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Media Coverage of Global Health: The Matter of Privacy

Our contemporary and appropriate interests in global health make matters of representation – both visual and textual – particularly important. When the media focuses on global health, researchers, practitioners and potential patients can benefit from the attention and opportunity to be better informed regarding these critical issues.

But media attention can also follow the patterns of bias that bioethics has grappled with. A recent article from McClatchy Newspapers regarding birth control issues in Uganda highlights this concern.

The article, titled “Unplanned Births Swamp Africa,” focused on the consequence of George W. Bush-era PEPFAR (President’s Emergency Plan for AIDS Relief) funding, a global anti-AIDS initiative that tied its distributions to the prohibition of any expenditures for reproductive health and planning. But despite the article’s informative value, it inadvertently highlighted the representational failures that too often accompany reporting on countries in Africa.

Although the bulk of the text was about Uganda, “Africa” was the nomenclature used. For educated readers, this failure to be specific when it comes to countries and peoples of Africa is no surprise. Too often Africa is represented as one singular continental mass, with its varied populations, countries, and structures of governance condensed into the stereotyped ease with which the continent has been historically referenced.

In a letter to our local newspaper, I pointed out this error and suggested its relationship to another lapse often found in news coverage of populations on this continent.  The article was accompanied by a photograph of a woman receiving an injection of Depo-Provera. The patient’s face is in full view as she received a treatment, making public what ought to have been her private decision about her reproductive health.

One response might be that there is nothing in the photo of an injection that seems to violate an ethical norm of privacy – it is not as if nudity is at issue. But nudity is not the ethical breach exposed here.

Reproductive health decisions are private matters. What consent was obtained for the use of this image? What was this Ugandan woman’s understanding of how and where her image might be used?

The article pointed out the controversy over women’s decisions about reproductive health in Uganda and the government’s objection to women’s reproductive autonomy. Is this woman’s safety compromised by the publication of her image? What ethical principles regulate the exposure of individuals whose status as patients helps to explain, or at the very least illustrate, matters regarding global health?

Women and racial minorities are among those whom bioethicists in this country consider potentially vulnerable populations. The image in this article was of a black woman. It’s difficult to imagine a photograph of a white woman receiving Depo-Provera accompanying an article about unplanned births swamping Europe. There are issues of identity and origin that make the latter image less likely to find its way to publication.

In my judgment, the failure to have an appropriate regard for the privacy of a Ugandan woman appears to be both careless and opportunistic. But in this moment of unprecedented and necessary focus on global health matters, bioethicists have an opportunity not to repeat the injustices against vulnerable subjects that are written into our country’s medical histories. Indeed, the history that has helped bioethicists identify vulnerable subjects gives us a responsibility to be especially vigilant in the research, practice, and conduct in matters of global health.

Certainly the ethical principles of privacy (or confidentiality), consent, justice, and autonomy reach beyond our political boundaries. Let’s take on the additional challenge of calling attention to situations when reports about global health issues and practices fail to adhere to the principles of ethical conduct.

Karla F.C. Holloway is James B. Duke Professor of English and Professor of Law at Duke University. She is a Fellow of The Hastings Center and a member of the Greenwall Foundation’s Advisory Board in Bioethics.

Published on: January 13, 2010
Published in: Bioethics, Human Reproduction, Media

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