Participatory Photography for Reproductive Justice: Recommendations From a Community Collaborative Pilot Project Incorporating Care as an Ethical Foundation

Well-Grounded Relationships

Collins’s (2015) slogan reducing care ethics into its core principles (‘dependency relationships generate responsibilities’) illustrates how socially conscious relationship building is central to this approach. A key aim of the pilot research was diversifying our ReproNorth network and creating collaborative, respectful relationships with partners that would outlast the pilot project. Our pre-established relationships with VCSE network partners were a major strength of our approach. Due to the short timeframe between funding notification (December 2024) and the grant’s spending deadline (June 2025), we moved rapidly to engage partner-participants and undertake the project; this rapid response would not have been possible without the firm foundation we had built with VCSE partners through formative network events in the preceding years.

To facilitate the creation of relationships of mutual respect, we prioritised creating a space for sharing that centred safety and trust, ensuring that everyone in the room felt comfortable and valued. Our efforts to build trust with participants included attention to small but important organisational details. For example, we selected a charitable, community-oriented location away from the university to avoid reinforcing power asymmetries. We took frequent breaks and ensured the space was suitable to facilitate prayers and meet disability-related needs. We also provided high-quality meals which met the dietary needs and preferences of all participants (vegan, halal), signalling we cared about group members’ needs and preferences and ensuring that everyone could participate with dignity.

Creating a safe space is a collective activity, necessitating a strong commitment from all participants. Indeed, many RJ organisations prioritise activities which facilitate group members sharing personal experiences and reflections with the explicit understanding that this facilitates deep understanding of one another, which is essential for working effectively for social change (Silliman et al., 2004). Notably, safe spaces can only go so far; people cannot be divorced from their experiences and world views just because a space has been declared safe. Participants’ practices of candid sharing and emotional disclosures within our pilot reflect the successful creation of a safe space, resulting in the development of close relationships and mutual support.

One of our VCSE representative partners commented:

“What really struck me was the similarity in emotions and feelings surrounding reproductive justice and how although we may have had different experiences, we could all still relate to each other and the way we felt about these experiences were what brought us together and truly made me believe in the power of a group of women in encouraging change.”

Trauma-Informed Approach

A feminist ethics of care entails actively recognising the need for caring (‘caring about’); assuming responsibility for the need for care (‘caring for’); taking direct action to meet need (‘caregiving’); and responding to the care provided (‘care receiving’) (Tronto, 1998). The act of founding ReproNorth to identify and address the often-neglected barriers to RJ in Northern England reflects both caring about and caring for. Our pilot represents a transition to ‘caregiving’—by academic partners and participants alike—and potential for impacts focussed on ‘care receiving’ for local communities.

Our trauma-informed approach informed our response to safeguarding, integrating key considerations of trust, safety and autonomy. In co-developing the photographic prompts, we consciously attempted to avoid prompts that could be triggering, making space for open interpretations and positive reflections. To create an environment enabling collaboration, trust and ‘good caring’, we opened each session with our co-developed ‘code of cooperation’, documenting the importance of creating a safe space, being respectful, and speaking slowly. One member of the research team commented

“I do think that the group set ‘ground rules’ was and is a key method to ensuring emotional safety and to aid in building rapport between participants.”

Considerations for safety and safeguarding were also reviewed during the training and at the start of each workshop, elevating personal choice; centring each individual as an expert in their own safety; stressing that there was no expectation to share/discuss photographs, and no expectation to discuss difficult or traumatic experiences. Participants were advised that they could opt out or indicate if something made them uncomfortable and if they would like to be signposted to support services.

Partnering with VCSE organisations, and nesting engagement of research partners from within these organisations, ensured that we could draw on the established safeguarding protocols and support links of our partner organisations, rooted in a deep understanding of local communities. To ensure the project experience was positive and supported, a representative from each of the VCSE partners involved also participated, providing familiarity and a recognised support contact within the group. The value of this approach was evident when one member of the research group disclosed challenges in leaving an abusive relationship during the project, resulting in the aligned VCSE partner being able to sensitively and effectively provide the appropriate support.

Previous work has underlined the importance of, and considerations for, trauma-informed co-production among women with complex needs (McGeown et al., 2023). Under our trauma-informed approach, we planned one-to-one check ins in advance of the training to set expectations, answer questions, and identify and respond to various cultural, religious, dietary and health needs in planning the training and workshops. We clarified details of the venue and who would be present within the room. For example, after determining that our external trainer in PP identified as a cis-man, we ascertained whether each participant was comfortable with this. We also conducted check-ins after each training day to identify and respond to any challenges, difficulties or support needs. These check ins were conducted over the phone initially, and later shifted to text message or email, according to participant preference. In parallel we incorporated reflective meetings between the academic partners to prioritise emotional safety and wellbeing. On reflection, our check-in process during training was potentially excessive – both for participants and academic partners. Check-ins adopted a targeted approach during the workshops that followed (e.g., providing contact information for academic partners, but conducting targeted check-ins with participants who had emotional sharing experiences), reflecting familiarity with the process, environment and group members.

