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PACEs in Maternal Health

Tagged With "Foster Youth's Journey in Motherhood"

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[Repost] Trauma-informed Care: It Takes More Than a Clipboard and a Questionnaire

Jim Hickman ·
California is about to launch an ambitious campaign to train tens of thousands of Medi-Cal providers to screen children and adults up to age 65 for trauma, starting on January 1, 2020. It is well-established that the early identification of trauma and providing the appropriate treatment are critical tools for reducing long-term health care costs for both children and adults. Research has shown that individuals who experienced a high number of traumatic childhood events are likely to die...
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Research roundup: Prospective ACE study and commentary about it; ways of asking about trauma; research on the power of internal resilience in juvenile offenders and a companion essay

Laurie Udesky ·
Association of Childhood Trauma Exposure With Adult Psychiatric Disorders and Functional Outcomes JAMA Open Prospective Study Delves Deeper Into Mental Health Effects of Childhood Trauma Psychiatry From Treatment to Healing: Inquiry and Response to Recent and Past Trauma in Adult Health Care Women's Health Issues Adverse Childhood Experiences and Psychological Distress in Juvenile Offenders: The Protective Influence of Resilience and Youth Assets Journal of Adolescent Health Adverse...
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RSVP now for 2020 MOM Annual Forum!

Karen Clemmer ·
Clinical Keynote: Pilyoung Kim, Ph.D. Motherhood and the Brain Pilyoung Kim, Ph.D., is an associate professor in the department of psychology and the Director of Family and Child Neuroscience Laboratory at the University of Denver . She and her team investigate the roles of prenatal and postnatal exposure to poverty and stress in (1) neural adaptation to parenthood in new mothers and (2) brain development in infants and young children. Her primary research method is pediatric neuroimaging...
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Some 350 Florida Leaders Expected to Attend Think Tank with Dr. Vincent Felitti, Co-Principal Investigator of the ACE Study; Expert on ACEs Science

Carey Sipp ·
Leaders from across the Sunshine State will take part in a “Think Tank” in Naples, FL, on Monday, August 6, to help create a more trauma-informed Florida. The estimated 350 attendees will include policy makers and community teams made up of school superintendents, law enforcement officers, judges, hospital administrators, mayors, PTA presidents, child welfare experts, mental health and substance abuse treatment providers, philanthropists, university researchers, state agency heads, and...
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The Decision that Changed My Life

Joyelle Brandt ·
Four years ago, I decided to start a conversation about the long term impact of childhood abuse. More specifically, about what happens when those abused children grow up and have children of their own. When I had become a parent, I went looking for books on this topic, and I didn’t find anything. But I knew I couldn’t be the only one who was dealing with this. And once I found one other person who was willing to write about this, I said, let’s collect these stories. The stories of these...
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The Developing Brain & Adverse Childhood Experiences (ACEs)

Lisa Frederiksen ·
Thanks to an explosion in scientific research now possible with imaging technologies, such as fMRI and SPECT, experts can actually see how the brain develops. This helps explain why exposure to adverse childhood experiences can so deeply influence and change a child's brain and thus their physical and emotional health and quality of life across their lifetime. The above time-lapse study was conducted over 10 years. The darker colors represent brain maturity (brain development). I have added...
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The pandemic may be intensifying postpartum depression. But there are resources to help. (The Lily)

Karen Clemmer ·
By Juli Fraga, May 8, 2020, The Lily. On March 18 — a day before California became the first state to issue a stay-at-home order — Courtney Pladsen, 34, a nurse practitioner who lives in Portland, Me., gave birth to her first child. Like many of the hundreds of thousands of U.S. women who have given birth during the coronavirus pandemic, Pladsen’s life was turned upside down. In preparation for parenthood, Pladsen and her husband had lined up support: a lactation consultant to help with...
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The Rise of the Trauma-Informed Mothers

