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PACEs in Maternal Health

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Nothing About Them Would Stand Out in a Crowd

Alice Kenny ·
photo credit: chuttersnap/unsplash.com By Alice M. Kenny (pseudonym) (The article below is an excerpt from my new book, Crazy Was All I Ever Knew: The Impact of Maternal Mental Illness on Kids . I have used a pseudonym to protect the privacy of family members.) The emotions adult children of parents with mental illness experience are a mixed bag. Sometimes a jumble. Guilt, loss, grief, and resentment are among the emotions that persist or bubble to the surface in adulthood. Some feel...
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NPPC shares lessons learned and results from ACEs screening pilot sites

Laurie Udesky ·
For Dr. Mercie Digangi, a pediatrician at Kaiser Southern California in Downey, CA, ACEs screening provided a crystal clear before-and-after in how she changed treatment plans for her pediatric patients, she explained to attendees of a December 2 webinar organized by the National Pediatric Practice Community on ACEs (NPPC) and cosponsored by ACEs Connection. Dr. Mercie Digangi One case that turned ACEs screening into a never-go-back moment for her was a three-year-old who was speech-delayed.
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Nurturing Children During Times of Stress: A Guide to Help Children Bloom by Yolo CAPC and YCCA

Natalie Audage ·
The Yolo County Child Abuse Prevention Council (CAPC) and Yolo County Children’s Alliance (YCCA) are excited to share Nurturing Children During Times of Stress: A Guide to Help Children Bloom. This guide for parents and caregivers, which we are launching during Child Abuse Prevention Month, contains tips and resources that parents and caregivers can use to promote resilience in their children and themselves. Nurturing Children During Times of Stress explains the effects of intense stress or...
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Opinion: To End Intimate Partner Violence, We Must Focus on Racial Justice and Healing [calhealthreport.org]

By Marc Philpart and Jacquie Marroquin, California Health Report, November 13, 2019 Like millions of Californians, the crisis of intimate partner violence has had a profound impact on our lives. The violence our family members experienced has created a ripple effect, setting us each on a unique journey for healing—as individuals, as families and as a community. While our journeys have been distinct, they have led to a similar understanding: Ending domestic violence is possible, but only if...
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Overdose and suicide among top causes of death for new moms in California, study finds [Sacramento Bee]

Gail Kennedy ·
By Elizabeth Shwe, The Sacramento Bee, June 14, 2019 Drug overdose and suicide are leading causes of death among California mothers within the first year after delivery, a recent study shows. Professor Sidra Goldman-Mellor of UC Merced and Professor Claire Margerison of Michigan State University found that drug overdoses were the second-leading cause of postpartum death and suicide was the seventh in California. Both constitute around 20% of all California postpartum deaths from 2010-2012.
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Parent Handouts updated and available In Dari, English & Spanish

Christine Cissy White ·
The updated parent handouts are now available in Spanish as well as English and Dari. Here's the blog post with links to all three versions of each flyer. All versions of the Understanding ACEs and Parenting to Prevent & Heal ACEs parent handouts can be downloaded, distributed, and used freely. Both flyers were made with generous support from Family Hui, a Program of Lead for Tomorrow, who is responsible for making the Spanish and Dari translations available. These are updates of the...
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Parental Depression and Its Impact on Child and Family Well-Being [CANTASD]

Karen Clemmer ·
Parental Depression and Its Impact on Child and Family Well-Being On March 9, 2018, The National Child Abuse and Neglect Technical Assistance and Strategic Dissemination Center ( CANTASD ) hosted a Digital Dialogue with Jessica Dym Bartlett, the Deputy Program Area Director for Early Childhood Development & Child Welfare at Child Trends . The conversation focused on the impact of parental depression on child and family well-being . This [ ARTICLE ] document summarizes the conversation...
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Parenting, Menopause & ACEs After-the-Chat Summary: Carey Sipp

Christine Cissy White ·
Have you talked with friends, siblings or co-workers about Parenting with ACEs while going through the change? Do you have any fascinating facts to share about how your OBGYN prepared or supported you when thrown by midlife, hormonal shifts and emotional residue from traumatic stress? Me either. And it's a shame. A lot of people parent, go through menopause, and have survived a bunch of ACEs. Conversations and information shouldn't be so hard to find. But they are. T hat's the reason we...
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Parenting with PTSD One Liners & Parenting with ACEs Chat Reminder

