The Health Needs of the Fa’afafine in American Samoa and Transgender Research Methodology

Abstract

Since the early years of anthropological ethnography, the Samoan third gender community, fa’afafine, has been the subject of research about theories and etiologies of gender and gender behavior. However, few studies have assessed their health needs. Without the necessary data, solutions to health problems in the fa’afafine community are unclear. This paper seeks to discuss this issue and offer suggestions for how research can be designed to better assess fa’afafine health needs.

First, this article will review current research on fa’afafine communities, highlighting how many methodologies carry ethnocentric bias and focus on etiology instead of the health data needed to create interventions for the community. Second, this article will discuss the health needs that arise from the cultural context of the fa’afafine with a focus on violence, HIV and sexual health, institutional recognition of gender variance and maternal and child health. Finally, suggestions will be provided for a third gender affirmative methodology that is inclusive of fa’afafine but also applicable to other gender variant communities globally. These recommendations include (1) structuring research appropriately to explore variation in these groups, (2) restructuring gender variables, (3) conducting community-guided and community-serving research, (4) considering historical dimensions of fa’afafine, gender variant and transgender marginalization and (5) including gender variant health issues in women’s health practices.

This paper was written based on a review of secondary sources as well as the author’s field notes and observations as a professional working on a project in the Department of Obstetrics and Gynecology at the Lyndon B. Johnson Tropical Medical Center in Tutuila, American Samoa.