VA Maternity Care Coordinator (MCC) program facilitates specialized care for military Veteran parents

For new families, healthy, evidence-based infant feeding education and support can be hard to come by, but among this often barren landscape of support, the VA Maternity Care Coordinator (MCC) program provides an oasis for military Veteran mothers.  

Retired USAF Lt Col Tammy Tenace BSN, MS, APRN-BC, now Women Veteran Education, Outreach and Research Coordinator  for James A. Haley Veterans Hospital in Tampa, Fla. says that the VA understands that pregnancy and parenthood often requires specialized care.

About a decade ago, as care providers started to notice that lactation and breastfeeding support was severely limited in civilian communities, they established the MCC role. MCCs maintain contact with Veteran families throughout the perinatal period, facilitating care that meets their specific needs. 

Because the VA does not provide obstetric care, the MCC acts as a liaison between the VA and the community obstetrical provider. MCCs follow Veterans through pregnancy and postpartum at one and six weeks postpartum. [https://link.springer.com/article/10.1007/s11606-019-04974-z]  The VA supplies Veterans with lactation supplies like breast pumps, nursing bras, nursing pads, storage bags, etc.

The MCC role has been established at every VA medical center, and Tenace has served as MCC at her hospital since 2016.  

Photo by George Pak : https://www.pexels.com/photo/family-sitting-on-sofa-beside-house-plant-near-the-windows-7983863/

Throughout the COVID-19 pandemic, what little perinatal support existed in civilian spaces, dwindled to almost nothing, Tenace points out. 

Hospital breastfeeding support groups, while only meeting a couple of times a week, stopped meeting altogether. Women weren’t allowed support people or their partners at appointments, and they began to feel isolated. 

“I realized I needed to do something; I couldn’t depend on the community,” Tenace says.  

Working through the Office on Women’s Health as a subject matter expert, VA National Consultant for Lactation Ashley M. Lauria, MA, RD, LDN, IBCLC helps establish standards of care in lactation programs at VA facilities nationwide. 

Tenace and Lauria both comment that among the hundreds of parents they have cared for, it is truly a rarity for an individual to express disinterest in lactation. Their experience reflects national numbers, where most dyads start out breastfeeding. 

Women Veterans are the fastest growing group among the Veteran population. In fact,  “by 2040, VA estimates they will comprise 18% of the Veteran population, versus just 4% in 2000,” according to a VA Pittsburgh press release.

In order to keep up with this demand, Tenace and her colleagues are in the process of curating a Certified Lactation Counselor (CLC) program. Made possible through funding from the Women’s Health Innovations and Staffing Enhancements (WHISE), ten of their staff members are completing the Lactation Counselor Training Course (LCTC), including Tenace, physicians, a health coach, advanced practice nurses, among others. 

“The most up-to-date information is really important,” Tenace begins. “[We are all] unlearning the things we thought we knew. The course has been instrumental to helping us feel like we are actually helping women, instead of relying on the knowledge that we thought we had. The course is detailed and professional, yet practical. The practicalness is what’s to our advantage. It’s how we actually help women breastfeed.”

Photo by Timothy Meinberg on Unsplash

Tenace and Lauria go on to explain that their efforts are Veteran-led. That is, their facilities host quarterly focus groups where they can learn about Veterans’ requests. 

“We want to know from women: what do they want?” Tenace comments. 

Because Veteran women often prefer support groups comprised of other Veterans, Lauria offers virtual lactation support groups that also act as social circles and a place for comradery. 

As James A. Haley Veterans’ Hospital designs new facilities, Tenace has been invited to offer input on the creation of lactation space for both employees and patients. Tenace applauds their leadership for focusing on improvement for the patient and employee experience. She also highlights that the newly designed main entrance will host a lactation pod. 

“I can’t think of a better way to show commitment,” she adds.  

Tenace and Lauria have embodied a passion for birth and lactation since their youth. Their work with the VA allows them to continue their mission to celebrate parents and their families and position themselves as life-long learners, evolving with the needs of Veteran mothers. 