Christine Cissy White ·
Parents with PTSD from ACEs sharing what's hard about parenting while post-traumatically stressed: "Managing the terror around the possibility of everyone being a perp." "How to talk to children about why they won't meet X relative." “There was a point when I would feel completely overwhelmed by something as simple as having to make breakfast and school lunches at the same time.” "I didn't understand that not all parents reacted or were triggered the way I was." "was stone set on not...
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Peer Program Uses Writing as a Tool for Trauma Recovery

Steve Stone ·
For the past several years, a small yet dedicated group of writers has gathered at Pathway’s Peer Support Program in Ashland, Ohio to explore ways to use writing for overcoming life’s challenges, healing from trauma and adversity and building social connections with others. Tapestry of Our Lives is the result of their hard work. The writings in this anthology are rooted in adverse life experiences and childhood trauma, such as physical, sexual or psychological abuse or severe neglect.
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Petaluma Health Center leads effort to link women to services

Karen Clemmer ·
Sonoma County was one of six sites selected nationally to participate in a CityMatCH practice collaborative to prevent substance exposed pregnancies. In 2012 Rebecca Munger CNM, PHN the Sonoma County Maternal, Child, Adolescent Health Coordinator lead a broad coalition of reproductive health champions who worked across sectors and settings to develop a trio of strategies to reduce substance exposed pregnancies. The first strategy developed with CDC and WHO technical support was a bundled...
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Please stop saying parenting is hard for everyone & read Parenting with PTSD instead

Christine Cissy White ·
Sometimes, we feel anxious, intrusive, or afraid when changing or bathing or own babies. Sometimes, we feel sick to our stomachs and worried while potty training, nurturing, or disciplining our toddlers. Sometimes, we feel shame-filled and ill-equipped when talking about puberty, body parts, or sexuality because of how and where we were compromised by caregivers as children as in our bodies, homes, and families. P arenting is brutally hard for some. If affection, attention and intimacy have...
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Postpartum Anxiety Is an Epidemic Among American Mothers. Why Does It So Often Go Undiagnosed? (Time Magazine)

Karen Clemmer ·
By Sarah Menkedick, March 20, 2020, for Time As a new mother, I worried about mouse poop in the small cabin where I lived. About fracking chemicals in the water. About glyphosate in the oatmeal. About flame retardants in pajamas. About phthalates in toys. Although it constantly overwhelmed me, I thought my anxiety was normal, even necessary. After all, it was my job to protect my child. When I mentioned my fear at my six-week follow-up appointment after birth—the sole instance of medical...
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Practicing Psychiatry During a Coronavirus Pandemic (MGH Center for Women’s Mental Health)

Karen Clemmer ·
By MGH Center for Women’s Mental Heath, April 7, 2020. As mental health providers, most of us are not on the front lines of the COVID-19 pandemic; however, we are feeling the ripples. Given the magnitude of this crisis and its significant impact on so many aspects of our everyday lives, it is likely that this experience will leave an indelible imprint on our psychological well-being for years to come. In an editorial in the Journal of Clinical Psychiatry , Dr. Marlene Freeman, associate...
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Pregnancy can be life-threatening for black women. SB 464 can change the equation [sacbee.com]

Alicia Doktor ·
Black History Month has come and gone. It is a month that reminds us of the resilience, fortitude and strength black Americans have exhibited to stay alive and thrive in this country. Black women in particular have borne the brunt of adverse experiences created by the nation’s racist foundations. While significant strides have been made, black women continue to suffer needlessly and disproportionately from the seeds of white supremacy that many of us continuously work to uproot. The issue of...
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Pregnant Behind Bars: What We Do And Don't Know About Pregnancy And Incarceration [NPR]

Karen Clemmer ·
There are 111,616 incarcerated women in the United States, a 7-fold increase since 1980. Some of these women are pregnant, but amid reports of women giving birth in their cells or shackled to hospital beds , prison and public health officials have no hard data on how many incarcerated women are pregnant, or on the outcomes of those pregnancies. A study published in The American Journal of Public Health Thursday changes that. The study included 57 percent of the US prison population (New...
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Preventable trauma in childhood costs north America and Europe US$ 1.3 trillion a year [WHO]

