young low-income workers in Brazil for thirteen years to explore the contribution of factors such as industrial structure and skill segregation on upward income mobility. We find that cities in the south of Brazil are more effective engines of upward mobility than cities in the north and that these differences appear to be primarily related to the exposure of unskilled workers to skilled co-workers, which in turn reflects industry composition and complexity. Our results suggest that the positive effects of urbanization depend on the skilled and unskilled working together, a form of integration that is more prevalent in the cities of southern Brazil than in northern cities. This segregation, which can decline with specialization and the division of labor, may hinder the ability of Brazil's northern cities to offer more opportunities for escaping poverty.

We acknowledge the support of Cristian Jara-Figueroa in the initial conceptualization of the empirical strategy. Barza and Viarengo gratefully acknowledges the financial support received from the Swiss National Science Foundation (Principal Investigator: Prof. Dr. Martina Viarengo; Research Grant n. 100018-176454). Hidalgo acknowledges the support of the Agence Nationale de la Recherche grant number ANR-19-P3IA-0004, the 101086712-LearnData-HORIZON-WIDERA-2022-TALENTS-01 financed by European Research Executive Agency (REA) (https://cordis.europa.eu/project/id/101086712), IAST funding from the French National Research Agency (ANR) under grant ANR-17-EURE-0010 (Investissements d'Avenir program), and the European Lighthouse of AI for Sustainability [grant number 101120237-HOR-IZON-CL4-2022-HUMAN-02]. The usual caveats apply. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

I have received speaking fees from organizations that organize members that invest in real estate markets, including the National Association of Real Estate Investment Managers, the Pension Real Estate Association and the Association for International Real Estate Investors.

MARC RIS BibTeΧ

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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

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There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities.

INTRODUCTION

Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve.

Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes. [1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research. [2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.” [3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops. [4]  Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture.

I.     Global Cultural Perspective of Embryonic Stem Cells

Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense, [5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research. [6] Consequently, global engagement in ESC research depends on social-cultural acceptability.

a.     US and Rights-Based Cultures

In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism, [7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.” [8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed. [9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field. [10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture. [11]

b.     Ubuntu and Collective Cultures

African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama , which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,” [12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth. [13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value. [14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society.

Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.” [15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail.

Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable. [16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus [17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines. [18]

Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim. [19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research. [20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF.  Their use is conditioned on consent, and available only to married couples. [21] The community's receptiveness to stem cell research depends on including communitarian African ethics.

c.     Asia

Some Asian countries also have a collective model of ethics and decision making. [22] In China, the ethics model promotes a sincere respect for life or human dignity, [23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life. [25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research. [26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions. [27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency. [28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021. [29] However, issues still need to be addressed in implementing effective IRB review and approval procedures.

The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy, [30] research ethics should also adapt to ensure respect for the values of its represented peoples.

Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies. [31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells. [32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval, [33] and in another instance, the oocyte source was unclear and possibly violated ethical standards. [34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust.

d.     Middle East

Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells, [35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research. [36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors. [37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so. [38]

Jordan has a positive research ethics culture. [39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial. [40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation. [41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.” [42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes.

e.     Europe

In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected. [43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44]

For example, in Germany, Lebenzusammenhang , or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.” [45]  Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount. [46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007. [47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization. [48] Spain’s approach differs still, with a comprehensive regulatory framework. [49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility. [50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices. [51]

II.     Religious Perspectives on ESC

Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives.

The Qur'an states:

“And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.” [52]

Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception. [53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible. [54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research. [55]

In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided. [56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden. [57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all. [58] Acceptance varies on applied beliefs and interpretations.

Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero, [59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all. [60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime. [61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit. [62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets. [63]

Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life. [64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception: [65]

“If she is found pregnant, until the fortieth day it is mere fluid,” [66]

Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation. [67] Stem cell research is accepted due to application of these religious laws.

We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory , which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions. [68] We only wish to show that the interaction with morality varies between cultures and countries.

III.     A Flexible Ethical Approach

The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities.

While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe. [69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation.

For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent. [70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context, [71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders.  This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research.

Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values. [72]

An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions. [73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion.

IV.     Concerns

Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values. [74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions.

