NSRH Blog
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  • 1 Mar 2019 1:41 PM | Anonymous

    NSRH is proud to join our fellow healthcare organizations in standing up to the latest attack on Title X with the following statement...

    The Final Title X Regulation Disregards Expert Opinion and Evidence-Based Practices

    February 26, 2019

    Washington, D.C. – The Department of Health and Human Services has released a final regulation that will significantly limit the health care available to patients under Title X of the Public Health Service Act (Title X). Leading women’s health care provider groups, medical organizations, and physician leaders representing more than 4.3 million health care providers are alarmed by the new regulation which disregards the expertise of the medical and scientific community and evidence-based standards.


    “As the only federal program exclusively dedicated to providing low-income patients, including adolescents, with access to family planning and preventive health services and information, Title X plays a vital role in the fabric of America’s family planning safety net. The final regulation is the latest of numerous recent decisions—from rolling back insurance coverage for contraceptives to attempting to eliminate funding for evidence-based teen pregnancy prevention programs—that unravel the threads of this safety net. Together, these decisions compound, leaving women and families with increasingly fewer options for obtaining medically accurate, affordable, and timely access to contraception and preventive care.

    “The new regulation weakens existing standards requiring that family planning programs funded through Title X offer a range of evidence-based contraception options. It also conditions federal funding for family planning services on a requirement that providers omit certain information in counseling patients and seeks to exclude qualified providers from Title X.

    “This regulation will do indelible harm to the health of Americans and to the relationship between patients and their providers. By forcing providers to omit critical information about health care and resources available, the final regulation directly undermines patients’ confidence in their care.

    “There is no room for politics in the exam room. For the health of the American people, every individual must have access to comprehensive, affordable care in a safe and timely fashion, just as every provider must be able to deliver medically accurate information and care. The administration should retract this regulation and consider the record volume of comments from the medical, scientific, and patient advocacy communities. Family planning policy should be driven by facts, evidence, and necessity, not politics and ideology.”


  • 19 Feb 2019 2:48 PM | Anonymous

    UPenn students publish letter calling out abortion myths and access issues in aftermath of 2019 State of the Union. 


    In a time of great division and attacks on so many of our basic human rights, it is bold and thoughtful collaborations at the local level that will help us chart the way forward. NSRH is proud of the University of Pennsylvania chapter and student leaders from If/When/How and Medical Students for Choice (MSFC) who published a compelling letter to their campus community in response to the recent State of the Union.

    "We love our relationship with If/When/How and MSFC, and we are proud to co-sign the letter. I hope it encourages other chapters to connect with the organizations on their campus," stated NSRH Chapter leader Katrina Lipinsky.

    NSRH is always ready to promote the work of our local leaders on campuses and in clinics across the country who are advocating for sexual and reproductive health for all. Check out the full statement below, drafted by Sabrina Merold, Penn Law '20, Co-Chair of Penn If/When/How. Way to go UPenn!


                               



    To the Penn Community:

    Over the past few weeks, politicians, the media, and the President have escalated their dissemination of inflammatory anti-choice inaccuracies about abortion later in pregnancy. This is a deliberate effort to obfuscate discussion of abortion regulation and deny Americans the right to make necessary reproductive healthcare choices.

    Penn Law If/When/How, Penn Nursing Students for Sexual and Reproductive Health, and Penn Medical Students for Choice want to call out these lies and center the conversation in medically accurate facts, the law, and the experiences of individuals who have had abortions later in pregnancy. All members of an educational community - even those who may not feel a personal connection to the issue -  are obligated to pay attention to these facts.

    Abortion is healthcare, a private medical decision, and a constitutionally protected right. By the age of 45, 1 in 4 women will have had an abortion. No one who has had an abortion, at any stage in pregnancy, owes anyone - especially a politician - an explanation.

    “Late-term” abortion is a medically inaccurate and vague term. Bills that seek to ban “late-term” abortions refer to abortions that happen after 20 weeks. Abortion care is needed after the first trimester for a variety of reasons, including serious health problems, fetal abnormalities, delays in finding out about the pregnancy, and difficulties accessing abortion services due to egregious legal and financial barriers.