Moving Beyond ‘Empowerment’ to Realise Multi-Level Social Change

Through this collaborative pilot, we sought to realise multi-level benefits to participants and local communities, in keeping with a RJ framework (Ross, 2017). Primarily, the pilot sought to generate individual (promoting autonomy and agency, personal identity, confidence, friendships) and community-level (building skills and capacity in communities, facilitating social inclusion and peer support) value. Our project evaluation demonstrated that the pilot resulted in change at these levels.

While some PP literature recognises empowerment as a key outcome of the approach (Duffy, 2011; Wang & Burris, 1994), we tentatively use this term in relation to our pilot. We collectively critiqued this concept during the training, reflecting that empowerment is a charged word: This framing may suggest academic partners hold the power, and are granting this power to participants (Weidenstedt, 2016). While power asymmetries are undeniable in research, this notation risks overemphasising what the academic partners can realistically offer, while simultaneously underestimating/devaluing the power communities (and individuals within communities) already wield.

Duffy (2011) reflects upon different interpretations of ‘empowerment’ expressed by participants after participating in a PP project, including finding their voice, growing in self-confidence, benefitting from social support and a sense of belonging. These numerous benefits align with reflections of the value of participating expressed by participants of our pilot. We suggest that varied benefits experienced by participants through participating in this project were not the academic partners empowering participants, but rather a collective process of building knowledge, skills, confidence and social support—a process which the academic partners benefitted from as well. We invited participants to engage in PP training alongside academic partners, not only to minimise power imbalances and facilitate truly informed consent, but also because this provided an opportunity for personal growth, through building confidence and research skills which are transferrable beyond this project. Notably, one of the collaborating VCSE partners has since applied the skills that they developed during our project to conduct their own PP project exploring stalking and harassment, resulting in an immersive exhibition that was displayed during the 16 days of activism against gender-based violence in December 2025. The other VCSE partner plans to use PP to produce their annual report in partnership with women who participated in the pilot.

Our approach fostered the values that underlie a (so-called) ‘empowerment approach’ to social change (Rogers & Singhal, 2003), specifically fostering autonomy, agency and confidence to support participants to become advocates for social change within their community (Liebenberg, 2022). Fairey (2018) identified the potential of PP to ‘provide platforms and opportunities for difficult listening’. Analysis of the dissemination process is infrequently included in PP research publications (Liebenberg, 2018). However, measuring audience response to the shared content is important to determine whether the project contributes to the knowledge base and informs change (Mitchell, 2015). To understand the impact of our knowledge dissemination across audiences, we invited free-text audience reflections across exhibition venues through QR code-generated anonymous feedback forms. Feedback from the exhibition illustrated its value to local audiences:

“My mother felt it was her duty to teach me my rights as a Black Muslim woman in a society that constantly fails us and harms us. That’s why this exhibition has affected me. I have now lived for almost 6 years in the North of England and have rarely heard about the experiences and perceptions of women here. That is why, once again, this exhibition is so important. To finally open a conversation about the position of women in the region.”

Supporting Diverse and Meaningful Involvement

We originally used the terminology “experts by experience” to engage lived experience partners, acknowledging the equivalent value of knowledge through personal experience versus formal qualifications. However, this was met with confusion by some, who questioned whether they were ‘experts’ and/or felt the need to list their qualifications to be seen/understood as ‘experts.’ On reflection, this may have been a barrier to engagement for some. By aiming to engage participants who would also become researchers and members of the ReproNorth network, we built from a tradition of participatory RJ research, wherein community members are trained to be researchers, advocates, and participants, becoming ‘researchers of their own reality’ (Silliman et al., 2004, p. 139). It’s possible that the nomenclature ‘researcher of your own reality’ may have been less confusing/off-putting.

The diversity of our research team offered a richness to collaborative discussions, but occasionally created challenge due to different interpretations of reproductive (in)justice. Due to the strong rapport and mutual regard among group members, conflicts were managed with an understanding, which is only possible when group members have been given a space to get to know one another. Professional affiliations shaped contributions but also complicated sharing in some cases. For example, one participant was a manager of a VCSE organisation supporting women whose first language is not English. Many of her photographs centred the experience of centre users rather than her own. On reflection, she viewed this as an opportunity to uplift overlooked marginalised perspectives that she had intimate awareness of through her professional role. The diverse and marginalised perspectives represented meant sharing was often emotive and unpredictable. We adopted a flexible approach, making space to safely and sensitively discuss issues participants wanted to share (ranging from experiences of reproductive (in)justice in the context of war and political unrest, to experiences of sexual violence).