Dawn Daum ·
The next generation is less likely to wear predisposed shackles of trauma because as trauma-informed parents we are re-wiring the traumatically stressed DNA that was passed down to us.
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‘This is not a child safety crisis. It’s a poverty crisis, a racism crisis.’ – A social worker and former foster youth featured in HBO’s ‘Foster’ shares her vision of societal and system change (www.risemagazine.org)

Christine Cissy White ·
Excerpts from article by Sarah Harris from Rise Magazine . Q: What led you to work in the foster care system? A: I am a former foster youth and I’ve been a social worker at the L.A. Department of Child and Family Services for 5 years. I entered foster care through probation, and I got into probation through survival. I was breaking the law for clothes and food. In foster care, I bounced around a lot. For the most part I was AWOL. I was in group homes but I stayed with family or friends.
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Tia Mowry-Hardrict Recalls 'Shame' Over Postpartum Depression: 'I Didn't Want to Admit It' (People Magazine)

Karen Clemmer ·
By Jen Juneau, November 5, 2019, for People Magazine. In a candid interview with Romper , mother of two Tia Mowry-Hardrict talks the harsh realities of mom guilt, postpartum depression, breastfeeding and more. Tia Mowry-Hardrict is an accomplished actress, food vlogger and much more, but her most important role is Mom. The former Sister, Sister actress, 41, posed alongside her daughter Cairo Tiahna , 18 months, and son Cree Taylor , 8, in a recent photo spread for Romper , in which she...
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TIC: News and Notes for November 2019

Scott A Webb ·
ACEs, Adversity's Impact Podcast: Dr. Nadine Burke Harris Vital Signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention - 25 states, 2015-2017 Animal study shows how stress and mother's abuse affects infant brain LGBTQ, traumatized homeless youth more vulnerable to being trafficked: Report How do these pediatricians do ACEs screening?Early adopters tell all When family relationships become toxic: The trauma of...
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Trauma-Informed Care as a Universal Precaution: Beyond the Adverse Childhood Experiences Questionnaire [jamanetwork.com]

By Nicole Racine, Teresa Killam, and Sheri Madigan, JAMA Pediatrics, November 4, 2019 Experiences of childhood adversity are common, with more than 50% of adults reporting having experienced at least 1 adversity as children and more than 6% exposed to 4 or more adverse childhood experiences (ACEs). There is currently a controversial debate in the medical field as to whether the ACEs questionnaire, which asks about abuse, neglect, and household dysfunction before age 18 years, should be...
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‘We are just destroying these kids’: The foster children growing up inside detention centers [Washington Post]

Photo credit and caption: Heard leaves the courtroom at the Boone County Courthouse in Madison. He hopes to train to be a tattoo artist. (Sarah L. Voisin/The Washington Post) Dec. 30, 2019 Though he's never been convicted of a crime, Geard Mitchell spent part of his childhood in a juvenile detention center, at times sleeping on cement floors under harsh fluorescent lights left on through the night during lockdowns. He attended high school by clicking through online courses and had “no one to...
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WEBINAR - NPPC's Pilot Site Case Studies: Lessons Learned from ACEs Screening Implementation

Molly Peterson ·
The Center for Youth Wellness' National Pediatric Practice Community on ACES (NPPC) is a co-designed community committed to collaborative learning. To promote this learning, we have been working with six pilot sites over the last year, representing practices of various sizes and service delivery settings, to implement ACEs screening and intervention. On Monday, December 2nd at 1pm PT , we will be holding a webinar to discuss the findings of these pilot site case studies. Please register...
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What Happens When Hollywood is Not Trauma Informed? MMH Advocates are Calling for Warning and a Boycott of Charlize Theron's New Movie "Tully" [huffingtonpost.ca]

Jessica Porten ·
"'... It's very disappointing the illness would be so grossly misdiagnosed in a major motion picture when we know that only 15 percent of women who experience a postpartum mood disorder get treatment because of the stigma and shame associated with it,' Zoblin told HuffPost Canada. 'I think mothers should be made aware going into the movie that it might be triggering.'" Warning: this post and the linked article contain spoilers for the new movie "Tully". The previews for this movie would lead...
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How It Feels & How We Heal: Parenting with ACEs Chat Quotes (You Tube, Database, PDFs, Links)