 

Photo by Brianna Lisa Photography: https://www.pexels.com/photo/mother-breastfeeding-her-child-in-park-11620457/

For more on VA maternity care services visit https://www.womenshealth.va.gov/docs/WomensHealthReproductiveHealthBrochure508.pdf

More on Veteran Health https://www.commonwealthfund.org/blog/2021/birth-equity-Veterans-and-servicemembers  

Regulations and resources for all military branches https://www.mom2momglobal.org/bficb 

Coverage for pregnancy and lactation care in the military health system https://www.military.com/daily-news/2021/11/01/tricare-cover-doulas-lactation-consultants-some-starting-jan-1.html 

‘Words have energy and power’: exploring language in infant feeding and perinatal health Part Two

This week, we continue our examination of the language used around infant feeding and perinatal health. You can read Part One here

Photo by Anna Shvets: https://www.pexels.com/photo/tattooed-mother-breastfeeding-her-baby-3845191/

Advantages of health versus the disadvantages of risky behavior  

The infant formula shortage in the United States pushed conversations about the cost (monetary and otherwise) of infant feeding to the headlines. One article claimed the “many, many costs of breastfeeding” which can be very real for parents living in a country that values profit over human and planetary health. But we must also consider the cost of not breastfeeding which shifts responsibility from individuals to systems. Max Ramirez of IBFAN & MOH Panama has said that “Talking about the advantages of breastfeeding versus the risks of not breastfeeding is like talking about the advantages of breathing instead of the consequences of smoking.”

 

Language and evolving marketing tactics  

When the International Code of Marketing of Breast-milk Substitutes and some of its subsequent resolutions came about, social media and digital marketing did not exist. 

The latest Marketing of breastmilk substitutes National implementation of the International Code Status report shows that “of the 144 countries with legal measures on the Code, only 37 explicitly mention promotion of BMS on the internet, digital channels or other electronic means.” 

However, it also points out that “for many types of promotion, including advertising, retail sales devices, and direct contact with mothers, explicit mention of digital channels may be unnecessary as they are already covered by more general language” in legislation. (p. vii)  

WHA Guidance from 2016 requires the full prohibition of donations of informational and educational materials by industry, a clarification from the 1981 Code text which allowed for donation of materials if requested by the government. Similarly, the Guidance calls for a complete ban on gifts or incentives for health workers, while the 1981 Code language prohibits gifts only if they can be shown to be financial or material inducements to promote products. (p. 18)

Alejandro Morlachetti, Regional Legal Advisor, Human Rights at PAHO/WHO explains that States can be held accountable under the International Covenant on Economic, Social and Cultural Rights in the context of business for how they regulate companies. 

Morlachetti says that the industry tries to evade these obligations with claims about limits on freedom of speech and access to information but “bans on advertising and promotion does not interfere with the economic activity of buying, producing and selling products, restriction on advertising cannot be compared with freedom of speech… [and] the protection and promotion of health is far more compelling than the industry’s claim to commercial speech freedom.” [https://www.paho.org/sites/default/files/presentation-human-rights-amorlachetti.pdf]  

During a USBC session on breastmilk substitute (BMS) industry marketing, one participant questioned: “When will the WHO actualize its language to human milk and include other parents who feed human milk that are not mothers?” 

Infant and Young Child Feeding Consultant for the World Health Organization (WHO) Nina Chad, PhD responded “Advertisers promote their products to consumers that are defined by large social media companies and the language that best describes this behaviour. In this case advertisers targeted women and mothers to the exclusion of other parents.” 

The United Nations (UN) issued  Guidelines to help United Nations staff to use gender-inclusive language in any type of communication — oral or written, formal or informal, or addressed to an internal or external audience in the six languages of the Organization. Their Toolbox contains training materials on the practical application of the Guidelines, information on related training courses and other relevant resources. [Find those resources here.] 

 

Shaking negativity, embracing relationships and fun 

Much of our language in maternal infant health evokes negativity: failure to thrive, failure to progress, cervical incompetence, etc.

Photo by Icaro Mendes: https://www.pexels.com/photo/mother-breastfeeding-her-baby-4226827/

In Fitting Flanges for Pumping: Rethinking Sizes and Materials, Jeanette Mesite Frem, MHS, IBCLC, RLC, CCE, CD suggests we do away with the term “lazy boob” and instead shift focus to the “bonus boob”. One participant shared that they call the “bonus boob” dessert. 

“It’s always fun to start with dessert,” they offered. 

Mesite Frem also talked about replacing the word “let down” to something like “release”. 