The value of PP in supporting diverse and meaningful involvement was highlighted by one of our team:

“I think the method of participatory photography really helped to break down any barriers that we may have encountered if using a different methodology. Any barriers such as language, finances, or speaking/writing skill were completely avoided, and the use of photography allowed a personal insight into each other lives, something I don't think we would have achieved as effectively otherwise.”

We anticipated, and made efforts to ameliorate barriers to participation by minimising costs and reducing burdens of bureaucracy at the individual level (e.g. limiting meetings and email communications to the minimum necessary, providing direct out-of-pocket reimbursement rather than university claim forms). However, there was an inherent burden of participation. Participants had competing priorities (both professional and caring) and it was challenging to align schedules and availability. On advice of the PP trainer, we limited inclusion to participants who could attend the majority of training to avoid detrimental impacts on relationship building and training experience. However, given the time commitment of the training (4 full days), we maintained some flexibility to accommodate lived realities and competing priorities (e.g., on two occasions, participants left early for personal reasons). English was not the first language of two participants, although they both had conversational English. We shared written documents in advance to facilitate desired translation prior to meetings. A cover page of the participant information sheet also provided an accessible summary. The manager of the VCSE partner organisation through which they were engaged also participated, representing a known and trusted contact point for clarification of information and understanding. This was also supported through our check-ins.

We agreed participation in this project should be collectively rewarding and not attract any avoidable negative repercussions. We were conscious that remuneration of participants in receipt social protection payments could be problematic, given income restrictions attached to these payments. Before engaging partners with lived experience, we consulted national research guidance (NIHR, 2025) and reached out to a VCSE organisation with an established lived experience model to inform our approach (Birth Companions, 2025). We provided written information to make participants aware of payment options (direct debit payment or vouchers), with options to tailor the payment arrangement based on their own financial circumstances (e.g., accepting reduced payments, or donating to a chosen charity). We also drafted a written letter (adapted from an NIHR template) to share with benefits authority staff to clarify the purpose and context of any payment they receive, and to highlight the difference between involvement in research and work, to avoid any negative implications around implied capacity to work.

In designing this project, we were not claiming a representative sample of local communities. Rather, we aimed to ensure that seldom heard communities felt able and supported to use their voice and share in the process of shaping this work. By including representatives from the VCSE organisations, as well as people with lived experience linked to these organisations, we were able to unite a broader collection of community perspectives. However, we must acknowledge that the perspectives of people not connected with VCSE organisations, potentially those who are most marginalised, are not represented in this work. This limitation was balanced against our overriding aim to root this work in the feminist ethics of care, ensuring a strong safeguarding offer through a clear link to a VCSE organisation. This ensured the process was not harmful or extractive.

One member of our research team commented:

“The process was fantastic at bringing women together from such different backgrounds, experiences, ages, professions and even traumas. The whole experience just captured the beauty of what it means to be a woman and brought together women, who perhaps may not have met in usual circumstances, to learn from and work together in such a special and meaningful way.”

Sharing Power but Maintaining Responsibility

Consistent with recommended approaches to meaningfully and democratically collaborate in knowledge production and dissemination (Liebenberg, 2018), we incorporated collective involvement across the research process (including photograph curation and exhibition planning, to ensure participants’ authentic voices were represented (Fairey, 2018). However, the nature and extent of involvement varied, and was not consistently equitable. Tronto highlights the role of power hierarchies in care work, explaining that while care work can be undertaken amongst equals, frequently ‘the caregiver has some kind of ability, knowledge, or resource that the care receiver does not have’ (Tronto, 1998, p. 17). Academic partners provided the financial and logistical resources to facilitate participation, shaped the overall work direction through the ways we secured funding and engaged participants, and brought our research knowledge and skills to bear on the project. As previously mentioned, all participants brought lived experience, with some additionally drawing upon a background in research, professional and/or advocacy in group discussions, highlighting how potential hierarchies are typically more of a gradient than a rigid structure. Nonetheless, as the named investigators, the academic partners maintained the responsibility not only for delivering promised outcomes, but also for ensuring the well-being of group members. Through a critically reflexive process of power sharing, we offered support in appropriate ways to ensure partners were not overwhelmed by additional bureaucracy and administrative tasks, recognising the difference between supporting someone to achieve their goals versus transferring responsibility.

