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

Abstract

Reproductive justice is a framework diversely applied to interrogate and challenge broad structural factors which constrain individual reproductive choices. This framework necessitates an intersectionally-aware and rights-based approach, which prioritises working with local communities and centres the reproductive experiences and needs of overlooked, devalued, repressed or marginalised populations. This paper considers the suitability of participatory photography as a tool for researching reproductive justice and describes a pilot project exploring reproductive justice challenges and opportunities in Northern England. We share our approach to co-design, collective interpretation and dissemination, offering methodological insight by incorporating care as an ethical foundation of the research. We consider the strengths and challenges of our approach, reflecting on relationship building, trauma-informed engagement of people with lived experience, informed consent, equitable inclusion, power sharing, and ‘empowerment’. Finally, we suggest recommendations for future participatory projects.

Keywords

participatory photography social justice reproductive justice participatory action research ethics of care

Introduction

Partly in response to a growing critique of the extractive nature of many research methods (Godrie, 2025; Gorman, 2024; Spyrou, 2024), participatory photography (PP) has developed as a method for research with (rather than research on) participants.¹ The method generally uses photographs taken and shared by participants to understand and, potentially, address social phenomena of interest to participants themselves. This approach seeks to share power with participants through extended and meaningful engagement in a collective research process. It is therefore particularly well-suited to social justice work, where equitable partnership is essential and social change is a shared aim. The laudable ideals of this method, however, can be difficult to realise in practice. In this paper, we introduce a PP pilot focusing on reproductive justice (RJ) in Northern England, incorporating care as an ethical foundation. We reflect on the strengths and challenges of our approach and offer recommendations for future research.

Reproductive Justice as Theory, Feminist Methodology, and Praxis

RJ is both a critical feminist theoretical framework, rooted in intersectional theory and international human rights, and a social justice movement. Building from a long history of resistance and activism by racially marginalised women in the United States (US) (Silliman et al., 2004; Luna, 2020; Roberts, 1997; Davis, 1983; Ross & Solinger, 2017), the term ‘RJ’ was originated by Black feminists in the early 90s to advocate for women’s rights to comprehensive reproductive health services and to critique structural reproductive oppression of marginalised people. Through strong engagement with international human rights frameworks and activism by women in Global Majority countries (Luna, 2020; Silliman et al., 2004), the RJ framework was consciously developed to be ‘universally adaptable’ (Ross, 2017). It has been applied to different social locations, sociopolitical environments and oppressive contexts to interrogate ways in which structural factors constrain reproductive choices, e.g., social welfare; incarceration; child removals; taxation; environmental degradation; digital surveillance; immigration policies; food insecurity; housing conditions, affordability and availability; and healthcare monitoring and delivery (Barnes & Fledderjohann, 2020; Fledderjohann et al., 2024; Fledderjohann et al., 2023; Fleming et al., 2019; Gaard, 2010; Galarneau, 2013; Gurr, 2011; Hayes et al., 2020; Hoover et al., 2012; Luna & Luker, 2013; Ninsiima et al., 2020; Nixon, 2013; Roberts, 2015; Ross & Solinger, 2017; Tomasovic, 2009).

RJ includes but also extends beyond a narrow view of reproductive rights as abortion rights to encompass sexual and reproductive health, bodily autonomy, and parenting rights, broadly defined (Luna, 2020; Luna & Luker, 2013; Roberts, 1997, 2015; Ross & Solinger, 2017; Silliman et al., 2004). It asserts all people have core rights to: (1) bodily autonomy; (2) not have a child; (3) have a child; and (4) parent (a) child(ren) with dignity in safe and healthy environments. RJ centres the experiences of overlooked, devalued, and marginalised populations whose reproductive choices are most repressed by broader structural forces: for example racially or sexually marginalised people, Indigenous populations, people in contact with the criminal justice system and people with disabilities.

