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Applying a Feminist Approach to Health and Human Rights Research in Malawi: A Study of Violence in the Lives of Female Domestic Workers

Mkandawire-Valhmu, Lucy PhD, RN; Stevens, Patricia E. PhD, RN, FAAN

doi: 10.1097/01.ANS.0000300178.25983.e1
Article

In this study, we responded to the human rights challenges posed in Malawi by burgeoning poverty, rapid urbanization, lack of employment opportunity for women, and AIDS-related morbidity and mortality as they affect young women in domestic service. Through focus groups and individual interviews with 48 female domestic workers, we examined violence from a postcolonial feminist perspective. In this article, we tell the story of how we operationalized our feminist science and forged relationships with Malawian women to identify the jeopardy they face and make steps toward an emancipatory change. We highlight substantive findings, but direct our focus to methodology, theoretical grounding, and implications for nursing research undertaken with vulnerable populations in the Third World.

The College of Nursing, University of Wisconsin–Milwaukee.

Corresponding Author: Lucy Mkandawire-Valhmu, PhD, RN, College of Nursing, University of Wisconsin–Milwaukee, PO Box 413, Milwaukee, WI 53201 (mkandawi@uwm.edu).

This study was supported by the Compton Foundation (Compton Peace Fellowship); University of Wisconsin-Madison, School of Nursing, The Eckburg Scholarship for Dissertation Research; the Graduate School, University of Wisconsin–Madison (Vilas Travel Grant); Nurses Foundation of Wisconsin; Sigma Theta Tau International, Beta Eta Chapter; and the University of Wisconsin–Madison, Global Studies program (The Scott Kloeck Jenson Travel Grant). The authors are grateful to the women who took out time to participate in the study. The authors are also thankful to Dr Rachel Rodriguez and Dr Keiko Nemoto-Vandeberg for their assistance in the development of the study.

This article was presented in the form of an oral presentation at the 31st annual research conference of the Midwest Nursing Research Society held in Omaha, Nebraska, March 2007.

POVERTY is an intransigent problem in Malawi, a small, landlocked country in Southeast Africa with a population of approximately 12.5 million.1 A decade ago, the National Economic Council estimated that 65% of the Malawian population was living in poverty.2 In recent years, the economic crisis has only grown worse. The United Nations Development Program's Human Development Index now ranks Malawi as one of the very poorest countries in the world, marked by deep income inequality with the richest 20% of the population consuming more than 56% of all goods and services, and the poorest 20% consuming only 5%.3 Malawi has limited manufacturing opportunities resulting in low demand for wage employment. Its agricultural production is vital to the economy of this mostly rural country, but earnings from agricultural exports and income from migrant work have also been decreasing.4 Meanwhile, the AIDS pandemic has taken a tremendous toll. Overall, HIV prevalence is 11.8%, higher among women than among men (13.3% vs 10.2%).5 AIDS and factors related to it have resulted in life expectancy at birth dropping below 38 years for both women and men in Malawi.3 Given burgeoning rural unemployment, lack of opportunity for employment in the formal sector, and rising AIDS-related morbidity and mortality, many young women are migrating to urban areas of the country and taking on a common form of gendered labor in the informal sector-–domestic work.

In Malawi, domestic work consists of every aspect of childcare from waking the children up to putting them to bed; washing by hands and ironing the household's dirty clothes; cooking the meals—if there is no stove, this would involve cooking over an open fire; dusting the furniture, and sweeping and mopping cement floors daily. For this work, participants in this study were given room and board and, on average, the equivalent of $10 a month.

Domestic work usually requires that the domestic worker live in the home of the employer. The context of poverty, and women's relative lack of power in relation to men in Malawi, combined with the potential for exploitation and abuse created by the living and working conditions of domestic labor, place young women in domestic service at risk for ongoing emotional, physical, and sexual violence, especially because there is no oversight or regulation of domestic work and no occupational protection for domestic workers. At this nexus of poverty, gender inequity, and potential for violence, there is an urgent need for health and human rights research,6,7 the kind of research that shifts the focus from questions of individual behavior to matters of social justice.8

