FIELD NOTES ogynecology Journal, 20(1), 33-37. ing it to take much longer to analyze than study. Therefore, reliability and accountabil- 8. Bhattacherjee, S., Datta, S., Saha, J. B., & anticipated. ity are essential to carrying out international Chakraborty, M. (2013). Maternal health care ser- vices utilization in tea gardens of Darjeeling, India. projects with a sensitive nature such as the Journal of Basic and Clinical Reproductive Scienc- FIELD NOTES Tool Discrepancies studies mentioned in this article. Conse- es, 2(2), 77. 9. Chakrabarti, A., & Chaudhuri, K. (2007). Antenatal The last major issue that arose was due to quently, working with partnering organiza- and maternal health care utilization: evidence from discrepancies and difficulties in inquiry about tions that not only have a reputable name but northeastern states of India. Applied Economics, 39(6), 683-695. sensitive issues with the interview tools. In the also have been recommended by other indi- 10. Singh, P. K., & Singh, L. (2013). Examining inter-gen- Mali study, there were issues when develop- viduals within their own country is essential erational differentials in maternal health care The Health Needs of the Fa’afafine service utilization: insights from the Indian demo- ing the interview tool due to the sensitivity of to the success of a study. graphic and health survey. Journal of biosocial sci- the inquired information. The main concern ence, 1-20. 11. Kusuma, Y. S., Kumari, R., & Kaushal, S. (2013). Migra- and comment made by the Malian IRB was Conclusion tion and access to maternal healthcare: determi- in American Samoa and Transgender how we were determined to inquire about in- This article provided an overview of two nants of adequate antenatal care and institutional delivery among socio economically disadvantaged cidences of sexual assault among these wom- reproductive health research studies previ- migrants in Delhi, India. Tropical Medicine & Inter- en and the inappropriateness of asking about ously conducted by the author in Mali and national Health, 18(10), 1202-1210. 12. Navaneetham, K., & Dharmalingam, A. (2002). Uti- Research Methodology such subject matters. This was also one of the India and the lessons learned. The author lization of maternal health care services in South- main reasons we had much difficulty obtain- chose both of these studies as they provide ern India. Social Science & Medicine, 55(10), 1849- 1869. Robert Carney ing IRB approval in Mali. In the India study, ideal examples of methodological challenges 13. Singh, L., Rai, R. K., & Singh, P. K. (2012). Assessing Rutgers University School of Public Health. Newark, NJ. USA. many members of the research team who de- international researchers may face. Some of the utilization of maternal and child health care among married adolescent women: evidence from veloped the interview tools were unsure what the lessons learned from these studies were: India. Journal of biosocial science, 44(1), 1-26. Since the early years of anthropological ethnography, the Samoan third gender community, fa’afafine, has the real expectations of the study were. The 1) provide direct emphasis of the study pro- 14. Mahapatro, S. R. (2012). Utilization of maternal and child health care services in India: does women’s been the subject of research about theories and etiologies of gender and gender behavior. However, few studies questions were extremely broad and had no tocol and the specific timeline to all individ- autonomy matter?. The Journal of Family Welfare, have assessed their health needs. Without the necessary data, solutions to health problems in the fa’afafine com- real direction. uals working on the study; 2) to obtain both 58(1): 22-33. munity are unclear. This paper seeks to discuss this issue and offer suggestions for how research can be designed 15. Mistry, R., Galal, O., & Lu, M. (2009). Women’s au- written and oral agreements from all the part- tonomy and pregnancy care in rural India: A con- to better assess fa’afafine health needs. Future considerations ner organizations to abide by the protocol; 3) textual analysis. Social Science & Medicine, 69(6), First, this article will review current research on fa’afafine communities, highlighting how many method- 926-933. A major future consideration for re- to ensure the study tools are approved for use ologies carry ethnocentric bias and focus on etiology instead of the health data needed to create interventions 16. Department of Health & Human Service. (2014). for the community. Second, this article will discuss the health needs that arise from the cultural context of the searchers who wish to conduct studies in low by all stakeholders; 4) to ensure adequate re- Global Programs & Initiatives: Strategy Objec- tives. Retrieved from http://www.globalhealth. fa’afafine with a focus on violence, HIV and sexual health, institutional recognition of gender variance and ma- and lower-middle income countries which sources are available for use prior to begin- gov/global-programs-and-initiatives/glob- ternal