More generally, in many spaces, breastfeeding has been reduced to a latch and how much milk is being produced. We’ve situated the lens obsessively on how the baby latches, forgetting that breastfeeding is so much more. 

In Implications of mother baby separation: Reflections from Nikki Lee, Lee explains, “It’s not about shoving a breast in baby’s mouth. The baby has to take the breast in. Mamma sets the table; the baby has to pick up the fork.”

She goes on to explore breastfeeding as a relationship.

“Another part of the problem stems from the way many lactation and medical professionals talk about infant feeding patterns, as if babies are some bizarre species with an unusual way of eating. The way an infant feeds is the same as the way adults eat. Adults take sips of water throughout the day, enjoy occasional snacks, eat light meals, and indulge in big feasts. In addition, babies breastfeed for medicine, pain-relief, fun, comfort, and an all-encompassing and pleasurable sensory experience; these are all reasons that adults eat too.

Lee offers yet another way to think about breastfeeding; she equates it to kissing your lover.  

She asks “You’d never say ‘Go away, I already kissed you twice an hour ago’ to your lover, would you?”

Photo by Subham Majumder: https://www.pexels.com/photo/toddler-in-pink-and-white-polka-dot-shirt-3614116/

For a baby who has been fed continually for nine months in the womb, who has to double its size in three or four months and whose stomach starts out the size of a marble, breastfeeding needs to be unlimited, especially at the beginning. Yet our culture does not recognize, respect nor support that relationship.

We can survive without kissing, much like we can survive without breastfeeding, but what does life look like without kissing? What does life look like without breastfeeding? What does life look like without falling in love? How happy– and can we be– without that sweetness?” Lee wonders.

Villaluna shared final thoughts in Decolonizing Language: Exploring Intent and Impact  wondering, “Where is the fun?!” 

Villaluna emphasized the importance of helping shape first food imagery to include older children as well as newborns and younger infants; celebrating nursing experiences like when Villaluna and toddler nursed in their milk and cookies Halloween costume

More OMW coverage on language in perinatal care http://www.ourmilkyway.org/considering-evolving-language-in-perinatal-care-and-beyond/ 

http://www.ourmilkyway.org/excuse-our-language/ 

http://www.ourmilkyway.org/still-watching-our-language/

‘Words have energy and power’: exploring language in infant feeding and perinatal health Part One

Words evoke imagery. 

Co-Director of Kabbalah Centre International Yehuda Berg has written that “Words are singularly the most powerful force available to humanity.” 

“We can choose to use this force constructively with words of encouragement, or destructively using words of despair. Words have energy and power with the ability to help, to heal, to hinder, to hurt, to harm, to humiliate and to humble…” he continues.

“What sets us apart from the animal kingdom is the use of symbolic language. Our ability to put our thoughts into words that symbolize objects allows us to communicate beyond the means of simple vocalization.” 

What do you think of when you see, say or hear the word breastfeeding? Is it a white woman with her white baby in flowing sheaths of gauzy fabric  feeding directly at the breast in a field of wildflowers? Is it a non-binary parent feeding their baby with a supplemental nursing system? Is it a parent feeding in public, covered by blankets so only the baby’s feet are visible? Is it a group of BIPOC women, holding their babies at their breasts looking fiercely at their audience? Is it pruned imagery of a baby’s mouth latched to a body on an informational pamphlet? 

Photo by William Fortunato : https://www.pexels.com/photo/mother-using-phone-while-breastfeeding-her-child-6392810/

During the United States Breastfeeding Committee’s (USBC) National Breastfeeding Conference & Convening 2022 session Decolonizing Language: Exploring Intent and Impact with Casey Rosen-Carole (she/her/s) of the Academy of Breastfeeding Medicine (ABM), Jordyn White, Deputy Director of Communities and Volunteer Relations at Human Rights Campaign, and Mari Villaluna, a lactating solo parent and doula, participants were asked to consider what breastfeeding looks like in our minds and how breastfeeding is perceived in society. 

Can we expand the images that come to mind when we use certain words? we were challenged.

“…Words have been streamlined to only pertain to certain types of people,” White began. “The visual connection to the word is always very strong. Words can be ostracizing even when they’re not intended to be. The goal in decolonizing language shouldn’t always be including new language, but also taking back the words that exist and reminding people that there are a myriad of ways that we can manifest.” 