While conventional modes of inquiry are still useful, it is also the case that what is needed are new, critical forms of participatory research about women's health and safety that promote and protect human rights.9,10 By critical, participatory research, we mean studies in which (a) health is conceptualized as historically situated in social relations of power, (b) research questions arise from and in the interests of those who face the greatest vulnerability, (c) methods themselves are potentially empowering, and (d) emancipatory change in oppressive conditions is sought.11–13

In this study, we responded to the human rights challenges posed by domestic work in Malawi by applying a feminist approach to the study of violence in the lives of female domestic workers. Feminist research is an excellent fit for analysis of health and human rights in diverse real-life settings because of its deep regard for women's experiences, its emphasis on exploring power relations and larger societal structures to understand how they might pose jeopardy for women, and its action imperative to involve women themselves in making change for the better in their situations.14 In particular, our approach was informed by a postcolonial feminist perspective.15–17 In this article, we tell the story of how we operationalized our feminist science and forged relationships with Malawian women to identify the jeopardy they face and make steps toward emancipatory change. We highlight substantive findings, with details available elsewhere (unpublished data, 2007), but direct our focus to methodology, theoretical grounding, and implications for nursing research undertaken with vulnerable populations in the Third World.

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POSTCOLONIAL FEMINISM

Today, nursing research among Third World peoples is increasingly conducted, both by indigenous investigators and by Westerners. It is important that we identify and understand the issues involved in this type of research and researcher-researched relationship.18 When we speak of Third World peoples, we mean those who live in low-resource environments, that is, postcolonial developing countries like Malawi. The Third World is not bound by national borders; however, it also exists for those who have witnessed but been excluded from the benefits and opportunities of modern capitalist states.19 In the United States, for instance, many women of color are burdened by poverty, racism, and gender oppression so severe as to pose challenges similar to their counterparts in developing countries.20 Our understanding of Third World women also includes the recognition that such women are not homogeneous, and an indigenous researcher among them may differ considerably because of education and class.

For decades, feminist scholars have challenged conventional research in its failure to take into account the power relations inherent in the research process and its purporting of the researcher as imparter of truth. A feminist approach, in general, emphasizes power relations and issues of partiality and positionality of the knower and the known.21,22 A postcolonial feminist approach, in particular, situates examination of gendered power relations' effects on social structures and social interactions within a larger critique of the status quo. As Reimer Kirkham and Browne suggest:

Post colonialism is inherently concerned with social justice, often on a grand scale that encompasses national power struggles, oppressions, diasporas, and globalization. The goal is not only to illuminate these wider sociopolitical and global issues but also to situate individual experiences, and the conditions, policies, and practices that shape those experiences, within these wider contexts.23 (p334)

As Third World women, the participants in this study experienced oppression that was related not only to gender and class but also to race and the legacy of imperialism.24 Consequently, in our analysis, we explored the implications of imperialism and Western influence and how they may have contributed to the violence experienced by female domestic workers in Malawi. We were sensitized by a persuasive literature demonstrating that the feminization of poverty in sub-Saharan Africa has been exacerbated over the last several decades by imperialist economic policies of Western Euro-American–dominated organizations, prominently the International Monetary Fund and the World Bank.25–27

Central tenets from a feminist perspective identify that men, as a social group, have greater access to resources and hegemonic authority, and across the globe exercise oppressive power over women in the policies and practices of institutionalized structures and in the day-to-day interactions conducted within human relationships.28 Such a perspective is helpful in contextualizing inquiry about female domestic workers as it acknowledges patriarchy as a factor at both the macro level and the micro level. The idea of contextualizing women's lives within the broader sociopolitical environment and identifying the broader oppressions within that environment is especially important to postcolonial feminists. By understanding the context in which women experience violence, we avoid what Uma Narayan29 refers to as “death by culture” wherein we simply offer a cultural explanation for the problems faced by Third World women and thus serve to promote stereotypes and adopt standards that all women are to conform to, failing which, their culture and identity are seen as being the cause of their detriment.