Karen Clemmer ·
By World Health Organization (photo by WHO/Malin Bring) The findings of a new study on the life-course health consequences and associated annual costs of adverse childhood experiences (ACEs) show that preventable trauma in childhood costs north America and the European Region US$ 1.3 trillion a year. The article, published in the Lancet and co-authored by Dinesh Sethi and Jonathon Passmore, Programme Manager, Violence and Injury Prevention, WHO/Europe, looks at the legacy of ACEs and their...
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What Is Postpartum Depression? Recognizing The Signs And Getting Help [npr.org]

Marianne Avari ·
By Rhitu Chatterjee, NPR, January 28, 2020. Shortly after she gave birth to her son last May, Meghan Reddick, 36, began to struggle with depression. "The second I had a chance where I wasn't holding [my son], I would go to my room and cry," says Reddick, who lives with her son and husband. "And I probably couldn't count how many hours a day I cried." Reddick is among the many women who suffer from depression during pregnancy and after childbirth . "There's this kind of myth that women...
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When Parents Fear "It's All My Fault"

Claudia Gold ·
Many of my colleagues in the field of early childhood mental health work with what are termed "high risk" populations. Children of drug addicted parents, victims of child abuse, and families in abject poverty. While the challenges these families face are daunting, I find myself feeling some envy for my colleagues whose clients are in such obvious distress that the need for intensive treatment of parent and infant is not in question. In my rural, small-town population things are not so clear.
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Whole People Series & Study Guide (www.pbs.org)

Christine Cissy White ·
There's a fantastic five-part series, Whole People , done by PBS, " spotlighting the impact of Adverse Childhood Experiences (ACES) through personal and community stories. It explores the long-term costs to personal well-being and our society. While much work needs to be done, there are many innovative developments to prevent and treat ACES. We all play a role in becoming a whole people." It's amazing. The five topics covered are as follows: Childhood Trauma Healing Communities A New...
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Why I'm Passionate About ACEs Awareness

Elizabeth Perry ·
When I was 42, I landed on my butt so hard I couldn’t imagine how it had happened. I found out that the beliefs and relationships I had built my life on and around were all lies, and my world and worldview came crashing down around me. From that place of desolation, at what was rock bottom for me, I had to figure out what was true and not true, what was right and wrong for me, who I was – not who I had become to be acceptable to others. I needed to figure out who was with me and to what...
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Why We Suck (at Self-Soothing & Self-Care): Dr. Dawn O'Malley

Christine Cissy White ·
Without yoga and coffee, I'm kind of a jerk. These are my personal "puppy uppers and doggie downers" and prevent me from being cranky, quick to cry, and ready for conflict. Coffee and calming make life more manageable. Humans even seem tolerable. Without them I might veer into hating humans for being so needy which is not a great trait for a parent, partner or a professional. Or a self. My partner says coffee and exercise are acts of kindness, service as promote public safety. In other...
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Women Need Professional Emotional Support During High-Risk Pregnancies, Study Finds [sciencedaily.com]

By Rutgers University, Science Daily, December 16, 2019 The study appears in the journal Psychology of Women Quarterly. About 15 percent of pregnancies worldwide are high-risk, making premature delivery, low infant birth weight and other poor outcomes more likely. In the United States, 10 percent of pregnant women require hospitalization because they have hyperemesis gravidarum, pre-eclampsia, kidney infections, gestational diabetes or are at risk for imminent delivery, among other...
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World Premiere: Stress & Resilience: How Toxic Stress Affects Us, and What We Can Do About It [developingchild.harvard.edu]

By Center on the Developing Child, Harvard University, November 13, 2019 When the stress in your life just doesn’t let up, and it feels like you have no support to get through the day—let alone do everything you need to do to be the best parent you can be—it can seem like there’s nothing that can make it better. But there are resources that can help, and this kind of stress—known as “toxic stress”—doesn’t have to define your life. In this video, learn more about what toxic stress is, how it...
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Youth Suicides, County-Level Poverty Go Hand in Hand [medpagetoday.com]

By Elizabeth Hlavinka, MedPage Today, October 28, 2019 Suicides among children were more concentrated in high-poverty areas, a researcher said here. Of 20,982 suicides to occur from 2007 to 2016, poverty-stricken counties had significantly higher suicide rates than counties with lower levels of poverty, and the rate increased along with poverty concentration, such that children in areas with the highest poverty levels (≥20%) were more than one-third more likely to die by suicide than kids in...
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Association of Special Supplemental Nutrition Program for Women, Infants, and Children with Preterm Birth and Infant Mortality [jamanetwork.com]

