Most people here don’t have health insurance; several don’t even know what it means. One person I talked to said that American Samoans don’t need it, since their families ARE their insurance.
Since coming here I’ve understood what he meant. Family is very important here- what affects you affects the rest of your family as well. There is no sense of a nuclear family- a household is not only made up of parents and their children, but of parents, children, grandparents, aunts, uncles, and several cousins. You are not necessarily even raised by your parents; I wouldn’t be surprised if the phrase “it takes a village to raise a child” originated here.
As a part of my research we are solely surveying mothers of infants on their feeding behaviors. This eligibility criterion is probably the biggest source of missing babies in our study, since the person coming in with the baby is often a grandmother, aunt, or sibling. Since some of our questions are about the pregnancy and breastfeeding, we can’t include these other caregivers.
Adoption is also very common here, but not in the way we are familiar with in the United States. Siblings and cousins often adopt each other’s babies, and there are times in which blood siblings are raised by different family members. Families being as fluid as they are, everyone ends up being your sister, brother, cousin, aunt or uncle, even if it’s not biologically true.
In one story we heard, there was a woman and her husband who really wanted children but couldn’t seem to bear any. The husband’s extended family called together a family emergency, and the husband’s brother and sister-in-law volunteered to have the couple’s first child. A few years later, the husband’s other brother and sister-in-law volunteered to have his second. The reason they volunteered? The woman was “meant to be a mother”. Even though the two girls are biologically the husband’s nieces, there is no question in the family’s mind that these two are the couple’s daughters.
Another example of the value of one’s family is the concept of fa’alavelave, monetary donations to family members. Whenever a family member is born, is sick, graduates school, or dies, the rest of the family is expected to donate significant amounts of money to the person in question. However, these expenses add up- since “family” is almost a small community, there are often contributions that need to be made. In return, you expect the same charitable spirit if anything happens to you. Being a part of a family turns into a small-scale health insurance plan.
While this is a great system for some of the islanders, fa’alavelave is starting to create some problems for others, especially the younger generations. The donations that need to be made are quite a large part of an individual’s salary, and are sometimes for occasions that are of no consequence to you- a grandmother’s sister’s death in California for example (in the most loose sense of “grandmother” and “sister”). Other times there are no donations for an occasion much more important to you, like paying for your college education off-island (these donations seem to become less mandatory once you leave the island, but then again, so do your returns). Concerns about fa’alavelave include pressure to participate and restricting economic movement, and while you have some say over your health insurance plan, you have no choice in your familial obligations.
Despite the issues that arise from this system in American Samoa, the strong sense of family is something to be commended and to be learned from. As my time in American Samoa draws to an end, I’ve been told by my co-worker’s family that if I were ever to return their home is my home, since I am a part of their family now (without the pressure of fa’alavelave, of course). And knowing how much they value family, this is an honor.