Perhaps the words that we have were never intended to have a singular meaning, White went on to suggest. 

As we close out Pride Month, in two installments,  we’re exploring concepts around the language we use in infant feeding. This week, we explore some of those concepts which pertain specifically to the LGBTQI+ community. Stay tuned next week for others that are more generally applied. 

 

Language limitations and opportunities for inclusivity 

English is a language of colonization, and it has limitations. 

Photo by Kampus Production: https://www.pexels.com/photo/a-gay-couple-parenting-a-child-7983196/

Currently in our country, people sometimes grapple with the “newness” of being transgender when in reality, being transgender is not a trend. Trans people have been documented in ancient societies, and so there has been language to describe those experiences too. 

USBC conference participant Candi Cornelius writes: “A native American term for LGBTQ population is ‘Two spirited individual’. In history they were spiritual leaders with great strengths since they walk in both worlds (male and female). Each tribe has their own stories of two spirited individuals.”

Casey Rosen-Carole (she/her/s) discussed ABM’s Position Statement and Guideline: Infant Feeding and Lactation-Related Language and Gender which covers language considerations like legal, research, translation, scientific accuracy, and personal preference. All of these arenas bring up different intricacies and challenges. 

For instance, “Desexed or gender-inclusive terms may be confusing in languages other than English. Many languages assign gender to every noun, so that such terms cannot be gender-neutral. For example, in an attempt to be gender inclusive, the word ‘parent’ is often substituted for ‘mother,’ but in many languages, ‘parent’ is a masculine noun that could mean ‘father.’ Many languages have no gender-neutral equivalent for relevant words. For example, in many languages, the term for ‘breast milk/human milk’ is ‘mother’s milk.’”

Check out Breastfeeding: A Universal Language of Love for a list of translations. 

Rosen-Carole sums things up by asking “Who are we talking to?” In a one-on-one interaction with a family, their language preferences should always be respected. When scientific accuracy is necessary, using desexed language may not be appropriate. 

As noted in the ABM protocol, “In clinical settings, health effects seen in mother–infant breastfeeding dyads cannot be generalized to other dyads due to lack of data and known or predictable differences with other dyads based on chromosomal, hormonal, and anatomic factors. Thus, substituting ‘parents’ for ‘mothers’ may be factually inaccurate.”

White made an important distinction for practitioners and researchers:  “The goal of this conversation and others like this is not to invalidate or undo any of the work that has been done because your research used the word ‘mother’ and ‘breastfeeding’. That’s not what’s happening here. We are evolving. The field is evolving.”

 

Reframing disparity and acting on inequity 

Equity has become a buzzword; in fact, one author brands the sentiment “Fakequity”. USBC presenters expressed their fatigue with the word. “We want to see action,” they said.

From Native Breastfeeding Coalition of Wisconsin: Oneida Nation

Director of the Urban Indian Health Institute and Executive Vice President of the Seattle Indian Health Board Abigail Echo-Hawk, MA (Pawnee) reframes the language we use when describing disparities and inequities. Echo-Hawk points out that it is not accurate to call out disparities within Indigenous communities; instead, Indigenous communities have disparities because of the systems that oppress them. 

Echo-Hawk and other USBC presenters asked participants to consider the implications of the term evidence-based. Historically and recently in the context of the COVID-19 pandemic, American Indian and Alaska Native populations have been left out of public health surveillance data, coined as Data Genocide. A parallel phenomenon is happening in API communities too.

Photo by RODNAE Productions: https://www.pexels.com/photo/man-love-woman-joy-8298421/

Alternatives suggested to evidence-based were community-based, people-informed and practice-based.  Another term to consider here is culturally rigorous science which is for and by the people.  

Hummingbird Indigenous Doula Services is a culturally responsive, full-spectrum, Indigenous doula program, proudly not rooted in “evidence”. Instead, it’s a community designed program and as Camie Jae Goldhammer,  MSW, LICSW, IBCLC, (Sisseton-Wahpeton) points out, it was specifically funded because “the outcomes are amazing” thanks to their people-based approaches. 

In the comments during these sessions, there were requests to do away with the word minority ASAP. 