By Samir Soneji and Hiram Beltran-Sanchez, JAMA Network, December 4, 2019 Key Points Question: Is receipt of Special Supplemental Nutrition Program for Women, Infants, and Children benefits during pregnancy associated with preterm birth and infant mortality among low-income expectant mothers in the United States? Findings: In this cohort study of 11 148 261 pregnant women with Medicaid coverage between 2011 and 2017, the proportion who also received Women, Infants, and Children benefits...
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Beyond Paper Tigers is Back!

Jennifer Hossler ·
Back for the second year, Beyond Paper Tigers conference will take place June 28th and 29th in Walla Walla, WA. Featuring Dr. Ken Ginsburg from Children's Hospital of Philadelphia as the keynote speaker, BPT builds on the story of one community and how they've learned that embracing trauma-informed care and implementing ACEs science truly takes a village. Operationalizing the latest in brain science, BPT will provide concrete strategies for intervention with youth, families, and communities...
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Beyond The Preventing Maternal Deaths Act: Implementation And Further Policy Change [Health Affairs]

Karen Clemmer ·
By Katy B. Kozhimannil, Elaine Hernandez, Dara D. Mendez, Theresa Chapple-McGruder. Feb 4, 2019, Health Affairs Maternal mortality is a death that occurs during pregnancy or within one year postpartum from “a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.” In the United States, maternal mortality is a clinical, public health, and social crisis. Between 1990 and 2013, maternal mortality...
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Black Mothers and Our COVID-19 Legacy (Medium)

Karen Clemmer ·
By Kendra F Montgomery Block, April 21, 2020 I have an urgent appeal from one Black mother to other Black mothers. Here are four things we can do to come out of this pandemic stronger — gleaned from my experience with the Black Child Legacy Campaign . The United States is a hard place to live if you are Black. Period. You can be old or young and Black; male, female or nonbinary and Black; poor or rich and Black. Our common Blackness subjects us to racial bias that negatively impacts our...
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Busy moms, Busy parents - engage your senses - a meditation aid?

Anna Sutton ·
Many of us forget that emotions are one of our sensory systems. Like smell, pressure, sight and hearing, it can go offline and need help to reset. When you are tired, hurting, thirsty, hot, your emotions get disregulated too. A reset (or regulating your senses) can help throughout the day. I just stumbled on the concept of meditation aids. If you're a busy mom or dad, consider an app that prompts you to stop and check in. Close your eyes and listen to a bell ring until it disappears. Those...
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CA announces robust perinatal depression prevention for Medi-Cal recipients

Laurie Udesky ·
Melinda Coates experienced a tumultuous pregnancy. “I was really mentally upset literally from day one (of the pregnancy),” she says. (Melinda Coates is a pseudonym. To protect her and her children’s privacy and safety, we are not using her real name.) Coates had hoped to get counseling last October, when she was seven months pregnant. That’s when she enrolled in the state’s Medi-Cal program, shortly after she and her abusive husband moved to California, “but nobody was able to get me in...
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California unveils ACEs Aware initiative to screen for trauma

Laurie Udesky ·
Will screening for adverse childhood experiences (ACEs) in California be mandatory? No, but it’s recommended. Will there be training for physicians and staff on how to screen? Yes. Who will be reimbursed for screening patients in California? Physicians who serve patients in the state’s Medi-Cal program — for now. For more answers to these and other questions that surfaced during a Dec. 4 webinar introducing Californians to a new statewide initiative, read on. Come January 1, California will...
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Call for Abstracts for NCHDV 2020 conference

Karen Clemmer ·
The National Conference on Health and Domestic Violence (NCHDV) seeks submissions that highlight research reports, practice innovations, advocacy initiatives, educational advances, and/or community programs that address one or more aspects related to domestic/sexual violence, other forms of violence, and health. The Call for Abstracts (CFA) invites leaders working in the fields of health and domestic/sexual violence to present their work at the 2020 Conference. Submission Deadline: Monday,...
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CERCH: the connection between blood pressure and fear of deportation in women of Mexican origin