Christine Cissy White ·
Parenting with ACEs is sharing inspiration, information, and expertise from our chat series in 3 formats. Parenting with ACEs: How It Feels & How We Heal Quote Collection (pdf version below as well) Quotes Database (pdf version below as well) Links to Chat Transcripts and before and after-the-chat blog posts. Thanks to everyone who showed up, who shared, and who is doing the important work that is our mission (prevent ACEs, heal trauma, build resilience). We know that work happens...
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Introducing NEW Becoming Trauma-Informed & Beyond Community

Christine Cissy White ·
Earlier this year @Dawn Daum wrote to us when she was ready to share ACEs science with people in the organization she works in to make a case for moving towards more trauma-informed care for the benefit of the staff and those they serve. She was frustrated because almost all the training and resources she found were geared towards schools, clinical staff or to organizations working with children and families rather than ACE-impacted adults in the workplace and who are...
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Love as Destiny: A Former Foster Youth's Journey in Motherhood [chronicleofsocialchange.org]

By Katarina Sayally, The Chronicle of Social Change, October 25, 2019 If you haven’t heard enough stories about what breaking the intergenerational cycle of foster care looks like, I want to share one. This is our story, and it’s a good one. When I found out I was pregnant, the only fear I had was, “What if my baby ends up in foster care?” As a former foster youth who works in the field, I am constantly reminded of this possibility. One study found that mothers in foster care were twice as...
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Nominate a Trauma-Informed Care Champion: #TICchampion

Mariel Gingrich ·
Becoming a trauma-informed organization requires clear communication about the transformation process, and support from staff at all levels of an organization. Often these efforts are spearheaded by “trauma-informed care champions”— individuals committed to raising awareness regarding the health effects of trauma and toxic stress and improving care for people who have experienced trauma. This week, the Center for Health Care Strategies (CHCS) invites you to recognize people around you who...
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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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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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Parental Depression Forecasts Kids' Later Physical Health [news.uga.edu]

By Allyson Mann, University of Georgia Today, October 24, 2019 When parents suffer from depression, kids may be at risk for physical health problems in young adulthood, according to a study from researchers including the University of Georgia’s Katherine Ehrlich. The results revealed an association between parental depression and youth metabolic syndrome—a condition that forecasts substantially increased risk for cardiovascular disease and diabetes. “The good news is that while parental...
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Perinatal Trauma Informed Care and the Trauma Sensitive Intake

Kate White ·
Monday, March 4, marks the beginning of Birth Psychology Month for the Association for Prenatal and Perinatal Pyschology and Health (APPPAH). This monthlong celebration features a panel of speakers around trauma informed practices for pregnancy, birth, and postpartum care. APPPAH received a grant for this project, so live lectures are free. Our first two speakers will be on Monday at 7 pm and 8:30 pm Eastern time. Jennie Birkholz, Principal of Breakwater Light, LLC, Trauma informed educator...
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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 Depression: Why The Word ‘Should’ Is So Dangerous [HuffingtonPost.com]

Samantha Sangenito ·
You should be happy. You should be thinner. You should always be filled with joy. You should be breastfeeding. You should be equally attentive to your other children. You should be socializing. You should be stronger. You should be more resilient. You should be more than what you are. Sound familiar? We live in a society that tells women how they should feel, think and look as mothers, even in early motherhood. Such repeated messages are easily internalized and, inevitably, they lead to...
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Preventing ACEs - Press Release from Health Officials and 2019 CDC Report

Tory Henderson ·
Health Officials Seek to Prevent Adverse Childhood Experiences Press Release from the Association of State and Territorial Health Officials (ASTHO) ARLINGTON, VA (Nov. 6, 2019) —At least five of the top 10 leading causes of death are associated with adverse childhood experiences (ACEs), according to a new report released yesterday by the Centers for Disease Control and Prevention (CDC). ACEs, such as abuse, neglect, and witnessing violence or substance misuse in the home, can lead to...
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Why therapy during pregnancy should be required [WashingtonPost.com]