Adopting a postcolonial feminist perspective for this study also enabled us to acknowledge women's strengths and capacities to change their own circumstances for the better.30 Consequently, as researchers, we saw ourselves not as liberators of the participants we were concerned about, but as facilitators of dialogue among them about the circumstances of their lives. From such dialogue can be born conscienticized political action by and for women.31,32 We saw the female domestic workers who participated in our study not as victims, but as survivors of violence who prevailed in spite of the limited resources and services available to help them.28

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DESCRIPTION OF THE STUDY

Overview

The study triangulated focus groups and in-depth individual interviews. It was conducted over a period of 6 months in 2005 in the city of Blantyre, Malawi, and involved a total of 48 women participants. All data were collected by the first author. She is a Malawian woman and a nurse educated at the doctoral level who is fluent in both English and Chichewa, the official languages of Malawi. The purposes of the study were (a) to explore the experiences of employer-perpetrated violence as described by Malawian female domestic workers, and (b) with these domestic workers begin to dialogue about their needs and interests in social change. Research questions included the following:

  1. How do Malawian women view their own experiences of working in domestic service?
  2. What are the socioeconomic and political forces that pull women into domestic work?
  3. What are the help-seeking dynamics of domestic workers who experience violence from their employers?
  4. What are the health implications of employer-perpetrated violence against women employed in domestic service?
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Sample

Recruitment took place at a governmental agency and at a nongovernmental agency, both of which assisted women in acquiring employment in domestic service. Over several days at each facility, the first author approached every young woman who came seeking assistance in finding domestic employment. She explained the study and indicated that women volunteers were being sought who were between the age of 17 years and 25 years, and who had been employed as domestic workers within the past year, but were not currently employed in this kind of position. All those who met eligibility criteria were invited to participate.

The sample of 48 participants had an average age of 21 years. All, raised in rural Malawi, had migrated to the city in search of employment. Ninety percent of the women were Christian; 10% were Muslim. On average, they had attended 7 1/2 years of school. While one woman had never attended school, the rest had to stop going to school before completing enough education to make them competitive in the formal job market. Most of the women dropped out at the primary school level (n = 36), while some dropped out at the secondary school level (n = 11). More than half of the sample (n = 27) had lost at least 1 parent. Nineteen percent (n = 9) had lost both parents. Marital status varied: 40% (n = 19) were never married, 13% (n = 6) were currently married, 46% (n = 22) had left their husbands, and 1 was widowed.

This sample of women did not differ greatly from the general population of Malawi. Muslims make up 12.8% of the population; Christians 79.9%.33 Median age at first marriage for Malawian women is 18 years. Only 57.4% of Malawian females younger than 18 years live with both parents.34 Furthermore, it is estimated that in Malawi, 17.5% of children younger than 15 years have lost 1 or both parents, about half of them because of AIDS.35 In terms of educational levels, the women who participated in this study fared somewhat better than Malawian women taken as a whole. One in 4 Malawian women has never attended school. Only 1 in 10 women has had some secondary school education.34

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Data collection

Data collection took place at the agencies where recruitment had occurred. Six focus groups of 2 hours duration were conducted; 5 groups had 6 participants each, and 1 group had 8 participants. Individual interviews lasting approximately 1 hour were carried out with an additional 10 women who were not in the focus groups. All focus groups and interviews were conducted in Chichewa and tape recorded for later transcription. All procedures were approved by the appropriate protection of human subjects committees in the United States and in Malawi.

Focus groups and individual interviews were triangulated in an attempt to elicit a rich set of data. The advantages of using focus groups for data collection include the possibility that participants might be prompted to remember more by hearing other women's stories. They might also feel supported by each other and therefore be more willing to disclose.36 While there are drawbacks of using focus groups, such as the risk for group thinking, domination by a subset of members, and potential breaches in confidentiality, focus groups have been found to be effective sites for imagining emancipatory political possibilities and collective action, especially within marginalized communities,37 making them well-suited to our feminist purposes. The advantages of individual interviews include the possibility that participants might feel more comfortable with the privacy afforded by a one-to-one conversation, and that the interviewer might be able to connect more directly with individuals and probe more specifically for detail.38 A central problem in cross-sectional interview designs, however, is that adequate rapport may not be able to be established for in-depth disclosure.

