In their article, “The conduct of ethical research collaboration across international and culturally diverse communities,” Kennedy, Renfrew, Madi, Opoku, and Thompson (2006) explain how the International Confederation of Midwives developed a set of ethical guidelines for research practice across diverse communities of women. As the authors indicated, “The conduct of research should be in itself an ethical pursuit…[;h]owever, this only holds true if studies adhere to an ethical framework, are conducted in appropriate settings, and are rigorously designed and performed” (p. 100). Furthermore, based on their own experiences, the anecdotes of colleagues, and their assessments of existing midwifery research, the authors contended that standards for ethical research often overlook the fact that “[w]hat may be considered ethical in the conduct of a research study in one culture may be unacceptable in another” (100). For this reason, the task of developing standards for ethical midwifery research was undertaken, and these standards were structured according to the Thompson ethical framework, while also taking into account international ethical standards, including the World Medical Association, the Helsinki Declaration of 1948, the Nuremburg Code, and the Belmont Report.

The Belmont Report is a seminal document in ethical standards for medical, nursing, and social science researchers, as the Report establishes the ethical principles for identifying, selecting, and working with human subjects in research situations. The Belmont Report articulated standards of research such as assessment of risks and benefits and informed consent, which are mandatory considerations in all contemporary research. The set of standards devised by the authors reaffirm the principles established in the Belmont Report but also go a step further by focusing specifically on standards for ethical research in diverse communities. Diversity, as they note, refers not only to cultural or ethnic identity, but also to economic status and other aspects of demographic identity.

In order to illustrate how the Belmont Report standards are not, in and of themselves, sufficient for protecting all subjects across diverse cultures, the researchers presented a case study that revealed “the complexities of conducting collaborative research across diverse communities” (p. 104). The researchers introduced the case by explaining that the research study detailed in the case was conducted in a resource-limited country by an institute in the country working in collaboration with researchers from developed countries. The observations made about the case demonstrate that even when applying Belmont Report standards, numerous errors in ethical awareness and decision-making can be committed that not only affect the research project negatively, but which could also cause harm to the participants. In this specific case, for instance, the local staff members recruited participants in a way that the clinical staff determined was a conflict of interest and transgressed social, familial, and cultural boundaries, potentially undermining the value of the data collection because the women who were selected were from the same family.

In order to prevent such errors, the researchers advocate taking preliminary measures during the conceptualization of the research effort, including avoiding “begin[ning] a research study in a setting that has absolutely no ability to sustain the project” (p. 106) and defining each stakeholder’s role in the research clearly. Although the researchers do not provide suggestions regarding how research collaborators can learn about the cultural characteristics of communities where they may be interested in conducting studies, they do suggest that it is important for researchers to understand the salient characteristics of family and social networks, appropriate means of recruitment, communication, and remuneration, and how studies may affect people in the context of the communities in which they live. Finally, the researchers indicated that collaborators must determine in advance how research findings will be disseminated, by who, and for what purpose.

Kennedy et al.’s research is important because their study analyzed existing ethical standards critically and applied the standards effectively in order to identify the standards’ limitations when they are used to conduct research in diverse communities. As researchers attempt to expand medical and social knowledge beyond traditional research subjects, the relevance of Kennedy et al.’s study will increase. As the researchers noted, the rigor and value of a study are compromised when research is not performed ethically, but ethics are not necessarily universal; thus, Kennedy et al. provided some guidance in this study for evaluating standards and applying them in culturally-specific contexts and in appropriate ways.

Kennedy, H.P., Renfrew, M.J., Madi, C.M., Opoku, D., & Thompson, J.B. (2006). The conduct of ethical research collaboration across international and culturally diverse communities. Midwifery, 22, 100-107.