RJ draws upon a foundation of critical feminist theory, integrating an analytic focus on power, social and structural oppression and social justice. Intersectionality theory weaves prominently through multivocal RJ theory, asserting that women’s multiple and intersecting cultural, social, economic, political and geographic locations shape divergent experiences of reproductive oppression and marginalisation (Crenshaw, 1990; Davis, 1983; Hill Collins, 2019). Loretta Ross (2017) draws on the commitment to action embedded within RJ to justify its place as a novel critical feminist theory:

“Reproductive justice praxis puts the concept of reproductive justice into action by elaborating the connection between activism and intersectional feminist theory”

RJ provides a critical framework for conducting structurally cognizant, rights-based research with a commitment to ‘praxis’, i.e. action resulting from the scholarship (Ross, 2017). RJ scholars have proposed additional principles of community-led RJ research (Mosley et al., 2022), including creating equitable research partnerships that centralise marginalised voices; optimising community assets; recognising and celebrating different forms of knowledge; and prioritising communities in knowledge translation efforts. This links directly to feminist commitments to relationality, trauma-informed approaches, safeguarding, and praxis (Collins, 2015; Godrie, 2025; Hill Collins, 2000; James, 2022; Jesudason & Kimport, 2013; McGeown et al., 2023; Mosley et al., 2022; Norwood et al., 2022; Richards, 2022; Ross, 2017; Silliman et al., 2004; Skenandore & Derkas, 2017; Spyrou, 2024; Tronto, 1998, and is consistent with Black feminist work on intersectionality (Hill Collins, 2019), which highlights how academic gatekeeping of ways of knowing is a form of epistemic violence that silences marginalised voices.

The RJ movement has built from the pioneering work of, and in direct coalition with, extant organisations and movements led by racially marginalised women (Luna, 2020; Silliman et al., 2004). A key cross-cutting practice of these organisations has been to root their work firmly in local community-based research and education by prioritising active collaboration with community members to identify key concerns, develop educational materials, direct the content and format of advocacy work, and jointly address internalised oppression (Silliman et al., 2004). For example, the National Black Women’s Health Project (NBWHP) implemented and provided training in a Self-Help model to foster small group dialogue and support to jointly address spiritual, physical, emotional, and psychological needs of participants in a safe space of shared experience. Similarly, Mohawk activist Katsi Cook has drawn on culturally meaningful practices of dance, roundtables with local community members, and research skills training for Mohawk community members to identify and address local communities’ unique needs and challenges and facilitate participant-researchers to become ‘researchers of their own reality’ (Silliman et al., 2004, p. 139).

A local lens is invaluable for RJ, which advocates for involving of communities most affected, connecting ‘local to global’ and ‘individual and community’, examining and critiquing power structures, and translocating power to communities (Ross, 2017). Whilst some structural reproductive oppressors may operate at a broader national or global level (e.g., political systems and policies), others may be tethered more locally (e.g., local resource distribution and infrastructure). As power to shape health and social policy relevant to RJ is often centralised, local populations may feel disenfranchised due to their distance from decision-making processes and considerations. Yet local communities are best placed to characterise and contextualise local reproductive injustices and offer solutions that draw on community assets.

This commitment to local community building and holistic self-care has been carried forward by SisterSong (2025), the leading RJ organisation in the US (which works in coalition with the aforementioned organisations and many others). For example, past events have included not only invited seminars and educational courses, but also self-care, creative and expressive activities meant to facilitate dialogue while addressing the broad spectrum of participants’ physical, spiritual, and emotional needs (Luna, 2020). These examples highlight that a commitment to a holistic, creative, and community-based approach to knowledge generation, education, and action underpin RJ scholarship and activism.

Participatory Photography as a Tool for Reproductive Justice

PP is a participatory action research (PAR) method that places priority on inclusive engagement of, and centralised focus on, community members in representing, recording the needs and strengths of, and (where desired) changing their communities (Wang & Burris, 1994, 1997). It shares key principles and values with RJ theory; indeed community-rooted PAR methods underpin research and activism in many RJ-oriented organisations (Silliman et al., 2004). While not the only approach to PP, photovoice is a particularly widely used approach to women’s health and community-oriented research (Catalani & Minkler, 2010; Duffy, 2011; Wang, 1999; Wang & Burris, 1994).