An open-ended interview guide designed around the research questions was used to facilitate both data-collection methods beginning with general, nonthreatening topics related to their work in employers' homes. As women talked and gained increasing ease in sharing their experiences, more specific and direct questions about violence were posed.39 For example, the topic of violence was broached with a question like “Some women that I have talked with have spoken about experiencing violence from their employers when they worked as domestic workers. Is this something that you have heard about?” Gradually, women were asked if they themselves had experienced any violence from their employers and what that had been like for them. Probes tailored to the ensuing conversation were used to encourage depth and detail of description.

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Data analysis

The first author transcribed the tapes in Chichewa, later translating the transcripts into English. Following the first 2 focus groups, a preliminary analysis was conducted. On the basis of this analysis, the interview guide was revised. For example, a preliminary theme that emerged was about “feeling like a slave” by virtue of how they were treated by their employers. A question was added for subsequent focus groups and interviews that inquired as to how women viewed themselves from within their domestic-worker role.

Overall, data were read several times and patterns and themes were linked together. More specifically, the data were coded using the 3 levels of analysis described by Schensul et al.38 The first level involved identifying discrete and concrete units of information. The second level involved identifying collections of units and categories of units that fit together or were related to one another. The third level involved differentiating and defining patterns and relationships among patterns to build a cultural portrayal explaining phenomena. Methodological and substantive consultation was accessed in Malawi and in the United States throughout the analysis period.

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Findings

Detailed findings of the study are available elsewhere (unpublished data, 2007) but a summary is offered here. A trajectory of life events was common in this sample of Malawian female domestic workers. They were born to poor families, and because they were girls, education for them was not prioritized for investment of meager family resources. Lack of formal education, combined in many cases with parental death, forced early marriage for some, and job seeking in the city for others. Their conversations revealed that too often the marriages they entered into brought them physical abuse from violent husbands and risks for contracting HIV from husbands who engaged in unprotected sex outside the marriage. The majority of those who had married escaped these harms by leaving their husbands. Separation, however, left them in poverty. Thus, their acts of resistance propelled them to the city in search of employment to support themselves and their children.

In all cases, the women who participated in this study were not able to gain formal positions in the labor sector. And, so they strove to obtain what employment they could as domestic workers in other families' homes. Domestic service provided the women with subsistence income, which they desperately needed, but they had to endure many hardships. Included in their accounts were sexual harassment and abuse from male employers, verbal abuse from employers and employers' family members, physical abuse in the form of beatings or slapping, overwork, food deprivation, withholding of pay, not being allowed to go to worship, and isolation from family and community. While not openly defying their employers, they asserted themselves in these demeaning and dangerous situations by reminding themselves over and over again of their self-worth. They also focused on their hopes and plans for the future—being able to leave domestic service and start a business of their own. And, they clung to their faith in a god for whom all things were possible. Because they were in the city far away from families in the country, they drew support from those who were available. They sought out other domestic workers, male and female, in the household and in the neighborhood who could share their wisdom about how to stay and when to get out. The agency of these individual women is apparent, because each of them survived to leave former employers who treated them poorly. At the time of the study, each was seeking better employment opportunities, albeit in domestic work, but with a consciousness of what had happened to them and a willingness to talk about it.

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OPERATIONALIZING A POSTCOLONIAL FEMINIST APPROACH

Safety

A feminist view of the world prioritizes women's safety. In the design and conduct of this study, ensuring safety was critical because we were engaging with women who were vulnerable to violence.40 Data-collection sites were limited to locations where women would naturally go if they were seeking employment as domestic workers, not where they might go to seek help because they were being abused or because they wanted to report problems with their employers. Some might argue that the study could have been more credible had women been recruited directly from the community. Yet such an endeavor might have placed women at greater risk in relation to confidentiality and retaliation, as it would then have been more apparent that they were interested in and initiating action to participate in an investigation about their employment. From a feminist perspective, the safety of the participants outweighed the need to collect data that might have been more representative.

The women who participated had been employed in domestic service jobs in the past, so they could speak to those employment experiences; however, they were unemployed at the time of the study. The purpose for recruiting young women who were not currently employed as domestic workers was to protect them from potential abuse from employers who might have inflicted further harm if they had become aware of the women's participation in a study like ours. Here again, a feminist perspective guided us to value the safety of the participants above any endeavor to enrich the currency of data by including women who were at the time of the study under the purview of an employer.