Other concerns include medical tourism, which may promote health inequities. [75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments. [76]

For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.” [77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices. [78]

The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.” [79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds. [80]

While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research.

For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society.

This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model.

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[4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk

[5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources:

Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research.  The New England journal of medicine ,  351 (3), 207–209. https://doi.org/10.1056/NEJMp048145 ; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos . The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos ; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy , 38 (2/3), 264–284. http://www.jstor.org/stable/24439776 ; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells.  The New England journal of medicine ,  351 (3), 209–211. https://doi.org/10.1056/NEJMp048147 ; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality.  Bosnian journal of basic medical sciences ,  4 (1), 5–14. https://doi.org/10.17305/bjbms.2004.3453

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[7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics . Oxford University Press.

[8] Sherley v. Sebelius , 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf

[9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109 th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text ; Bush, G. W. (2006, July 19). Message to the House of Representatives . National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html

[10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells . National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells

[11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells.  Social Research ,  73 (3), 819–834. http://www.jstor.org/stable/40971854

[12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics . 22. 10.1186/s12910-021-00678-4.

[13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics , 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight , 49 (4).

[14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics , 22 (2), 112–122. https://doi.org/10.1111/dewb.12324

[15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324

[16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa.  Stem Cell Res Ther   4 , 54 (2013). https://doi.org/10.1186/scrt204 ; Pew Research Center. (2014, May 1). Public health a major priority in African nations . Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/

[17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024 . National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf

[18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80 , see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia . UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html

[20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries.  Middle East Fertil Soc J   24 , 8 (2020). https://doi.org/10.1186/s43043-019-0011-0 ; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics , 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247

[23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

[24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction.  Frontiers in pharmacology ,  13 , 1013740. https://doi.org/10.3389/fphar.2022.1013740

[25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech.

[26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine , 12 (6), 647–656. https://doi.org/10.2217/rme-2017-0035

[29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

[30] Chen, H., Wei, T., Wang, H.  et al.  Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017.  BMC Public Health   22 , 434 (2022). https://doi.org/10.1186/s12889-022-12839-0

[31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan.  Curr Stem Cell Rep   1 , 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6

[32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production . NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production

[33] Park, S. (2012). South Korea steps up stem-cell work.  Nature . https://doi.org/10.1038/nature.2012.10565

[34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned.  Accountability in research ,  13 (1), 101–109. https://doi.org/10.1080/08989620600634193 .

[35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

[36] Association for the Advancement of Blood and Biotherapies.  https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia

[37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia.  BMC medical ethics ,  21 (1), 35. https://doi.org/10.1186/s12910-020-00482-6

[38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics , 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics , 23 (3), 260–268. https://doi.org/10.1111/dewb.12355 ; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know . Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know

[39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France.  Biotechnology Law Report ,  32 (6), 349–356. https://doi.org/10.1089/blr.2013.9865

[45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf

[47] Regulation of Stem Cell Research in Germany . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany

[48] Regulation of Stem Cell Research in Finland . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland

[49] Regulation of Stem Cell Research in Spain . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain

[50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered:

Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110.

Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ...  Revista do Colegio Brasileiro de Cirurgioes ,  41 (5), 374–377. https://doi.org/10.1590/0100-69912014005013

Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India . Routledge.

For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe   

[51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights.  Cultura (Iasi, Romania) ,  14 (2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent?  Research Ethics ,  13 (1), 23-41.  https://doi.org/10.1177/1747016116650235

[52] The Qur'an  (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23

[53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life . Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/

[54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics , 31: 399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386

[55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association , 12 (4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf.

[56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52.  https://doi.org/10.5372/1905-7415.0801.260

[57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation.  Journal of Religion and Health ,  30 (1), 35–41. http://www.jstor.org/stable/27510629 ; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva . A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm

[59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. (( King James Bible . (1999). Oxford University Press. (original work published 1769))

Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…”

In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David.

Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…”

These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth.

[60] It should be noted that abortion is not supported as well.

[61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day . Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

[62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells . Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html ; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology . Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf.

[63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed . Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/

[64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society , (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law).  Journal of assisted reproduction and genetics ,  25 (6), 271–276. https://doi.org/10.1007/s10815-008-9221-6

[66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet) . Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en

[67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[68] Gert, B. (2007). Common morality: Deciding what to do . Oxford Univ. Press.