Grounded in feminist theory and the concept of critical consciousness, the first use of this method (initially called ‘photo novella’) was described by Wang and Burris (1994) in their participatory exploration of the health needs of rural women in China. In this approach, participants determine the direction for the work, and their view of the worlds in which they live has primacy (Wang & Burris, 1994, 1997). The method facilitates a dialogue between community members, recognising each participant will have a unique perspective, and provides a platform for sharing that dialogue with relevant stakeholders. This mirrors the RJ polyvocal approach, which emphasises that, as all people occupy multiple intersecting social locations, no single voice can adequately represent the unique concerns relevant to the reproductive contexts within which each person lives (Ross, 2017). PP can generate rich narratives rooted in lived experience and local knowledge, and powerful and accessible visual research findings that inspire action, which may catalyse social change (Carlson et al., 2006).

A Participatory Photography Reproductive Justice Pilot

Established in 2021, ReproNorth is a network of partners who share a commitment to interrogate systems of oppression that propagate health inequities and compromise RJ in Northern England. Our lens is holistic and intersectional, recognising the overlapping effects of class, race, disability, gender, and other important social identities in shaping experiences of RJ. By adopting a RJ framework, our research is sensitive to upstream societal structures and systems of oppression that constrain individual autonomy, while simultaneously recognising the strength of individuals and local communities in resisting structural inequities. ReproNorth represents an effort to build a collective of RJ research and action in Northern England, centring the perspectives of marginalised communities. Our place-based focus responds to evidence of geographical inequities in power and resources needed for health, disadvantaging women living in the North of England (Bambra et al., 2024; Whitehead et al., 2014). The Woman of the North report (Bambra et al., 2014) revealed that women living in Northern regions are more likely to live in poverty and experience poor health compared to women living in the rest of the country, as well as experiencing the highest prevalences of domestic violence and children in care nationally. Despite national ambitions to devolve more powers to local areas (MHCLG, 2024), England remains highly centralised, with policymaking disconnected from the realities of life in ‘the North’. Furthermore, a report by the Northern Health Science Alliance (Martyn, 2022) revealed stark regional inequities in investment in health research and innovation, with notable underinvestment in the North.

The ReproNorth membership includes academics; clinicians; and Voluntary, Community, and Social Enterprise (VCSE) partners supporting a diversity of northern residents (including people experiencing food poverty, people in contact with the criminal justice system, racially marginalised groups, and people who are claiming asylum or have refugee status). Since inception, ReproNorth has invested in relationship building with VCSE partners to foster a sense of trust and mutual respect and to collaboratively agree upon aligned priorities and shared values. Our work is guided by core values that promote power sharing; non-judgemental approaches; collective responsibility, inclusivity and cultural humility. These values are rooted in a feminist ethics of care, where care entails both a mental disposition and, linked to this, a set of practices (Tronto, 1998). The feminist ethics of care is a ‘moral task’ which requires that care be embraced as a central value, necessitating a morally-rooted process of judgement for responding to the messy, complex, and individually unique realities of care work (Tronto, 1998). Incorporating both ethical and political elements, care ethics provides a lens through which to incorporate and respond to marginalisation, centre relationships and advance social justice (Brannelly, 2018; Collins, 2015; Hill Collins, 2000; James, 2022; Kittay, 1999; Richards, 2022).

A shared priority our network identified was co-develop a research agenda informed by, and responsive to, the local community. Building from our firm foundation of relationship building and values mapping, we successfully applied for a small (∼£25,000) grant to support a pilot research project that aimed to: diversify our network through engagement of people with lived experience of structural oppression; strengthen relationships between collaborators; develop new skills in PP; and co-identify priorities for further research. Below, we provide a detailed accounting of our pilot, structured according to Liebenberg’s (2018) components of PP in action (co-design, collective interpretation, and dissemination).

Co-designing a Participatory Photography Pilot

Our pilot aimed to engage five people with diverse lived experience through our VCSE partners to become members of the ReproNorth network and to collaborate on a pilot to inform the network research agenda. The use of PP was determined in advance by the academic partners in recognition of its value as a collaborative, inclusive and accessible method and its alignment with ReproNorth values. We applied feminist research methodologies within a RJ framework to centre knowledge co-creation, social justice and collective praxis, incorporating feminist commitments to relationality, trauma-informed approaches and safeguarding.

