A ketubah is handed over, kept in the house and produced only rarely, which makes it the ideal surface for decoration in a tradition cautious about images elsewhere. Illuminated examples survive in quantity from Italy, where the seventeenth and eighteenth century Venetian, Roman and Anconan workshops produced architectural borders, zodiac cycles, biblical scenes and elaborate papercut frames; from the Netherlands; from Iran, where the style is entirely different and the borders are floral and calligraphic; and from the Jewish communities of Cochin and Calcutta. European illuminated examples survive from the medieval period as well, and the workshops that produced them were often the same hands that decorated other communal documents.
The modern practice is a straightforward continuation. Ketubot are commissioned from calligraphers and artists, hung on the wall of the home rather than filed, and constitute a small but genuine contemporary craft market.
The text has moved too. The Conservative movement added the Lieberman clause in the 1950s, a provision submitting a future divorce to a rabbinical court, intended to address the position of a woman whose husband will not give a religious divorce. Reform and other liberal communities use reworded, mutual and egalitarian texts, often alongside or in place of the Aramaic, and same-sex ketubot are written in those communities. The traditional Aramaic form continues unchanged where it is used.