Verbal informed consent was chosen rather than written informed consent not only because participants had limited formal education but also because a signature posed risk for identification. Likewise, no participant was given a paper copy of the consent form as the form could then have been found by someone else, who might thus have been made aware that the participant had experienced violence and/or had participated in a study in which she disclosed information about violence. In retrospect, a more egalitarian approach might have been to offer a paper copy and allow participants to decide whether or not to take it, but that might have affected power relations to the detriment of the study, as we go on to discuss.

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Power

For women with limited formal education and, therefore, limited ability to read and write, the very act of reading or writing in front of them serves to emphasize the power differential between them and the researcher. Taking into account the adult literacy of Malawian women, which stands at 54%,41 reading and writing in Malawi is a privilege not available to many. Other researchers and activists working with low-income women with limited formal education have found that their use of pen and paper made the women they were working with uncomfortable. Yunus,42 for example, described his interactions with women in Bangladesh. In his Nobel Peace Prize–winning efforts to encourage women to participate in microlending projects, he never used a pen or notepad on initial visits for fear of scaring women away. It was only in subsequent visits, after women had gained some skills in negotiating for their needs, that Yunus allowed himself written materials in their presence.

With these power issues in mind, informed consent was obtained through conversations with the women rather than by reading a consent form to them. All the elements of consent were addressed in these conversations, and participants were clearly made aware that this was a study about violence. Likewise, during data collection, a written interview guide was not conspicuous. Structured questions were not read to the women. Rather, conversational questions were posed in line with the guide.

While the first author made these efforts and others liked it to minimize symbols of power, such as dressing in everyday Malawian apparel, use of equipment (tape recorder) necessary for effective data documentation could not be avoided. Furthermore, the very presence of the researcher and the act of conducting research in the agencies where women sought employment assistance was out of the ordinary.

Focus group methodology was chosen with the view that it might help balance power between the researcher and participants.43,44 At the outset of the first focus group, the researcher seated herself in a chair, inviting participants to do the same. But the women sat on the floor, so the researcher quickly joined them. Together on the floor, they formed a circle in which the women faced each other. This seating was adopted for the rest of the groups. In response to the topics introduced, it was the women in the groups who developed the conversations that ensued. They encouraged each other to talk by rephrasing questions and by posing questions of their own. For example, women repeatedly brought up their concerns about the problem of HIV and its implications for their lives, situating it within the socioeconomic and political forces that pulled them into domestic work in the first place, as well as within the context of sexual violence in domestic service. While the researcher did not elicit these stories about HIV, they became central to the findings.

Throughout the data-collection phase, focus groups proved to be forums for the women to discuss personal issues and painful episodes, many of which they said they had never discussed with anyone before. A process of solidarity-building was initiated in the short time when participants interacted together, suggesting that the creation of structures that would facilitate Malawian women coming together to share common experiences might have transformative power for improving domestic workers' lives. These outcomes also verify the importance across cultures and across countries of women's group work in combating violence against women.45

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Disclosure in solidarity

Individual interviews were incorporated into the design because the literature suggests that their use allows for deeper exploration of specific topics.38 We anticipated that individual interview participants would be more likely to disclose sensitive details about their experiences than would focus group participants. Our findings ran contrary to this. Women in the focus groups disclosed in greater depth and detail about personal experiences than women in the individual interviews. The latter rarely elaborated. For example, participants in the focus groups initiated discussions about sexual abuse perpetrated by male employers, whereas participants in the individual interviews asserted the existence of this problem, but upon probing found it difficult to continue with the conversation.

We believe that the focus group participants might have felt more comfortable interacting with one another as opposed to the researcher, and that this contributed to the richness of data from these forums. Their contributions during the groups indicated that they identified with the situations of violence being discussed. They pointed out commonalities of experience, and offered support and validation to one another—all positive interactional dynamics that were not possible in individual interviews.