Samantha Sangenito ·
People frequently consider going to therapy before they make a major life transition, such as getting married or changing careers. But what about when embarking on a monumental shift such as parenthood? Women, who are advised to exercise and watch what they eat while they are pregnant, don’t always think of psychotherapy as an important part of their prenatal care regimen, but it can be critical to the well-being of mother and baby, both during and after pregnancy. For many people, pregnancy...
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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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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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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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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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Can Trained, Paid Peer Support Help New York City Keep Foster Parents? [chronicleofsocialchange.org]

By Megan Conn, The Chronicle of Social Change, December 2, 2019 When Roxanne Williams became a foster parent four years ago, she started in the deep end of the parenting pool. New York City child welfare workers brought her a boy with limited English on a Friday afternoon and left after confirming her home was safe, leaving Williams to muddle through their first days together on her own. “It was rough – you weren’t getting the calls back [from her foster care agency] as fast as you wanted...
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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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Comics Shed Light On The 'Scary Thoughts' That Can Come With Motherhood [HuffPost]

Karen Clemmer ·
Maternal mental health expert Karen Kleiman is tackling the stigma of postpartum depression and anxiety, one comic at a time. Kleiman has a background in psychology and social work and is the founder of The Postpartum Stress Center, an institution based in Rosemont, Pennsylvania, that’s provided support to pregnant and postpartum women for 30 years. Collaborating with illustrator Molly McIntyre , Kleiman has released comics inspired by submissions to the center’s #speakthesecret campaign ,...
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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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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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FREE Webinar Series - register now for first webinar on Fri 2-10-19

Karen Clemmer ·
2019 Webinar Series Join us for a FREE webinar series deepening our understanding of specialized issues and populations in perinatal mental health! Designed for care providers who work with new families, join us as we learn about some of the complex issues impacting young families. The virtual trainings will take place quarterly on Fridays from 12-1pm (PST). The series is free to all but prior registration is required. Login information for each session will be provided upon registration.
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From the moms, partners and kids of all ages - Happy Father's Day!

Anna Sutton ·
While it should not just be today that we take time to honor, respect, remember and thank the Fathers of all generations (greats, grands, immediate, adopted, foster, neighbors and all), it is a day to say thank you to all the dads, uncles, foster dads, adopted dads, grand dads, favorite neighbors, and just cool and awesome men in our lives who support the mothers and women in their challenging transitions into and throughout motherhood. We salute all the dads in all generations! And we love...
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6 Warning Signs That It’s More Than The Baby Blues [Scary Mommy]

Karen Clemmer ·
With the baby blues occurring in nearly 80% of postpartum mothers, it can be hard to tell whether or not they are a cause for worry. The term “baby blues” is used to describe the flood of feelings a mother experiences shortly after giving birth. Between the sudden change in hormone levels, the extreme lack of sleep, trauma of childbirth and everything else that happens in the first few weeks postpartum, it’s understandable for a new mother to feel overwhelmed. The trouble with the baby blues...
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ACEs Community Spotlight Series: Dr. Richard Honigman, Central Nassau Pediatrics

Margaret Wayne ·
For our second community spotlight interview, I spoke with Dr. Richard Honigman, a pediatrician at Central Nassau Pediatrics in Levittown and infant mental health advocate. We discussed the importance of addressing childhood adversity and the relevant work he is doing both inside and outside his practice. Please note that responses have been adjusted for length and clarity. Dr. Honigman is also the first recipient of the 2019 Ed Tronick Award for Distinguished Contribution to Infant-Parent...
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ACEs Research Corner — November 2019

Harise Stein ·
[Editor's note: Dr. Harise Stein at Stanford University edits a web site -- abuseresearch.info -- that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she's posting the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! -- Jane Stevens] Jackson DB, Chilton M, Johnson KR, Vaughn MG. Adverse Childhood Experiences and Household Food Insecurity. Am J Prev Med. 2019 Nov;57(5):667-674. PMID: 31522923...
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ACEs Science Champion Series: Dr. Angela Bymaster: This Faith-Based Physician Integrates ACEs Science with Healing Arts