Mr. Rashaad Lambert, Director Of Culture & Community @ Forbes/Founder of For(bes)TheCulture explains in There Is Nothing Minor About Us’: Why Forbes Won’t Use The Term Minority To Classify Black And Brown People, “…Non-whites are already a majority of the world’s population. Second, in my lifetime, people of color will compose a majority in America. Finally, as any Black or Brown person will tell you (and as echoed in the words of Prince), there is nothing minor about us.” 

Stay tuned next week for Part Two.

Facilitating the bond between children and fathers or male-identifying partners

 There’s quite a bit of literature on why it is important for fathers to support breastfeeding, and robust recommendations on how fathers can be good support people.

Photo by Anna Shvets: https://www.pexels.com/photo/a-man-in-blue-long-sleeves-playing-with-his-baby-11369399/

Specifically in Black communities though, there’s a “lack of resources for men to learn about and advocate for breastfeeding.”  George W. Bugg, Jr, et al. write in Breastfeeding Communities for Fatherhood: Laying the Groundwork for the Black Fatherhood, Brotherhood, and Manhood Movement  that “Black men deserve to be educated in culturally competent ways about prenatal and postpartum care to advocate for their partners. This is not happening in a systematic way in the Black community. In the Reproductive Justice space, Black men are basically being treated as if they are invisible.” 

As a whole, our nation lacks support for fathers and male identifying partners to bond with their babies. The father–infant relationship should be honored “in its own framework rather than as an alternative to mother–infant theory.” (Cheng 2011

Author Carolynn Darrell Cheng, et al points out in Supporting Fathering Through Infant Massage that “fathers may feel dissatisfied with their ability to form a close attachment with their infants in the early postpartum period, which, in turn, may increase their parent-related stress.”

Photo by Caroline Hernandez on Unsplash

Infant massage is such a neglected modality, especially in the NICU, where it reduces both the risk of sepsis and bilirubin levels, and gets babies home sooner because their brains mature more quickly and they gain weight faster,” Nikki Lee points out. 

Beyond its benefits to infants, Cheng and colleagues have found that “infant massage appears to be a viable option for teaching fathers caregiving sensitivity.” Their work showed that “fathers were helped by increasing their feelings of competence, role acceptance, spousal support, attachment, and health and by decreasing feelings of isolation and depression. Although not all fathers saw the direct benefit of infant massage instruction, they did note they enjoyed participating in an activity that gave them special time with their infants and appreciated the opportunity to meet other fathers.” 

More broadly, skin-to-skin contact has a positive effect on paternal attachment.  

The results from Effects of Father-Neonate Skin-to-Skin Contact on Attachment: A Randomized Controlled Trial identified touching as the highest-scoring Father-Child Attachment Scale (FCAS) subscale. 

Ontario artist Lindsay Foster’s viral image of fathers BJ Barone and Frankie Nelson meeting Baby Milo captures perfectly the flood of oxytocin that skin-to-skin affords fathers and male-identifying parents.

Fathers BJ (left) and Frankie (right) embrace their seconds-old-newborn boy Milo. Milo’s umbilical cord is still attached to the surrogate in this image.
Photo by Ontario artist Lindsay Foster.
Formerly published in: http://www.ourmilkyway.org/skin-to-skin-image-goes-viral/

The World Alliance for Breastfeeding Action (WABA) identifies other ways in which fathers can be “empowered by a whole-of-society approach to fulfill their fathering capacity.” 

WABA suggests that fathers should be engaged and involved throughout the 1,000 days and health systems and care providers can provide knowledge on breastfeeding through antenatal visits, other breastfeeding classes and enabling their participation during labor and delivery and postnatally. 

Sufficient paternity or parental leave is vital to allow time to care for and bond with their new family. 

There is also “a need for greater vigilance against promotion and unethical marketing of breastmilk substitutes targeting fathers to ensure that they also get unbiased information.” [More here.] 

In our national sphere of advocacy, last month, Foundations of Fatherhood Summit hosted Wide World of Fathering  with a mission to advance fatherhood and families in Michigan communities and beyond. The speaker lineup was full of individuals passionate about fatherhood and working to shift the way we view males as parents. 

Presenter Reginald Day, CLC for instance, hosts a podcast called Get At Me Dad which reveals the true narrative of BIPOC fathers–”present, connected and raising strong families.”