Karen Clemmer ·
MCAH professor Kim Harley and Brenda Eskenazi of Center for Environmental Research and Children's Health (CERCH), and MCAH program head Julianna Deardorff co-authored a recent study in the Journal of the American Heart Association on the positive correlation between fear of deportation and increased blood pressure among women of Mexican origin. The study was highlighted in an article on cnn.com . Read the CNN article about the study here .
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Child and Maternal Health in Rural Areas Lags the Nation, Highlighting Barriers to Access [PEW]

Karen Clemmer ·
By Stacey Millett, February 25, 2020, for PEW Trusts Cross-sector solutions needed to address complex challenges One in five Americans lives in a rural area, including about 18 million women of reproductive age, but key indicators, including mortality figures, show that the health of mothers and children in these communities lags behind that of their urban peers and is worsening. Nationwide, child mortality rates have declined over the past decade, but recent research shows that improvement...
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Children 'failed in first 1,000 days', says MPs [BBC News]

Karen Clemmer ·
The Health and Social Care Committee said the first 1,000 days were critical, but not enough was done. It warned cuts to children's centres, health visiting and services to support parents had left families vulnerable. Nearly a third of children are not "school ready" by the time they reach five, because they have not developed the necessary skills and behaviours. The cross-party group wants the government to pay for extra contact with health visitors beyond the age of two-and-a-half. The...
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Circumstances of Overdose Among Street-Involved, Opioid-Injecting Women: Drug, Set, and Setting (PubMed)

Karen Clemmer ·
Conclusion: While all overdoses result from the pharmacological action of drugs, some overdoses were triggered by circumstances occurring in women's set or setting. Overdose prevention policies should embrace not only individual-level behavioral interventions, but also structural measures to address stress, social isolation, and risky drug use contexts that plague the lives of street-involved women who inject opioids. [ Please click here to access the full journal article. ]
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CMS Issue Brief: Improving Access to Maternal Health Care in Rural Communities

Karen Clemmer ·
In an ideal maternal health system, all women would have access to comprehensive, seamless medical care with links to behavioral, economic, and social supports. Additionally, they would be engaged with this system before, during, and after pregnancy. Across the United States, many women are not receiving care in this ideal system, and women in rural communities face unique challenges that make it harder for them to reach this ideal or any care at all in some cases. Because maternal health...
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Come Chat with Dr. Claudia M. Gold: An ACE-Informed Pediatrician

Christine Cissy White ·
Date: July 11th Time: 10 AM PST / 1 PM EST Location: Parenting with ACEs Group , Online Flyer: Attached below. Please share. Dr. Claudia M. Gold has practiced general and behavioral pediatrics for 25 years and specializes in early childhood mental health. She is on the faculty of the University of Massachusetts, Boston Infant-Parent Mental Health program, William James College, and the Austen Riggs Center where she is a Human Development consultant. Dr. Gold is author of the following...
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Consequences of Military Sexual Trauma for Perinatal Mental Health: How Do We Improve Care for Pregnant Veterans with a History of Sexual Trauma?

Megan Gerber MD MPH ·
Sharing our recent editorial which includes a call for TIC in maternity care: "Nevertheless, there are ways in which VA may be able to augment the maternity care pregnant veterans receive to empower and facilitate more trauma-informed approaches to obstetric care. These include investing in programs to ensure peer support, possibly through use of mobile health technology; facilitating collaboration with maternity care providers through provision of handheld/electronic maternity records...
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Deeper than the Deepest Well

Kate White ·
We now know that babies DO feel pain, and in fact, they are even more sensitive to it than adults. The study of baby’s experiences in utero and the first two years of life have led to the rise of early developmental trauma as a reality today, especially with the acceptance of implicit memory and that the body remembers.
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Donna Jackson Nakazawa Chats Live with Jane Stevens & You: Nov. 14th

Christine Cissy White ·
Featured Guest: @Donna Jackson Nakazawa Topic: Well-Being, Self-Care & ACEs Date: November 14th, 2017 Time: 10 AM PST / 1 PM EST Where: Here / Chats Donna Jackson Nakazawa is an winning researcher, writer and public speaker on health and family issues. She explores the intersection between neuroscience, immunology, and the deepest inner workings of the human heart. Her most recent book, Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal , examines...
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Dr. Gabor Maté & Full-Potential Parenting, Even When It Is Hard