[69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA , 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association .; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979).  The Belmont report: Ethical principles and guidelines for the protection of human subjects of research . U.S. Department of Health and Human Services.  https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

[70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes.  Journal of assisted reproduction and genetics ,  35 (7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine , 10 (12), 1715–1716. https://doi.org/10.1002/sctm.21-0234

[71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA.  Reproductive biomedicine online ,  18 (5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8

[72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa.  Clinical trials (London, England) ,  3 (3), 306–313. https://doi.org/10.1191/1740774506cn150oa

[73] Veatch, Robert M.  Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict . Georgetown University Press, 2012.

[74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity.  Research Ethics ,  14 (3), 1-17.  https://doi.org/10.1177/1747016117739939

[75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry.  Voices in Bioethics ,  8 . https://doi.org/10.52214/vib.v8i.9894

[76] Stem Cell Tourism: False Hope for Real Money . Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism , See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis.  Voices in Bioethics ,  3 . https://doi.org/10.7916/vib.v3i.6027

[77] Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation,  New Genetics and Society , 30:2, 141-153, DOI:  10.1080/14636778.2011.574375

[78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[79] International Society for Stem Cell Research. (2024). Standards in stem cell research . International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research

[80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier . Stanford University Press.

Olivia Bowers

MS Bioethics Columbia University (Disclosure: affiliated with Voices in Bioethics)

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

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Star USC scientist faces scrutiny — retracted papers and a paused drug trial

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Late last year, a group of whistleblowers submitted a report to the National Institutes of Health that questioned the integrity of a celebrated USC neuroscientist’s research and the safety of an experimental stroke treatment his company was developing.

NIH has since paused clinical trials for 3K3A-APC, a stroke drug sponsored by ZZ Biotech, a Houston-based company co-founded by Berislav V. Zlokovic , professor and chair of the department of physiology and neuroscience at the Keck School of Medicine of USC.

Three of Zlokovic’s research papers have been retracted by the journal that published them because of problems with their data or images. Journals have issued corrections for seven more papers in which Zlokovic is the only common author, with one receiving a second correction after the new supplied data were found to have problems as well.

For an 11th paper co-authored by Zlokovic the journal Nature Medicine issued an expression of concern , a note journals append to articles when they have reason to believe there may be a problem with the paper but have not conclusively proven so. Since Zlokovic and his co-authors no longer had the original data for one of the questioned figures, the editors wrote, “[r]eaders are therefore alerted to interpret these results with caution.”

“It’s quite unusual to see this volume of retractions, corrections and expressions of concern, especially in high-tier influential papers,” said Dr. Matthew Schrag, an assistant professor of neurology at Vanderbilt who co-authored the whistleblower report independently of his work at the university.

Both Zlokovic and representatives for USC declined to comment, citing an ongoing review initiated in the wake of the allegations, which were first reported in the journal Science.

“USC takes any allegations of research integrity very seriously,” the university said in a statement. “Consistent with federal regulations and USC policies, this review must be kept confidential.”

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USC neuroscientist faces scrutiny following allegations of data manipulation

Accusations against USC’s Berislav Zlokovic were made by a small group of independent researchers and reported in the journal Science.

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Zlokovic “remains committed to cooperating with and respecting that process, although it is unfortunately required due to allegations that are based on incorrect information and faulty premises,” his attorney Alfredo X. Jarrin wrote in an email.

Regarding the articles, “corrections and retractions are a normal and necessary part of the scientific post-publication process,” Jarrin wrote.

Authors of the whistleblower report and academic integrity experts challenged that assertion.

“If these are honest errors, then the authors should be able to show the actual original data,” said Elisabeth Bik , a microbiologist and scientific integrity consultant who co-wrote the whistleblower report. “It is totally human to make errors, but there are a lot of errors found in these papers. And some of the findings are suggestive of image manipulation.”

Given the staid pace of academic publishing, publishing this many corrections and retractions only a few months after the initial concerns were raised “is, bizarrely, pretty quick,” said Ivan Oransky, co-founder of Retraction Watch .

The whistleblower report submitted to NIH identified allegedly doctored images and data in 35 research papers in which Zlokovic was the sole common author.