    We join legal experts in calling 20-week abortion bans unconstitutional under Roe v. Wade. Roe established the right to an abortion in the United States up until fetal viability (determined by doctors to be around 24 weeks gestation) and stated that abortion is legal after viability if the pregnant person’s life or health is threatened. Laws banning abortions at 20 weeks have been blocked in Arizona and Idaho.  In January 2018, the Senate rejected a federal ban.

    Anti-choice politicians, including the president, have responded to recent and proposed legislation in New York and Virginia by brazenly spouting lies. Most egregiously, these laws have been characterized as “infanticide,” “post-term abortion,” and “allow[ing] a baby to be ripped from the mother's womb moments from birth.” We believe politicians and the media must be held accountable for such distortions, as in reality:

    • On January 22, 2019, New York Governor Andrew Cuomo signed the Reproductive Health Act, codifying Roe v. Wade into state law. Under New York’s old law, which had been in place since 1970, abortion was legal during the first 24 weeks of pregnancy and a pregnant person could only get an abortion after 24 weeks if their life was in danger. The Reproductive Health Act moves abortion regulations from the state’s criminal code to the health code. It also allows a healthcare practitioner to perform an abortion after 24 weeks if the pregnant person’s health is threatened or if the fetus would be unable to survive outside the womb.
    • In Virginia, third-trimester abortions are allowed when the treating physician and two other doctors determine that continuing a pregnancy would result in death or “substantially and irremediably impair the mental or physical health of the woman.” Virginia House Bill 2491 would simply end the requirement for two additional doctors to sign off and strike “substantially and irremediably” from the current law, ending medically unnecessary barriers that keep pregnant people from accessing healthcare.

    Any conversation about abortions later in pregnancy must center the voices and experiences of individuals who have needed this form of healthcare.  In a recent open letter, many such individuals wrote, “We are not monsters. We are your family, your neighbors, someone you love. We are you, just in different circumstances.”

    We urge you read their open letter and respond to their call for “Americans to weigh the restrictions on later abortion against our stories, not the hypothetical cases that have been fabricated to win political points.” We also urge you to witness the story of Erika Christensen, a New Yorker forced to travel to Colorado to get an abortion in the third trimester of her pregnancy after she was told her fetus had a condition that would be fatal soon after birth. The cost of the abortion at the clinic in Colorado was $25,000.

    In order to achieve reproductive justice we must understand the harm such restrictions inflict on women, people of color, families, and other marginalized communities. A term coined by women of color, reproductive justice is “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” Penn Law If/When/How strives to center our advocacy and pro bono service in this framework. In the words of Stacey Abrams during her rebuttal to the State of the Union, “America achieved a measure of reproductive justice in Roe v. Wade, but we must never forget it is immoral to allow politicians to harm women and families to advance a political agenda.” Future medical and legal professionals - and all members of educational communities - must understand that abortion restrictions disproportionately harm people of color and low-income people. We must center the voices of individuals with marginalized identities - too often excluded from mainstream media -  in conversations on abortions later in pregnancy.


    Penn Law If/When/How

    Penn Nursing Students for Sexual and Reproductive Health

    Penn Medical Students for Choice                                                                                                                                                                                                                                               
  • 29 Aug 2018 11:17 AM | Anonymous

    #NursesforSRH #EndHyde #BOLDIgnited

    The NSRH Nursing Students of Color Caucus wants you to join All* Above All’s BOLD Ignited! Campaign and plan an event in your community on Sunday, September 30th, the anniversary of the Hyde Amendment. 

    For 42 years, the Hyde Amendment, which blocks federal Medicaid funding for abortion services, has restricted access to critical reproductive healthcare. Today, we see an increasing number of policies targeting not only access to abortion care but maternal, contraceptive, and gender affirming care, just to name a few. These policies are having direct consequences for our patients, particularly for people of color, migrants, and the LGBTQ community. 

    As nurses, midwives and students, we struggle to provide compassionate, comprehensive healthcare every day. But we know that the struggle does not stop there...we have a duty to advocate for the rights of our patients! This means we take to our clinics, our campuses, and our nursing and healthcare communities to light the path towards sexual and reproductive healthcare and justice...for all. 

    As part of the campaign, we are asking you to plan an event that highlights your dreams, values, and commitment to sexual and reproductive healthcare. We want events that pose critical questions like: What does reproductive justice look like for you as a student, nurse, or midwife? How can I advocate for greater access to abortion services on my campus, in my community, and in my state? Most of all, we want events that build community and continue to grow and emBOLDen our vibrant nurse community! 