Women in the focus groups also used storytelling and humor to talk with each other about difficult topics and to reveal important information to the researcher. They built on each other's stories providing validation of what was being said, and they laughed together to take the edge off painful experiences they were relating. The use of humor and laughter in focus groups can have positive effect by building solidarity and enabling participants to more comfortably disclose their experiences.46

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Strengths and transformative possibilities

A focus on women's strengths is of value to feminist researchers because they investigate problems women face. Also, at the heart of feminist research is the understanding that the researcher is not the liberator of those she is studying. Rather, a feminist research process can facilitate political action by women themselves.32 This praxis principle guided data collection, and became very apparent in data analysis. Participants' discussions revealed their capacities to change their own circumstances for the better. As our summary of findings suggests, these women were clearly agents in their own survival as opposed to victims. They resisted violence in spite of the limited resources and services available to them in Malawi. Our findings ended up being less about the oppressive power of violence and more about how women prevailed against it (unpublished data, 2007).

A feminist openness to the needs that women expressed moved us to the goal of social action.16,28,47 Participants in this research were unable to identify structures, policies, or formal services in Malawi that helped them when they were experiencing violence at the hands of husbands or employers. Learning of the findings from this study, a group of women living in the region of Malawi where the study was conducted mobilized to approach the first author and request her assistance in developing a shelter for abused women and girls. Domestic violence shelters are relatively few in Malawi. At the time of the study, there were no domestic violence shelters in the city of Blantyre. The first author communicated the women's request to her collaborators in the United States. Additional travel to Malawi ensued in which further discussion with the women took place. Upon returning to the United States, fund-raising activities have been carried out with the help of various feminists and scholars. We are happy to report that plans for building a structure to provide emergency shelter and safety to women and girls in Blantyre are under way.

Transformative possibilities suggested by findings from this study go beyond action to provide shelter services to abused women and girls in Malawi. Efforts of many sorts might be mounted to promote Malawian women's civil rights, mobility, bodily integrity, access to education, and substantive equality in the workplace that could have direct effects on increasing the health and safety of women like the domestic workers who participated in this study. For instance, participants' hopes and dreams about being able to leave domestic service and become proprietors of their own businesses might be brought to fruition through interventions that make micro loans more available to low-income Malawian women, education in the trades, and other resources necessary for starting and sustaining women-run businesses and cooperatives.

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CHALLENGES OF DOING POSTCOLONIAL FEMINIST RESEARCH

Reflexivity

The challenges of applying a postcolonial feminist approach in this study arose for the most part from the need to engage in reflexivity as researchers.32 Reflexivity from a feminist perspective involves acknowledging one's own values and biases,28 and analyzing the constructs of power and privilege at work in society to see how they affect one's scholarship and activism.19 Ultimately, the researcher must examine her power in relation to the power of those participating in the research.47

Even though she is a Third World woman, the first author had to reflect on her own knowledge as situated in the context of having been educated in the West. So, while others might view her as an insider to this research by virtue of being a Malawian woman, she was also an outsider. Unlike the participants, she possessed a high level of education and enjoyed upper-middle-class status. She also had the ability to do research and write about other women's lives. The participants, on the other hand, were not only from more challenging socioeconomic circumstances, but also had been employed and had experienced oppression at the hands of people much like the first author, that is, upper–middle-class Malawians.

It is not easy or comfortable to reflect authentically on one's position in relation to participants, particularly when taking into account the realities of societal privilege and power. The process of reflexivity is further complicated by the very structures of research, which so often distance researcher from researched. Yet by acknowledging our positionality, we become part of rather than separate from the knowledge we are creating with participants. Haraway48 asserted it is in naming one's location that a researcher moves closer to those she is attempting to study.

As a Malawian woman, the first author did have insight into the lives of the participants that a Western feminist researcher might not have. For example, when participants narrated their fears in relation to being exposed to HIV infection, both from their husbands and from their male employers, they did not use the terms HIV or AIDS in their conversations. Rather, they used euphemisms such as “the disease” or “this disease that is common these days.” This indirect way of referring to HIV and AIDS is common among most Malawians because of the fear and stigma that direct references provoke. Having been socialized in Malawi, the first author understood this argot. She refrained from saying HIV or AIDS directly as well, using instead the terms participants used, which seemed to contribute to an ease of interaction about the topic.

The first author's fluency in the language spoken by participants was an obvious advantage as well, lending credibility to the findings.49 Mentorship from the second author, a Western feminist researcher, helped clarify issues of power and reflexivity, and provided guidance in theoretical grounding and writing. The exchange of ideas and learning that continues to take place between us can only serve to Malawian women's lives better as we work together with them to develop the resources and support they are asking for.