Pre-planning discussions were conducted with our VCSE partners to prioritise meaningful and equitable engagement. Particularly emphasised were (1) budgeting to reduce barriers to participation, meaning not only compensating participants for their time in keeping with UK’s National Institute of Heath and Care Research (NIHR, 2025) guidelines, but also covering catering for events and reasonable costs for expenses such as transportation; (2) being responsive to lived realities of parents, for example arranging workshops and training during the school day; and (3) creating opportunities for collaborators to engage with the research at an early stage as confident and valued partners by providing training to build knowledge of RJ and by covering costs for their participation in PP training alongside academic partners. This not only left the research team (three academic partners, five people with lived experience and two VCSE partner representatives) on a more even epistemological footing than in traditional approaches, facilitating genuine collaboration throughout the project, but also strengthened group relationships and contributed to confidence and capacity building.

As a core underpinning value of our research was power sharing, we were keen to avoid over-defining the research focus in the funding application, as this would risk limiting genuine co-design. Whilst input was gained from VCSE partners at the application stage, the detail was kept flexible to allow space to incorporate diverse perspectives. The funding application built upon our network values and ethical principles and defined a broad area of focus for exploratory work (RJ in Northern England), charting the specifics of how we would engage people with lived experience and jointly participate in PP training and project co-design to deliver workshops) but not, for example, the specific photographic prompts and dissemination strategy.

We incorporated care as a feminist ethical foundation of the research (Tronto, 1998). In applying this lens, researchers assume responsibility to advance change, integrating a necessity for ‘praxis.’ Brannelly (2018) presents an ‘ethics of care research manifesto’ which advocates for a social justice approach centring experiential knowledge of marginalised groups, relationships and social change. We drew on pre-existing relationships with our VCSE partners to understand what would be needed to facilitate safe participation among their communities. It was clear that a trauma-informed approach (McGeown et al., 2023) would be important given that people supported by these organisations included women claiming asylum or with refugee status, women in contact with the criminal justice system and women with experience of violence. Before engaging with people with lived experience, we arranged training for academic and VCSE partners on best practices for a trauma-informed approach, run by Birth Companions, a charity dedicated to tackling inequities across parenthood, with an established Lived Experience Team (Birth Companions, 2025). Key practices identified included general suggestions for sensitive, empathetic language; accurately setting expectations and providing full information about not only content, but also pragmatic logistical aspects of activities; and the value of frequent check-ins before and after events.

We used a convenience approach to recruitment, advertising the opportunity through our VCSE organisation partners in January 2025 using digital and physical posters and word-of-mouth. We limited inclusion to five people (due to funding constraints) who were available to attend the participatory photography training and who were known to our partner VCSE organisations. This ensured a strong safeguarding offer was in place. We successfully engaged five people (with representation of people who are racially and sexually marginalised, women with refugee status, and people with experience of disability and violence) into the ReproNorth network with the expectation of collaborating on the pilot. These members joined three academic partners and two VCSE representatives to undergo 4-day in-person bespoke training delivered by the organisation PhotoVoice. In its approach to training, PhotoVoice builds upon Wang and Burris’s theoretical foundation (1994, 1997) but has established specific applications to PP that centre ethical considerations and participant wellbeing (PhotoVoice, 2023, 2025). Modules included defining PP; working with images; working with cameras; ethical considerations; designing projects; designing workshops; creating outputs; working with text and consent processes. No members of the group had prior experience of this research method, so the training acted as a leveller, granting each group member the chance to experience and reflect on being a participant. On the final day of the training, we were supported by the external facilitator to co-design our pilot. On completing the training, the five people with lived experience and two VCSE representatives all expressed interest in participating in the pilot.

After receiving ethical approval for our updated research plan, the external facilitator supported us to collaboratively develop prompts through a follow-up Zoom meeting. Prior to the meeting, we shared a summary of the training content related to photographic prompts, inviting suggestions for possible prompts. During the meeting, the RJ framework and project aims were reviewed, before using the online platform Padlet to allow people to suggest prompts in real time using anonymised names. This anonymisation meant no one person’s view was prioritised; participants could feel comfortable sharing their genuine views, and academic partners could feed into prompt development without our prompt suggestions being prioritised due to power dynamics. After the call, prompts were clustered thematically by the academic partners before being shared with participants, inviting them to reflect on the themes and indicate their preferred prompt within each theme.