    Additional event funding support and All* Above All event SWAG is available upon request. Please contact cassandra@nsrh.org if interested.

    In the theme of boldy igniting the path forward, we suggest organizing one of the events below. For other event ideas, please check out All* Above All’s toolkit (pw: BOLDIgnited!2018).

    • Flashlight Clinic Escorts: Organize a volunteer group to do night-time clinic escorts.
    • Cosmic Bowling: Organize a cosmic bowling fundraiser for your local abortion fund. For more on abortion funds in your area, visit nnaf.org.
    • GlowUp & Be BOLD Movie Night: Host a movie night with glow sticks, glow-in-the dark poprocks, and other glowing treats. Use the film to spark conversation about ways to advocate for sexual and reproductive healthcare in your community. Suggested films include:
       
      • Trapped (Netflix)- This documentary “follows the struggles of the clinic workers and lawyers who are on the front lines of a battle to keep abortion safe and legal for millions of American women.” (from website).
      • Vessel (Netflix/Itunes)- This documentary follows one doctors attempt to expose the realities created by global anti-abortion laws by legally offering abortions on a ship, in offshore waters.
      • The Abortion Diaries (Vimeo)- This documentary features 12 women who speak candidly about their experiences with abortion.
      • When Abortion Was Illegal: The Untold Stories (Vimeo)- This documentary explores the era when abortion was illegal, from the end of the mid-19th century through the Roe v. Wade Supreme Court decision in 1973.
      • After Tiller: This documentary features the only four doctors left in the US who openly provide third-trimester abortions since the assassination of Dr. George Tiller in Kansas in May 2009. 

    The Nursing Students of Color Caucus is a project of NSRH. For information on the group or how to join, please contact Alli Mitchell at Allidoulalove@gmail.com.

  • 27 Jun 2018 8:01 AM | Anonymous

    Nurses at the Forefront of Change:

    Advancing Comprehensive, Compassionate Sexual and Reproductive Healthcare for All


    Nurses for Sexual and Reproductive Health is now accepting presentation proposals for our 6th Annual Conference, Nurses at the Forefront of Change, which will be held in Atlanta, Georgia from October 26-28th, 2018!


    Nursing Students for Sexual and Reproductive Health is now Nurses for Sexual and Reproductive Health (NSRH)! We have recently expanded our mission to include nurses, nurse practitioners, and midwives who are students, faculty, clinicians and researchers. In order to realize our bold and ambitious new vision, we are inviting our network of nursing students, nurses and midwives to help us chart this vibrant future of sexual and reproductive health (SRH) for all. This requires that we be prepared to serve, not only as skilled providers, but also as agents of social change.


    The 2018 NSRH Activist Conference will be a space where we can build community, incubate bold ideas, and learn innovative skills. We want to know, from you: What do we as nurses and midwives need to do to make compassionate, comprehensive sexual and reproductive healthcare available to all?


    In addition to interactive sessions, we will hear from nurses on the ground about what they are facing in their nursing programs, in their advocacy work and at their clinics. We will learn about the latest studies and trauma-informed methods in SRH. We will listen and learn from nurses of color about what it means to incorporate Reproductive Justice into nursing. We will work together to advance a new role for nurses as leaders in SRH. We are a powerful and beloved community of care providers...it’s our time to shine!


    Proposals should be for 90 minute presentations and include a title, paragraph summary, clearly stated objectives, target audience and desired materials/tech needed. We are looking for presentations that ideally include the following:


    • At least 20-30 minutes of interactive activity and/or audience engagement. This can include Q & A; group/partner work; role-playing; journaling or visioning exercises; opinion polling and/or icebreaker activities; or case study analysis and discussion.
    • CREATIVITY. We encourage presenters to consider using dynamic presentation models, such as the Prezi software, to achieve more interactive, engaging presentations. You can watch this video to learn more, and also visit prezi.com to sign-up for your free account!
    • Topics that address one or more of the following areas: clinical training and education in SRH, nurse advocacy and activism, nursing school curriculum change, nurse scope of practice in abortion care, reproductive justice in nursing, advancing nurses as healthcare leaders
    • INCLUSIVITY. All presentations should be inclusive and incorporate discussion and content related to gender and sexuality, racism and bias, and reproductive justice.