Christine Cissy White ·
Note: Allison Morris had dozens of experts in her summit series through Full-Potential Parenting. I took notes only on those by Donna Jackson Nakazawa , Gabe Maté and Sebern Fisher (coming later this month). Though the audios are no longer available, for free, they can be purchased for $100. or less (depending on the year), here. Forgive me for sounding like an advertisement, I don't know Allison personally. I am a huge fan of all parent-led resources and wish I discovered this series...
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Dr. Melissa Merrick Explains CDC's Vital Signs/ACEs Report [Prevent Child Abuse America]

Jane Stevens ·
Dr. Melissa Merrick, president & CEO of Prevent Child Abuse America, provides four key takeaways from the Centers for Disease Control and Prevention’s latest Vital Signs/ACEs report , of which she is the lead author. Merrick also identifies several practical solutions for creating the conditions for safe, stable and nurturing relationships and environments for all children, families and communities, which are fundamental to preventing ACEs. Among these solutions is strengthening economic...
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Dr. Melissa Merrick Explains CDC's Vital Signs/ACEs Report [Prevent Child Abuse America]

Jane Stevens ·
Dr. Melissa Merrick, president & CEO of Prevent Child Abuse America, provides four key takeaways from the Centers for Disease Control and Prevention’s latest Vital Signs/ACEs report , of which she is the lead author. Merrick also identifies several practical solutions for creating the conditions for safe, stable and nurturing relationships and environments for all children, families and communities, which are fundamental to preventing ACEs. Among these solutions is strengthening economic...
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Effects of maternal stress detected in 2-month-olds [Herald Tribune]

Karen Clemmer ·
Kids say the darnedest things, even before they can speak. In a recent study published in JAMA Pediatrics , for the first time the brains of 2-month-olds told the effects of their mothers' stress by way of electroencephalography readings. Researchers were able to see different patterns in brain activity for those with mothers who were more stressed versus those of mothers who were not. Even more telling, brains with increased maternal stress showed signs of delayed development compared to...
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Employer Behavioral Health Programs Need Opioid, Suicide Focus [Health Payer Intelligence]

Karen Clemmer ·
Most employers plan to highlight behavioral and mental health in the future, but they will need to address opioid abuse and suicide to succeed. April 02, 2019 - Seventy percent of employers are either currently addressing or plan to address behavioral health over the next few years, according to a recent survey from Willis Towers Watson, but many of these initiatives fail to focus strongly on opioid abuse and suicide prevention. Programs that do not offer enough support for employees at risk...
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Facing Postpartum Depression: The Honesty, Courage and Support It Takes to Seek Help for PPD

Robyn Brickel, M.A., LMFT ·
“Nobody would believe what an effort it is to do what little I am able” – Charlotte Perkins Gilman, the Yellow Wallpaper, 1892 It is wonderful to see the birth of a child greeted with warm enthusiasm and support. We celebrate the joy of a growing family, and the excitement of a new life. Relatives and friends often provide gifts and extra help. But for some new moms, motherhood brings on many complex emotions besides the happy ones. While we may greet a new baby with happiness and delight –...
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Fairness for Breastfeeding Mothers Act of 2019 Signed Into Law [Cal WIC]

Karen Clemmer ·
This Act may be cited as the ‘‘Fairness For Breastfeeding Mothers Act of 2019’’ A bill just signed into law by President Trump will require federal buildings that are open to the public and have public restrooms to also have designated lactation rooms for breastfeeding. The rooms will be available for use by members of the public as well as federal employees. The Fairness for Breastfeeding Mothers Act ( H.R. 866 ) was sponsored in the House by Congresswoman Eleanor Holmes Norton (D-DC) and...
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Family First Scholarships for 21st Annual Families and Fathers Conference

James Rodriguez ·
21st Annual Families and Fathers National Conference February 24-27, 2020 Hilton Los Angeles Airport 5711 West Century Boulevard Los Angeles, California 90045 I am honored to announce The Family First Scholarship supported by the Annie E. Casey Foundation as a Title Sponsor and State of California First 5 as a Co-Sponsor for the 21 st Annual Families and Fathers Conference, Next Level 2020! the terms "putting family first" and "it takes a village to raise a child" parallels with why we have...
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