After eight prompts were agreed, an academic partner met with each participant to review upcoming workshop details and answer question. During this contact, participants were provided with a point-and-shoot camera and a community statement card, which broadly explained the project to help to address any questions or challenges that they might experience when photographing within community settings. Participants were given ∼1 week to take as many photos as they wished for each prompt, and were reminded that they had full control over which prompts to engage with and which photos they wished to share (if any).

Photo Sharing, Curation and Collective Interpretation

In the first workshop, participants provided their camera SD (memory) cards and specified which photo(s) they wanted to share for each prompt. The PI loaded these (and only these) photos onto a laptop connected to a projector. One member of the academic team had to join (only) this meeting remotely due to travel constraints. It was understood that she could see the photos and hear the conversations, that she was taking detailed notes throughout the discussion, and that she was in a private location using headphones and so the discussion could not be seen/heard by any other parties. All participants agreed to this in advance and were reminded of this (and consent re-confirmed) on the workshop date.

After briefly reminding participants of our agreed ‘code of cooperation’ (ground rules collectively developed during the participatory photography training), reviewing safeguarding considerations and reiterating basic details of the RJ framework, the PI shared participant photos for each prompt one at a time, with participants taking as much time as they wished to explain and reflect on their photo(s). With consent, the two other academic partners took detailed notes on the discussion throughout the day while the PI facilitated discussion of reflections on specific photographs and process more generally. Several photos prompted extended discussions among group members. At the end of the session, plans for the next workshop were discussed and collectively agreed. Participants were reminded to develop their captions to communicate broader context and intent of each photograph over the two days between the workshops.

The second workshop focused on finalising captioning, initiating collaborative thematic analysis, collective curation of the photos, and planning next steps. The photos from the first workshop were briefly shared on the projector, with 3 × 5 printed copies also distributed across the table. A few participants decided to share additional photos since the last workshop. These were shared via the projector, with reflection from the photographer. Following a captioning discussion, members were asked to work collaboratively in two groups to identify common themes across photographs and associated captions. Subsequently, the PI-facilitator guided a collective discussion, resulting in an agreed list of five themes, with one academic partner capturing main- and sub-themes on flipchart paper in real time and another taking detailed notes.

Before commencing photograph curation (which would form the final photo set for outward facing dissemination activities), photo-sharing consent forms were reviewed with participants on a one-to-one basis to determine which (if any) photographs they were happy to share, and for which purposes. Participants consented to sharing all but one photograph (which captured a family member) for purposes related to the project, including an exhibition. Participants were also asked to confirm their preferences for first name/pseudonym to credit their work.

Using the printed photos, participants were asked to independently mark their three favourite images with a coloured sticker to ensure everyone had a voice in curation. Photographs not marked were temporarily removed. We then collectively discussed marked photographs and grouped them into previously identified themes. This was not straightforward, as some photographs straddled multiple themes. Some photographs seemed to fit into one theme, but on revisiting the broader context and intent of the photographer through the associated caption, a different theme was deemed more applicable. Where there was disagreement on which theme a photo fit within, priority was given to the photographer’s preference. This process facilitated deep, critical discussion of the collectively identified themes. In reviewing the themes alongside the photographs, we began to collaboratively visualise how an exhibition might be structured and to consider key messages we wished to highlight.