“There had been rumblings about things not being reproducible [in Zlokovic’s research] for quite some time,” Schrag said. “The real motivation to speak publicly is that some of his work reached a stage where it was being used to justify clinical trials. And I think that when you have data that may be unreliable as the foundation for that kind of an experiment, the stakes are just so much higher. You’re talking about patients who are often at the most vulnerable medical moment of their life.”

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Over the years, Zlokovic has created several biotech companies aimed at commercializing his scientific work. In 2007, he co-founded ZZ Biotech , which has been working to gain federal approval of 3K3A-APC.

The drug is intended to minimize the bleeding and subsequent brain damage that can occur after an ischemic stroke, in which a blood clot forms in an artery leading to the brain.

In 2022, USC’s Keck School of Medicine received from NIH the first $4 million of a planned $30-million grant to conduct Phase III trials of the experimental stroke treatment on 1,400 people.

In Phase II of the trial, which was published in 2018 and called Rhapsody, six of the 66 patients who received 3K3A-APC died in the first week after their stroke, compared to one person among the 44 patients who got a placebo. Patients who received the drug also tended to report more disability 90 days after their stroke than those who got the placebo. The differences between the two groups were not statistically significant and could have been due to chance, and the death rate for patients in both groups evened out one month after the initial stroke.

“The statements that there is a risk in this trial is false,” said Patrick Lyden, a USC neurologist and stroke expert who was employed by Cedars-Sinai at the time of the trial. Zlokovic worked with Lyden as a co-investigator on the study.

One correction has been issued to the paper describing the Phase II results, fixing an extra line in a data table that shifted some numbers to the wrong columns. “This mistake is mine. It’s not anybody else’s. I didn’t catch it in multiple readings,” Lyden said, adding that he noticed the error and was already working on the correction when the journal contacted him about it.

He disputed that the trial represented any undue risk to patients.

“I believe it’s safe, especially when you consider that the purpose of Rhapsody was to find a dose — the maximum dose — that was tolerated by the patients without risk, and the Rhapsody trial succeeded in doing that. We did not find any dose that was too high to limit proceeding to Phase III. It’s time to proceed with Phase III.”

Schrag stressed that the whistleblowers did not find evidence of manipulated data in the report from the Phase II trial. But given the errors and alleged data manipulation in Zlokovic’s earlier work, he said, it’s appropriate to scrutinize a clinical trial that would administer the product of his research to people in life-threatening situations.

In the Phase II data, “there’s a coherent pattern of [patient] outcomes trending in the wrong direction. There’s a signal in early mortality … there’s a trend toward worse disability numbers” for patients who received the drug instead of a placebo, he said.

None are “conclusive proof of harm,” he said. But “when you’re seeing a red flag or a trend in the clinical trial, I would tend to give that more weight in the setting of serious ethical concerns around the pre-clinical data.”

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The NIH paused the clinical trial in November, and it remains on hold, said Dr. Pooja Khatr, principal investigator of the NIH StrokeNet National Coordinating Center. Khatr declined to comment on the pause or the trial’s future, referring further questions to USC and NIH.

The NIH Office of Extramural Research declined to discuss Rhapsody or Zlokovic, citing confidentiality regarding grant deliberations.

ZZ Biotech Chief Executive Kent Pryor, who in 2022 called the drug “a potential game-changer,” said he had no comment or information on the halted trial.

Zlokovic is a leading researcher on the blood-brain barrier, with particular interest in its role in stroke and dementia. He received his medical degree and doctorate in physiology at the University of Belgrade and joined the faculty at USC’s Keck School of Medicine after several fellowships in London. A polyglot and amateur opera singer , Zlokovic left USC and spent 11 years at the University of Rochester before returning in 2011 . He was appointed director of USC’s Zilkha Neurogenetic Institute the following year.

A USC spokesperson confirmed that Zlokovic has retained his titles as department chair and director of the Zilkha institute.

About this article

Corinne Purtill is a science and medicine reporter for the Los Angeles Times. Her writing on science and human behavior has appeared in the New Yorker, the New York Times, Time Magazine, the BBC, Quartz and elsewhere. Before joining The Times, she worked as the senior London correspondent for GlobalPost (now PRI) and as a reporter and assignment editor at the Cambodia Daily in Phnom Penh. She is a native of Southern California and a graduate of Stanford University.

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