    Proposals will be accepted on a rolling basis until August 13th, 2018. Please email your proposal to cassandra@nsrh.org. Please use ‘NSRH Conference Proposal’ in the Subject line and send all content as Word or PDF attachments, NOT in the body of the email.


    Upon selection, presenters will be offered free conference registration. AV and technical support should be discussed with NSRH staff prior to October 1st, 2018. Additional financial support may be available and should be discussed with NSRH staff, as needed.



  • 25 May 2018 1:59 PM | Anonymous

    Nurses for Sexual and Reproductive Health (NSRH) has joined with other organizations to oppose proposed changes to Title X that would severely decrease access to essential healthcare services. Following is the response signed on to by ACOG, AAP, ACNM, ACP, APAOG, NPWH, NSRH and SAHM:



    America's Women's Health Providers Oppose Efforts to Exclude Qualified Providers from Federally-Funded Programs

     

    May 23, 2018

    Washington, D.C. -- The American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), the American College of Nurse-Midwives (ACNM), the American College of Physicians (ACP), the Association for Physician Assistants in Obstetrics and Gynecology (APAOG), the National Association of Nurse Practitioners in Women's Health (NPWH), Nurses for Sexual and Reproductive Health (NSRH), and the Society for Adolescent Health and Medicine (SAHM) released the following statement in response to the Trump administration's proposed rule restricting qualified providers from federally-funded programs:  

    Organizations representing over 300,000 women and children's health providers oppose all efforts to exclude qualified women's health service providers and limit health care information through the Title X program.

    Politicians have no role in picking and choosing among qualified providers. Title X is the only federal program exclusively dedicated to providing low-income and adolescent patients with access to essential family planning and preventive health services and information. Under this proposed rule, more than 40 percent of Title X patients are at risk of losing access to critical primary and preventive care services. Further, patients served by Title X will lose access to meaningful health information. The proposed rule dangerously intrudes on the patient-provider relationship.

    Restricting access to care and information will increase rates of unplanned pregnancy, pregnancy complications, and undiagnosed medical conditions. It will reverse decades of progress that have brought our nation to a 30-year low for unplanned pregnancy and record low teen pregnancy rates. These public health victories are due in large part to the good work of the Title X program and qualified providers who offer high-quality patient care. The administration should advance policies that continue this positive trend, not undermine it.

    Policy decisions about women's health must be firmly rooted in science, and increase access to safe, effective and timely care. Together we strongly urge the administration to put patients first and withdraw this proposed rule without delay. Our organizations will submit comments to further highlight the dangerous negative impact of women's health and the patient-provider relationship. 

    NSRH Comments on the Proposed Rule

    As nurses, midwives, and providers of sexual and reproductive healthcare, we are concerned and emboldened by this administration's attempt to deny critical healthcare to patients. We know, firsthand, that access to information about healthcare is as important as access to care itself, and this rule serves to restrict us as providers from giving our patients needed healthcare information. Furthermore, restricting funding of essential services directly impacts working class people, denying them access to healthcare as their basic human right. We join our colleagues in calling for the withdrawal of this rule, while remaining committed to providing compassionate and comprehensive sexual and reproductive healthcare to all, regardless of economic status or identity.


    You Will Be Able to Respond

    The federal government will make a site available for public comments on the proposed rule. We will provide you with a link to the site as soon as it is up and running.

  • 27 Mar 2018 10:49 AM | Anonymous

    NSRH applauds the American College of Nurse-Midwives’ (ACNM) newly announced Position Statement “Midwives as Abortion Providers,” released the week after the National Academy of Sciences, Engineering, and Medicine (NASEM) Report “The Safety and Quality of Abortion Care in the United States.” 

    The American College of Nurse Midwives represents Certified Midwives and Certified Nurse Midwives in the United States and their new Position Statement acknowledging, validating, and supporting “Midwives as Abortion Providers” and abortion as a vital component of sexual and reproductive healthcare is an important endorsement of the role of midwives in abortion care.

    Continue reading Stephanie Tillman's comments on ACNM's Position Statement. Ms. Tillman, CNM, is Chair of the NSRH Board of Directors.