We also discussed whether any photographs were extraneous within each theme and could be removed. These conversations were challenging as the photographs were inherently personal contributions. The close relationships between the research team at this stage increased our discomfort and reluctance to remove photographs. Both academic partners and participants were mindful of ensuring everyone had at least one photo represented in the final curated images. Participants generally did not suggest removing another person’s photo; some participants suggested their own photo should be removed if they felt their work was duplicating the subject of another photo in the theme, which was met by supportive discussion among participants about the contribution of each photograph. Following this extended thematic discussion, we collectively decided the photographs that had not initially been marked for selection should be reconsidered, with some photographs re-introduced under the main themes. The workshop closed with a discussion of next steps, with focus on recommendations for research and action, goals for future network involvement, and dissemination. The workshop discussions yielded topic themes that were broad and naturally flowed from collaborative discussions during the photo sharing. Whilst some effort was made to subcategorise larger themes during the collaborative workshop sessions, we were limited in terms of time. Further work was required to refine these themes in preparation for knowledge sharing. Where refinements were made, they were in response to content from the captions and collaborative discussions, and outputs were always checked with the broader research team. Photographs illustrating the collaborative process of curation and interpretation can be viewed in the supplemental material.

Dissemination

With the exception of a peer-reviewed academic output detailing our approach and a future funding bid, the plans for dissemination were kept flexible in our original funding application to allow us to respond to participant preferences and permissions in relation to sharing their work.

During co-design and prompt development, the external facilitator prompted us to engage in collaborative discussions about audiences this work aimed to speak to, and to what purpose, which shaped our approach to dissemination. Our group jointly agreed that we primarily wanted findings to be shared with local communities, but also recognised value in sharing findings with power brokers positioned to influence change locally, including local decision-makers and community leaders. As in previous PP projects (Mitchell, 2015), we decided to host an exhibition across multiple sites to reach a variety of audiences.

To value the group relationships and celebrate our collective work, we decided to host an intimate exhibition limited to the research team prior to broader dissemination. Our exhibition was then displayed in a freely accessible public space (the foyer of Open Eye Gallery, Liverpool) for a four-week period in July 2025, with photographs and captions displayed on 15 panels (640 mm × 864 mm) positioned on stands. This exhibition was preceded by a public launch to engage relevant local power brokers and community leaders. Each VCSE partner organisation then hosted the exhibition in turn to reach the local communities at the heart of this work. The exhibition was accompanied by a booklet that brought together the photographs, captions, and themes, representing something tangible that both the research team and the audience could take home with them. A virtual exhibition of this work is available to view through our website: https://www.repronorth.com/we-re-telling-our-own-story.

Discussion

In our experience, PP rooted in an ethic of care was a useful and appropriate method to facilitate working in genuine partnership with community members to develop an important and impactful project which was well-suited to our RJ topic. We emphasise, however, that there is no one ‘right’ way to design a project; co-design is inherently unique to the particular time, place, and individuals involved. Our project had both strengths and weaknesses, which we discuss in turn below. In some cases, strengths of our approach were simultaneously weaknesses; this was not a clear dichotomy of ‘good’ vs. ‘bad’ practice but rather an evolving experience which required continuous reflective monitoring and adaptation.

Strengths

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.”

“I found this exhibition very moving hearing other women’s stories. I was able to identify with a lot of the photos. Women’s stories should be showcased more.”

“Very interesting and grateful to be exposed to something I’ve never really considered a problem. Something I, as a man, have never been personally affected by. [I grew up] with a single mother who struggled mentally, physically, and financially. It is very valuable to me to see women supporting one another in this way, and bringing awareness to our city.”

Challenges

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.

Recommendations

Every project is unique, and there is no one-size-fits-all approach for PP research. Nonetheless, several lessons emerged from our experience which may be transferrable. First, it is essential to invest in community relationship building in advance of co-developing research. Our project would not have been a success without the strong relationships we had spent years building with our community partners. Second, it is important to map shared values and good practice for ethical principles ahead of time. Even the most experienced research team will encounter unanticipated challenges. Our mapping of principles and values ensured the research team came in with a shared understanding of our responsibilities, which facilitated trouble-shooting discussions when challenges emerged.

Third, budgeting both adequate time and material resources is crucial. Building a rapport among group members, undergoing training, taking, sharing, and curating photographs, analysing data, and planning for and undertaking dissemination activities are all time and money intensive activities. Ensuring participants have sufficient time and material support to meaningfully participate in the full process is the only way to ensure a project is truly participatory. This may include earmarking a budget specifically for participant-led dissemination activities. At the same time, resource constraints will always be a factor. Being transparent and honest from the outset about what is possible is equally important when setting expectations for outputs and future work.