Father-son duo Mark and Corey Perlman host another podcast called Nurturing Fathers based on the Nurturing Fathers Program

Last week, New Mexico Breastfeeding Task Force Board Member Francisco J. Ronquillo hosted a Hearing our Voices virtual roundtable for fathers and male-identifying partners. 

Reaching Our Brothers Everywhere (ROBE), an organization which seeks to educate, equip, and empower men to impact an increase in breastfeeding rates and a decrease in infant mortality rates within the African-American communities, hosts a monthly virtual call where males can discuss maternal child health related topics.   

In partnership with Reaching Our Sisters Everywhere (ROSE), ROBE will host the 11th Annual Breastfeeding and Equity Summit in New Orleans from August 25  to 27, 2022 where presentations center on equity in breastfeeding, maternal health, fathers and partners, and infant health initiatives.

 

Our Milky Way past coverage on fathers

Photo by PNW Production: https://www.pexels.com/photo/a-family-walking-together-on-a-boardwalk-8576210/

New CLC engages fathers, supports breastfeeding, heals communities

Fathers profoundly influence breastfeeding outcomes

Founder of Fathers’ Uplift adopted into breastfeeding movement

The Institute of Family & Community Impact hosts event to boost paternal mental health

Paternal mental health and engagement

Robert A. Lee, MA answers the call

A lasting bond 

Skin to skin image goes viral

Changing families demand changing policies

22 more actions in 2022

 In our third installment of 22 in 2022, we bring you 22 MORE Actions in 2022, because there is always work to do. 

Source: United States Breastfeeding Committee

22 in 2022 was inspired by Life Kit’s 22 Tips for 2022, and we hope it provides inspiration for you to forge forward with this important work.

  1. Learn about the Girls’ Bill of Rights. Empowered women start with empowered girls. 
  2. Watch a film centered around maternal child health like  A Doula Story, The Milky Way breastfeeding documentary, Chocolate Milk, Zero Weeks, Legacy Power Voice: Movements in Black Midwifery or register to play Factuality
  3. Identify and network with an individual or organization with a mission that intersects with maternal child health. This shouldn’t be a challenge… “All roads lead to breastfeeding!” (A popular adage at Healthy Children Project.)  Often, we find ourselves preaching to the choir, shouting in an echo chamber, whatever you want to call it. It’s time to reach beyond our normal audience. 
  4. Follow Dr. Magdelena Whoolery on social media to stay up to date on strategies that combat the multi-billion dollar artificial baby milk industry. 
  5. Sign on to USBC’s organizational letter in support of the DEMAND Act of 2022.
  6. Congratulate, encourage or simply smile at a mother. 
  7. Explore White Ribbon Alliance’s work around respectful care. You can start by watching this poignant webinar Healthcare Professionals Honoring Women’s Demands for Respectful Care
  8. Read The First Food System: The importance of breastfeeding in global food systems discussions.
  9. Read Lactation in quarantine: The (in)visibility of human milk feeding during the COVID-19 pandemic in the United States
  10. Sign this petition to stop unethical formula research on babies. 
  11. Check out the updated Center for WorkLife Law’s Winning New Rights for Lactating Workers: An Advocate’s Toolkit
  12. Register for a free PQI Innovation webinar.
  13. Read the revised Academy of Breastfeeding Medicine (ABM) Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads here
  14. Gear up for World Breastfeeding Week 2022 and National Breastfeeding Month. 
  15. Check out this NIH project Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project which seeks a deeper understanding of human milk biology to address ongoing and emerging questions about infant feeding practices.  
  16. Learn about the Melanated Mammary Atlas.
  17. Consider becoming a ROSE community transformer or share the opportunity with someone who may be interested. 
  18. Get familiar with WHO’s recent report How the marketing of formula milk influences our decisions on infant feeding and disseminate the corresponding infographics
  19. Sensitize journalists and the media to stimulate public debate on the links between breastfeeding and the climate crisis as suggested by the World Alliance for Breastfeeding Action (WABA).
  20. Get to know how breastfeeding and proper nutrition fits into the Sustainable Development Goals (SDGs)
  21. Access one of the National Institute for Children’s Health Quality’s (NICHQ) webinars on breastfeeding, infant health, early childhood or health equity here
  22. Engage with the PUMP Act Toolkit! This is crucial, time-sensitive work that will make a huge difference for families across our nation.

Read our original list of 22 Actions here and our celebration of unsung sheroes/heroes here