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Compensation

Because participants were unemployed at the time of the study, and because income in Malawi is so wanting for women, much consideration and debate went into making a decision about compensation for research participation. On the one hand, we wanted to compensate the women for their time and efforts in contributing valuable knowledge. On the other hand, given their socioeconomic status, almost any form of compensation, no matter how small in relation to US dollars and cents, whether monetary or material, could potentially coerce participation. Ultimately, we settled on giving each participant a box of crayons for her children or younger siblings. Our view was that a box of crayons was not such a highly desirable gift as to compel a young woman to participate in the study if she did not want to, yet still a gift she might appreciate. We reasoned it was not a gift for her, but for the children in her life. Also, participants only became aware during the informed consent conversation that they would receive the gift, making us more confident that they voluntarily agreed to learn about the study because of their interest and not because of a desire to obtain the crayons.

It is important to note, however, that none of the women eligible to participate in the study declined participation when invited. As feminist researchers, we had to entertain the notion that women might have felt obligated to participate because of the authority represented by the researcher. The question becomes whether women truly believe that there are no repercussions to a decision to refuse research participation, even when it is emphasized that they will not be penalized. Ongoing dialogue among researchers and various stakeholders is needed in relation to compensation, informed consent, and how to fully protect and promote the human rights of Third World women in the context of research.50

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Confidentiality

Confidentiality is a challenge with the use of focus groups in any context. While this methodology was an asset to the study, the sensitive nature of what was to be discussed caused us some trepidation. While it was emphasized to participants that particular details discussed in the groups were not to be shared with others, it could not be guaranteed that participants would maintain strict confidentiality. But, because participants did not necessarily have personal relationships with one another before participating in the study, our concerns about confidentiality were alleviated to some degree. It was unlikely that individuals shared the same network of family and friends. Furthermore, we thought it important to trust the women and to have them trust each other to share their burdens without placing one another at risk by breaking confidentiality.

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IMPLICATIONS FOR NURSING SCIENCE

As nurse researchers engage more and more in the international arena, a postcolonial feminist perspective is instrumental. Systemic injustice apparent in the realities of poverty, racism, subjugation of women, environmental degradation, and exploitation of Third World peoples must be the purview of nursing research and collective action for change.23 It is imperative that nurse researchers develop expertise about globalization and its multiple and complex ramifications for health and human rights. If nursing research is to make a difference in today's world, we must make the details of international trade agreements, development assistance, debt relief, and other macroeconomic policies part of our basic disciplinary knowledge base. Nurses need to be investigating at home and abroad the health effects on local subpopulations of broader phenomena such as destabilization of agricultural societies, rapid urbanization, civil war and regional conflict, strident nationalism, privatization of government assets and obligations, and erosion of safety net services like social welfare, public education, and public health infrastructure.

Consciousness of our position as researchers is integral to the conduct of research. Whether we wish to or not, those of us who are Western represent the wealthy and powerful industrialized countries of North America and Western Europe which, in modern times, have dominated other nations in global policy and economic contexts. We carry with us a collective history of imposing Western values and conceptions of God, democracy, science, and corporate profit. It is incumbent upon nurse researchers in these privileged positions to critique past colonial practices that have created severe, sometimes catastrophic, economic, political, and health disparities between West and East, North and South; and to resist current neocolonial policies that maintain and exacerbate these disparities.

It is important that nurse researchers avoid duplicating the paternalistic practices of modern imperialist states, which heretofore have decided the fates of women of color in developing countries without their input and collaboration.20 For nurses who engage in international research, particularly those who work with and for Third World women, realizing that women themselves are the most knowledgeable parties about their own circumstances is essential for facilitating health and human rights. According them due respect as capable agents in their own lives challenges Western assumptions about their confinement to oppressive familial and cultural space.30 Yet, we can have a place in helping design programs and policies that alleviate suffering and protect women and girls. As Meredeth Turshen51 (pxxiv) writes about African women, “Let us remember, even strong backs need support.”

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Keywords:

domestic work; feminist research; health; human rights; Malawi; Malawian women; postcolonial; violence

© 2007 Lippincott Williams & Wilkins, Inc.