and child health. Finally, suggestions will be provided for a third gender affirmative methodology that is focus on reproductive health is allowing am- ning of data collection; and 5) to provide al-health-strategy/strategy-objectives/#7 17. White, D., Dynes, M., Rubardt, M., Sissoko, K., & Ste- inclusive of fa’afafine but also applicable to other gender variant communities globally. These recommendations ple time to conduct such in-depth studies. adequate trainings to all interviewers and phenson, R. (2013). The Influence of Intrafamilial include (1) structuring research appropriately to explore variation in these groups, (2) restructuring gender There are many components that need to personnel who will be interacting and work- Power on Maternal Health Care in Mali: Perspec- tives of Women, Men And Mothers-in-Law. Inter- variables, (3) conducting community-guided and community-serving research, (4) considering historical di- be considered and accomplished before data ing with study participants. This being said, national perspectives on sexual and reproductive mensions of fa’afafine, gender variant and transgender marginalization and (5) including gender variant health collection can begin. Therefore, planning for qualitative research is essential to understand- health, 58-68. issues in women’s health practices. 18. Bove, R. M., Vala-Haynes, E., & Valeggia, C. R. (2012). delays in the execution of data collection will ing reproductive health-seeking behaviors in Women’s health in urban Mali: Social predictors This paper was written based on a review of secondary sources as well as the author’s field notes and obser- benefit study investigators. Revisions of the women in low and lower-middle income and health itineraries. Social science & medi- vations as a professional working on a project in the Department of Obstetrics and Gynecology at the Lyndon cine,75(8), 1392-1399. interview tools may also need to be consid- countries. As one of the two studies detailed 19. Godha, D., Hotchkiss, D. R., & Gage, A. J. (2013). B. Johnson Tropical Medical Center in Tutuila, American Samoa. ered due to the sensitive nature of the ques- in this paper was unable to be carried out as Association Between Child Marriage and Repro- ductive Health Outcomes and Service Utilization: tions that may be asked. If researchers are a result of several of these challenges, utiliz- A Multi-Country Study From South Asia. Journal of Introduction Terminology able to pilot the interview instrument, it will ing the lessons learned from this study and Adolescent Health, 52(5), 552-558. There have been many anthropological studies examining the cul- It should be noted that this article uses the term gender variant to 20. Coombes, R. (2004). Supporting surgery for obstet- benefit them in the long run, as it will allow remembering that communication is crucial ric fistula. BMJ, 329(7475), 1125. tural and social contexts of the fa’afafine since initial ethnographies in describe communities, identities and behavior that do not fit binary for study investigators to determine the na- to the success of any international study, and 21. Wall, L. L. (2006). Obstetric vesicovaginal fistula as the 1930s. In Samoan culture, there are three distinct genders, man, understandings of gender. Gender variance is a broader term that is an international public-health problem. The Lan- ture of the responses that they may obtain. study investigators in the future will be en- cet, 368(9542), 1201-1209. woman and fa’afafine. Commonly described as a third gender catego- more inclusive of different cultural gender identities. The term trans- Variation may occur in the types of responses abled to effectively carry out international 22. Hassan, M. A., & Ekele, B. A. (2009). Vesicovaginal ry, fa’afafine translates as, “in the manner of a woman”. It describes in- gender is used in the U.S. to define any individual that identifies as a fistula: Do the patients know the cause?. Annals of which are obtained based on different inter- public health research. African medicine, 8(2), 122-6. dividuals who are born anatomically male, but are culturally identified gender that does not match the one they were assigned by society. In viewing styles, therefore piloting the tool may 23. O’Loughlin, J. (1997). Safe motherhood: impossible as women. However, data on fa’afafine health needs and consideration Samoan culture, fa’afafine is not culturally defined in the same way as References dream or achievable reality?. The Medical Journal assist in understanding areas which may need 1. Collumbien, M., Busza, J., Cleland, J., & Campbell, of Australia, 167(11-12), 622-625. for cultural changes in recent years are lacking. transgender people are in the U.S., but transgender is often used as a improvement. O. (2012). Social science methods for research on 24. Kumar, S., Kekre, N. S., & Gopalakrishnan, G. (2007). A review of literature on health concerns of the fa’afafine reveals cross-cultural cognate both colloquially and professionally.