Sylvia Paull ·
Dr. Angela Bymaster, a family physician at Washington Elementary School in San Jose, CA, operates her clinic in a portable unit on the school property. Because the unit faces students as they are dropped off by their families, she gets to “pick up the kids” before they are sent to the clinic, practicing “upstream medicine.”
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Re: Why Aren't We Talking About Postpartum Mood Disorders in Immigrant Women [PMag.com]

Grace Harris ·
This was a wonderful article - there is always a lot to consider in providing mental health services. Culture definitely makes a difference and especially when layered on all of the expectations we bring to motherhood. I would recommend this for anyone working with moms on peri natal mood issues.
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Re: Helping Young Children Exposed to Trauma: A Systems Approach to Implementing Trauma-Informed Care [chdi.org]

Karen Clemmer ·
Marianne, Thanks for sharing this important information! The video is interesting. The attached infographic and the report with talks about cost-savings are also very useful and informative. Nice! The goal of CONCEPT (The Connecticut Collaborative on Effective Practices for Trauma) is to minimize the effects of trauma exposure and improve overall health and well-being for all children in Connecticut’s child welfare system who were exposed to abuse, violence and other forms of trauma...
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Can Paid Maternal Leave Help Address the Disparities in Maternal Mortality? (NIH)

Karen Clemmer ·
By Rada Dagher, Ph.D., M.P.H. Posted on June 28, 2020 , National Institute on Minority Health and Health Disparities. Maternal mortality rates in the United States have reached an all-time high. While these rates have dropped globally in the last few decades 1 , in the United States, they have more than doubled between 1987 and 2015 2 . The picture is even grimmer for racial and ethnic minority communities, where African American and American Indian/Alaska Native women have the highest...
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State budget signed [childrennow.org]

Kelly Hardy ·
Hello 4CA friends – Sending a quick update on the state budget. Please add on if you have more/different information – thanks! The short story is that many of the worst cuts that were discussed were NOT enacted in the final budget, which is good news. Some of the items most related to childhood trauma include: The final budget rejects the May Revise proposal to reduce $4.5 million General fund from the Black Infant Health Program . While there will be no cuts to Prop 56 Medi-Cal supplemental...
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ACEs research roundup: ACEs, racism, promoting equity and resilience

Laurie Udesky ·
Racial /Ethnic Disparities in Health Care Access Are Associated with Adverse Childhood Experiences , Journal of Racial and Ethnic Health Disparities Racism , Psycho-Social Stress, and Health-related Quality of Life International Journal of Maternal Child Health and AIDS Promoting equity and resilience: Wellness navigators' role in addressing adverse childhood experiences American Psychological Association Co‐Occurring Youth Profiles of Adverse Childhood Experiences and Protective Factors:...
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'A Better Normal:' Can universal ACEs screening be equitable? -- Concerns and solutions

Laurie Udesky ·
Can universal ACEs screening be equitable? A conversation about concerns and solutions. When: Tuesday, Oct. 13, 2-3:30 pm PDT/5-6:30 pm EDT This webinar explores what it takes to ensure that equity is built into the process of screening and providing support for families who have experienced trauma and want help. REGISTER HERE Background At the beginning of this year, California, through the ACEs Aware initiative began rolling out universal screening for adverse childhood experiences (ACEs),...
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For Pregnant Women, Stigma Complicates Opioid Misuse Treatment [thefix.com]

By Amarica Rafanelli 10/22/20, for The Fix.com New and expectant mothers face unique challenges when seeking treatment for an opioid use disorder. On top of preparing for motherhood, expectant mothers often face barriers to accessing treatment, which typically involves taking safer opioids to reduce dependency over time. The approach is called medication assisted therapy, or MAT, and is a key component in most opioid treatment programs. But with pregnant women, providers can be hesitant to...
 
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