  • 26 Mar 2018 9:12 AM | Anonymous

    After a landmark study, a committee convened by the National Academies of Science, Engineering, and Medicine (NASEM) released a comprehensive report, "The Safety and Quality of Abortion Care in the United States." The report unambiguously concludes that "legal abortions in the United States - whether by medications, aspiration, dilation and evacuation (D&E), or induction - are safe and effective."

    "The report examines evidence related to safety and quality of abortion services by Advanced Practice Clinicians, including Nurse Midwives, Nurse Practitioners, and Physician Assistants, and unequivocally highlights the important role that these clinicians can and do play in abortion provision." Continue reading Stephanie Tillman's comments on the study. She includes links to the full report and other resources. Stephanie is Chair of the NSRH Board of Directors. 

    Since the report was released, new resources have become available:


  • 2 Aug 2017 1:58 PM | Anonymous

    Written by Katherine McMahon

    The United States has incomparable rates of incarceration, and in 2015 there were 111,495 women in state and federal prisons. It is estimated that in 2005, 80% of incarcerated women were already mothers of young children. Many of the women who are incarcerated are young, have committed non-violent crimes and are first time offenders. There are a variety of factors that contribute to incarceration (race, economic injustice, unequal access to education and employment). Women can enter jail under a variety of circumstances, sometimes already mothers, often already pregnant, and sometimes unknowing of the fact that they are pregnant. In 2006 nearly 50% of all pregnancies were unplanned in the United States. Sometimes when a woman enters a correctional institution she is made aware of her pregnancy for the first time. The policy is for these women to be informed and have the full range of legally available options for continuing or terminating the pregnancy. Incarcerated women should have access to the same medical attention that a woman who is not incarcerated would have full access to.

    However, this medical care for incarcerated women is circumstantial and can vary from state to state and even jail to jail. There are very few specifics provided for the prison system to follow under the law, leaving each system to make their own rules and regulations over what medical needs they will cover. Stories of inadequate care abound. Incarcerated women who have asked their guards for medical attention because they believe they are in labor have experienced unnecessary delays. Women give birth in their cells with no medical staff to assist in cases of emergencies with the mother or the child, and even when they have access to medical attention they are often still shackled.

    The shackling of women during labor and delivery presents a significant danger to the safety and wellbeing of women and babies. Few states have laws banning the use of shackles during pregnancy, most states ignore the medical advice showing that shackles are unnecessary during labor. Obstetricians report being unable to find the guard to unlock shackles when an emergency cesarean section is needed, delaying emergency care. Women have filed complaints and publicized their stories about their long term health issues and injuries from being shackled during and after labor. Not to mention that this practice of shackling women while pregnant or in labor is demeaning and humiliating.

    Pregnant women are entitled to proper medical care by competent medical professionals. Criminal justice reform is needed in order to have stronger federal regulations over what medical care is provided to incarcerated women and how it is provided. Incarcerated women need advocates who are not behind bars, nurses and doctors prepared to fight for proper medical care and criminal justice reform. For more information about pregnant women behind bars check out some of these resources:

    Katherine McMahon is a third-year student at the University of Oregon in the School of Journalism and Communications. Originally from Seattle, Washington, Katherine has been involved in social justice since middle school. After working with organizations such as Legal Voice and Planned Parenthood, Katherine plans to pursue a career in journalistic social justice.

    Graphic courtesy of Bitch Media.

  • 7 Jul 2017 2:28 PM | Anonymous

    This blog post was written by Vanessa Shields, who is a member of the Gulf Coast chapter of NSSRH.

    I have worked with New Orleans Abortion Fund as an intake volunteer and clinic escort since 2014. The mission of the abortion fund is simple, we provide funding for abortions. Many of us are also clinic escorts at our local abortion clinic where weVanessa Shields ensure people visiting the clinic are able to enter the health care facility free from harassment. As a nurse, this volunteer work has enhanced my understanding of the struggles and barriers faced by members of my community to manage family planning and fertility, as well as the health and well-being of their families. My experiences working with the abortion fund have also made me more cognizant of state legislation around restricting access to reproductive health care, much of it scientifically inaccurate and lacking evidenced-based medical input. This is particularly relevant in the Deep South, where legislative efforts to chip away Roe v. Wade are a persistent threat. I am undoubtedly a better patient advocate, and more motivated social justice activist, because of my work with the abortion fund.