While not all projects will focus on potentially sensitive topics, ethical considerations must be accounted for. In our case, because of the nature of reproductive injustices, we recognised the importance of incorporating care as an ethical foundation and adopting a trauma-informed approach that integrated safeguarding considerations. Regardless of the substantive focus of the work, principles, such as providing detailed information about activities and expectations up front, implementing regular check-ins with participants, and fostering a safe space for sharing, are likely to be broadly useful and relevant. Finally, while much of our focus has been on participants’ well-being, we suggest that academic partners should also include themselves when thinking of ways to prioritise care for the collective. The stress of responsibility and required emotional labour that runs alongside the excitement of a participatory project is draining. Ensuring adequate time and planning resources for collective caring for all partners is critical for avoiding burn-out and ensuring that long-term engagement is sustainable.

Conclusion

Tronto (1998, p. 18) reminds us that ‘While perfection is impossible, improvement is not; through good caring, people are better able to live in the world’. This paper provides details of one imperfect RJ project rooted in the feminist ethics of care; a moral and ethical lens through which to work that can be applied across different areas of scholarship. In contributing this methodological insight, we hope to facilitate future participatory projects oriented towards ‘good caring’.

Our key aims going into the project were to diversify our network, strengthen relationships, co-design the network research agenda and gain proof of concept for use of PP as an appropriate method in this context. While overlapping in many instances, participants also had different ideas of what success looked like, particularly with respect to outputs. To the extent possible within our limited budget, we made space to respond to these diverse views and priorities, sourcing some additional funding to support an exhibition and committing to sustainable relationships with partners through collective membership of the ReproNorth network. If no other sharable photographic outputs had been generated, we would have still considered the project a success because we were able to build lasting, equity-oriented relationships and support a diverse range of goals. In designing future projects that build upon our foundational pilot work, our aim is to ensure the balance of power tips further towards community and lived experience partners to elevate authentic local voices in research and action to advance RJ.

Supplemental Material

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

Supplemental Material for Participatory Photography for Reproductive Justice: Recommendations From a Community Collaborative Pilot Project Incorporating Care as an Ethical Foundation by Sophie Patterson, Liza Caruana-Finkel, Jude Jones, Felicity Dobrushi, Kate Chadwick, Jasmine Fledderjohann in International Journal of Qualitative Methods

Footnotes

Acknowledgments

This manuscript describes the contributions and experiences of a broad set of collaborators. We would particularly like to acknowledge the passion, time and wisdom brought by the participants and collaborators of this pilot project, and the generous support of the community organisations involved. Similarly, we wish to acknowledge the contributions of broader members of the ReproNorth network for their support during key stages of this project, particularly Dr Rachael Eastham for her co-leadership of ReproNorth. We would like to thank the Birth Companions Lived Experience Team for sharing insight and recommendations on their trauma-informed approach to engagement of people with lived experience. We would also like to thank Tom Elkins from PhotoVoice for not only delivering ethically conscious bespoke training in participatory photography, but also for being a friend, mentor and advocate throughout this project. Finally, we would also like to thank Open Eye Gallery Liverpool for their enthusiasm and generous support in exhibiting our work.

ORCID iDs

Sophie Patterson

Liza Caruana-Finkel

Ethical Considerations

Ethical approval was obtained from the Faculty of Health and Medicine Research Ethics Committee at Lancaster University (FHM-2025-5220-RECR-2).

Consent to Participate

Informed consent was treated as a process rather than a single transaction – please refer to the manuscript for further detail. In brief, participants provided written consent to participate in the project after reading a detailed information sheet. Additionally, participants completed a photo-sharing consent form indicating which (if any) photos they were willing to share, and for what purpose.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by Quality-Related (QR) Participatory Research funding from UK Research and Innovation (UKRI). Sophie Patterson is supported by a Clinical Lectureship in Public Health from the National Institute for Health and Care Research (NIHR). Jasmine Fledderjohann is supported by a UKRI Future Leaders Fellowship.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The photographs and captions are the intellectual product of the participants. Whether participants chose to share their work, and for what purposes, remains their choice. As a result, data will not be made available for other researchers.*

Supplemental Material

Supplemental material for this article is available online.

Note

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