We Need to Talk About Photo Consent in Global Health
Editor’s Note: As the world faces the once-in-a-century pandemic of COVID-19, it’s more important than ever that we challenge colonial ways of approaching global health. As Sarah Dalglish wrote in an op-ed in The Lancet, “The global health model is based in large part on technical assistance and capacity building by the US, the UK, and other rich countries, whose response has been sclerotic and delayed at best…The pandemic has given the lie to the notion that expertise is concentrated in, or at least best channelled by, legacy powers and historically rich states.” The below piece is part of our ongoing decolonizing global health series.
We need to talk about consent in global health communications. I’ve worked in global health communications for the past two years, and I believe in the power of storytelling to effect change and to elevate unheard voices. I know that strong communications are necessary to gaining and maintaining funding and can often determine if a project has impact. In these ways, I believe in my work.
But I’ve also been in situations where I questioned my work. I’ve seen how uncomfortable people can get when I, a white woman, show up with a camera and ask questions. I’ve been in situations where it seems like the signature on our consent form is only an approximation of informed consent.
In recent years, consent has gained more support in global health, and most organizations now require a consent form in order to use any content. But consent forms are nearly always created by an NGO’s American headquarters and designed with American legal protection in mind. They are usually a full page of text, with awkwardly worded, difficult to understand “legalese” phrases. When it comes to field work, these forms don’t translate, literally and figuratively.
It’s not just in the global health sector that the issue of photo consent is relevant. More people are now talking about the white savior complex and the images that go along with it — including the “African child” selfie. Taking ownership of another person’s image and controlling the narrative around it without permission is yet another power imbalance. We must ask: if it was me or my child, would I feel comfortable with this stranger taking photos without asking me? Posting them to the internet?
All children have a right to privacy, and particularly internet privacy. In the United States, most schools do not allow any photos to be taken of students without explicit adult guardian-signed permission. Understandably, parents are cautious about when and how their children’s images are posted and shared. Why should other children not be entitled to that same right?
Generally, it’s agreed upon that these basic requirements exist for informed consent:
1. The person is asked for consent in a language they feel comfortable in
2. The person specifies if you can use their full name
3. The person understands where and how the picture could be used, including Internet usage
4. The person understands that they can refuse at any time with no negative repercussions. This means they should be asked by someone they feel comfortable saying “no” to. In most cases, this is not a white American.
I’ve had professional training in storytelling, ethical communications, and consent, with the above principles. Yet I’ve found that this training hasn’t helped much when it comes down to the real work abroad. It’s time for more than just training and trusting that it will be put into practice.
In the field, I often need to rely on my coworkers, or even a friendly English-speaking stranger, to translate and explain the consent form. I have no idea what they’re saying. Sometimes, the person will speak to them for no more than a minute and put a pen in the signatory’s hand. “She’s OK with it? You’re sure?” I ask, looking at a seemingly uncomfortable woman. “Oh, yes, yes,” they’ll say, “You told her this might be used online?” I ask, “Yes, yes.” I then have to decide if that’s enough, if I can trust that it was fully explained and that the photo can be used.
Photos of project implementation are necessary to global health work. Opportunities to capture high quality photos in rural places where projects have high impact are surprisingly limited. There’s often a time pressure: get a supply of high quality photos in an hour at a health facility event. If it’s crowded, a single photo can require many signatures, including the people in the background.
How can we address this issue?
1. Work with vetted local photographers and film crews when possible who speak the language and have experience with consent. However, there is not always the time or budget for this.
2. Design simpler, clearer consent forms and translate them into the main local language of a region before the trip to the field. Yes, this can be inconvenient, but it is possible.
3. Clearly discuss ahead of time who on the team will be responsible for handling consent forms, ideally someone who speaks the local language.
4. Work harder to build a culture of photo consent in our organizations, and change the view that the form is a required nuisance or an afterthought. Share it outside of the communications department to anyone who may be taking pictures.
5. Do the work to ensure adequate preparation before a site visit, including a forewarning to those present that a photographer will be coming and an explanation of what the purpose of the documentation is.
Privacy is a difficult issue around the world now as the digital era continues to raise complicated ethical questions, many of which we do not have answers to. But if, in the West, we are going to insist on a reasonable expectation of privacy for our own children, on giving permission to use their image, we should insist on these same rights for everyone else’s children too.
Sarah Anderson is a 2019–2020 Global Health Corps fellow at PATH in Zambia.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.