Liebenberg reflects on the challenge of balancing responsibility and engagement for academic partners within a participatory research process, observing the tendency for academics to ‘disengage from the process and inadvertently retract their skill set from the collaboration’ (Liebenberg, 2018, p. 2). An issue that arose for the academic partners was whether to include our own photos in the two workshops and dissemination activities. Due to budgetary constraints, the academic partners facilitated the workshops. We attempted to reduce the risk of researcher bias in steering theme development and photograph selection through reflexive practice and using open, non-leading facilitation questions. We elected not to include the photographs from academic partners due to anticipated logistical challenges of both facilitating and sharing, and the risk of biasing the research due to power hierarchies (for example, if participants felt our photos were the ‘right’ way of responding to prompts or felt wary of cutting our photos in curation). However, this negated the possibility for us to participate in the research as researchers of our own realities, obfuscating our relevant experiences and engagement in discussions as valued members of the group. Moreover, one participant flagged after the workshops that she had felt ‘vulnerable’ when she realised we would not be sharing our photos—a norm of photo sharing among all group members had been established during our joint training and had generated trust, but suddenly we, as the academic partners, had withdrawn ourselves from this process of mutual sharing.

“I suddenly felt very vulnerable - that you would all be there to 'judge' the photos and me… even though you had done everything possible to make it as inclusive/participatory and we had all been together to design the prompts!”

To respond to this reflection, the academic partners shared and discussed their interpretation of the photographic prompts when the group reconvened for the intimate exhibition.

Limits to Control

Wang describes photovoice as ‘a method that enables women to control the photographic process in order to express, reflect and communicate their everyday lives’ (Wang, 1999, p. 186). However, this control becomes harder to exert during dissemination. Participant control over the research process (and projection of their authentic voice through this work) relies on captions being appropriately aligned with text to ensure the audience appreciates their intent and broader contextual realities. However, even with the captions linked to the photographs, audiences will still interpret it within their own parameters of experience.

Our training highlighted that whilst participants have the choice over if and how to share their work, when photographs enter the public domain, the environment and actors shift, introducing risks of unapproved onward sharing, appropriation of images and subversion of originally stated intent and context (Steer, 2008). Control becomes even more of a challenge when photographs enter digital spaces. RJ is a complex issue that attracts diverse views, meaning the public reaction to shared photographs is unpredictable, and may not be positive. Sharing work locally, where participants are known, adds an additional layer of vulnerability.

We responded to this complex, challenging landscape by integrating discussions about consent across all stages of the research (rather than as a single time point transfer) to support fully informed decision-making. Informed consent and the underlying ethical principles were key elements of the PP training, ensuring a solid grounding for all participants, regardless of previous knowledge. The training clarified that the photographs and captions represented the intellectual product of the participants and should not be shared without their explicit permission, and there should be no expectation to share this work. We reiterated at the start of each of our workshops that there was no pressure or expectation to share photographs.

During the training, a template photo sharing consent form was shared and reviewed with participants. We minimally adapted this document for use within our pilot and circulated in advance of the first workshop. In the final workshop participants completed a written informed consent form to indicate which (if any) of their photographs and captions they are happy to share, and for which purposes. This process gave participants the freedom to tell their story their way, and to share the information that they chose to, whilst being aware of the risks of doing so. Fully appreciating and understanding consent in this context supported agency in participation. This was exemplified by a comment from a member of our research team:

“This was not just an exercise in asking bystanders permission, this was the appreciation that each had consent to choose to reflect the stories they wanted to tell, and the agency to frame it within their own context and in their own words.”

Scale and Unpredictability of Investment

As Tronto (1998) notes, prioritising needs in the face of resource limitations is inherently a site for conflict in care work. The investment (financial, emotional, time) required for this project to succeed was considerable. Due to the nature of our funding, we had ∼6 months to engage participants, secure appropriate ethical approvals, complete the training in PP and trauma-informed engagement, co-design and conduct the research, and finish spending on any planned dissemination activities. The budgetary and timeline constraints set on our project restricted the scope and collaborative extent of this work. For example, financial limitations meant that we could only afford to host two PP workshops, consequently the time dedicated to theme development was not as extensive as previously hoped, and leaving additional discussions to take place over email rather than face-to-face.

The success of this project was strongly dependent on the passion, dedication and investment of collaborators. The academic partners were acutely aware that the short-term funding and lack of security related to future grant opportunities could stifle the momentum of work, disappoint collaborators and potentially compromise relationships. This risk is acutely felt given the passion among the group for this work area, particularly in the immediate aftermath of this project. Academic partners responded to this by being honest and transparent with collaborators when setting expectations for the pilot and what followed. By inviting all collaborators to become part of the ReproNorth network, we signalled our intention and commitment to maintain and strengthen the relationships beyond this project.