What Kind of Images are Appropriate for NGO Campaigns?

After seeing the same image on ads throughout my browser from Smile Train, I decided to quickly write the following email on September 9 assuming that they would not respond:

Smile Train,

You do great work, but please consider the removal of this picture:

It is one that takes advantage of the child who has no ability to choose if this image is used so prominently.  It also plays into the wrong emotions from your potential donors and creates a system where such images are OK to show.
Instead, why not show more pictures like this one:

A play on the name would be wonderful as you show images of smiling children because they have had surgery. Why not create hope and build a movement that is empowering rather than one which is disheartening and depressing.  You do the former so well, why not match that with the images on your site?

Thank you for your time and I wish you all the best in your efforts.

Tom Murphy

To my surprise, I got the following response the next day from Donor Relations Assistant Duncan Quirk (which he has graciously permitted me to share):

Dear Tom,

On behalf of everyone here at Smile Train and all of the children that come through our programs, thank you for your recommendation.

As much as we would love to show the beautiful smiles of the children after their surgeries in all of our advertising, our latest market research tests have shown that, presently, we do receive a higher donation response to advertisements that only feature the before pictures. In order to help more children, we have to go with what our market tests tell us.

After donations, we do send before and after pictures to show to our donors the dramatic impact that they have had on a child's life, and hopefully as we continue to conduct market research, the tides will shift and we can start advertising with the before and after pictures again. I will pass your email onto our marketing team and if you have any other questions or concerns, please don't hesitate to let me know. Thanks again.

All the best,

I followed up asking if Smile Train would be willing to share any of the market research.  Mr. Quirk replied today informing me that they will not be able to share it as they place a large amount of time, effort and resources into collecting it and would prefer not to share their market testing publicly.

After posting this to my blog, people requested to know their procedures for obtaining permission for the photographs. I emailed Mr. Quirk again and he responded by saying:

So you and your readers know, Smile Train obtains written permission for use of patient photos to spread awareness about cleft and to raise additional funds for the hundreds of thousands of children who are still waiting to get the surgery they so desperately need.

While the marketing research of Smile Train could very well be right, I am concerned about the implications in the long term.  Should the current campaign bring in revenue at the cost of associating poverty with 'doom-laden' imagery? If it is possible, it would be great to know more about such studies.  The VSO released their findings based on the media's portrayal of poverty recently called 'The Live Aid Legacy' (see a summary here). It shows how portrayals of poverty can have a significant affect on people. An example of one such finding is:

Stereotypes of deprivation and poverty, together with images of Western aid, can lead to an impression that people in the developing world are helpless victims. 74% of the British public believe that these countries "depend on the money and knowledge of the West to progress.

So, I ask, is it worth it?  Do NGOs have the opportunity to operate both ethically and successfully? Or do some sacrifices need to be made?  Should short term awareness and financial support take precedence over long term harm to education of poverty? And, at the root, is the image that Smile Train uses of the crying boy OK?

To me, it is quite simple. The image should not be used under any circumstances. However, I do not have to raise money for an organization and must recognize what that affords me in terms of this debate. There are two strong pulls going on in this discussion and how to weigh the dignity of an individual verses raising of funds, to me, should not even need a scale.