    I was honored to be published, in the national LGBT publication, The Advocate, last month, on why supporting abortion access is part of my Pride month. Pride, for me, means being an ally for people who have had abortions — because Pride is about celebrating all the ways we live, love, and build our chosen families. Read The Advocate Article!

    Vanessa lives in New Orleans, LA with her partner, two perpetually sleepy rescue dogs, and a sassy cat. She graduated from the accelerated BSN at Louisiana State University in 2017 and has a MA in International Politics from the University of Bradford, UK. Vanessa is a nurse for people living with HIV in New Orleans.


  • 16 May 2017 4:32 PM | Anonymous

    Over the past couple of years, NSSRH has been committed to expanding our scope of work beyond “choice”. While abortion care will always remain at the core of the work we do, we are actively moving toward embracing and supporting the Reproductive Justice framework. We have put out an organizational intention statement, updated our mission and vision, and went through a formal name change process. Most recently we created a position statement and core messaging that incorporates who we are, what we do, and why we are needed. As always, we welcome your feedback and thank you for your continued support.

    MISSION

    NSSRH is a national grassroots organization dedicated to providing nursing students with the education, tools, and resources necessary to become social change agents within the healthcare system as it relates to sexual and reproductive justice.

    POSITION STATEMENT

    Catalyst for social change, advancing holistic health with compassion, dignity and justice. For nursing students, faculty, alumni and allies, NSSRH is a recognized leader in advancing holistic, comprehensive sexual and reproductive health (SRH), including abortion, with compassion, dignity and justice. For over a decade, NSSRH has cultivated a bold and growing national network of grassroots nursing student activists to ensure the full spectrum of SRH education is integrated in nursing school curricula. NSSRH provides nursing students with the education, training and tools so they can make a difference in their patients’ daily lives, especially among the most marginalized and underserved communities.

    CORE MESSAGES

    • Compassion, Dignity, & Justice

    • We are nursing student activists and leaders, and we’re committed to providing holistic sexual and reproductive health care with compassion, dignity, and justice.

    WHO WE ARE

    • Nursing Students for Sexual and Reproductive Health (NSSRH) is a catalyst for social change and a recognized leader fostering a bold and growing national grassroots network of nursing student activists.

    • NSSRH is the leading organization founded by and for nursing students that has continued to embolden, inspire, and support nursing student leaders, providing them with the necessary tools, skills, and opportunities to become powerful agents of social change.

    • NSSRH is a national organization supporting sexual and reproductive health and justice through grassroots power-building and advocacy to transform nursing education.

    WHAT WE DO

    • We advance holistic sexual and reproductive health with compassion, dignity, and justice.

    • We provide nursing students with education, training, and tools to make a difference in their patients’ health and lives, while elevating the dignity and justice of the most marginalized and underserved communities.

    • We elevate the voice of nurse leaders before key decision makers to ensure the full spectrum of sexual and reproductive health education, including abortion, is integrated into nursing school curricula.

    • We believe holistic, comprehensive sexual and reproductive health education and services should include the full spectrum of care necessary to support decision-making around sexuality, gender identity and expression, reproduction, and pregnancy.

    • We stand in solidarity with the Reproductive Justice and social justice movements to advance inclusion, equity, and dignity, and challenge systems that marginalize and harm people of color, young people, immigrants, LGBTQ people, and rural and low-income communities.

    WHY WE’RE NEEDED/IMPACT

    • Ensuring that sexual and reproductive health is included in nursing school curricula is critical to prepare nurses to meet the needs of our patients. We are working to fill that gap and transform the nursing education landscape.

    • Many of us seek a nursing education because we want to change the world by providing holistic care with compassion and dignity. Unfortunately, if we support sexual, reproductive, and gender-affirming health care we may feel isolated at nursing school, or that the educational program doesn’t meet our needs. NSSRH creates a space where students come to find community and connect with like-minded people, advance educational goals, and build empowerment.

    • We are building a nursing student activist corps to ensure that a full spectrum of sexual and reproductive health education is integrated into nursing school programs and prepare the next generation of nurses to provide quality care, including for the most marginalized and underserved communities.

    Thanks to ConwayStrategic for their partnership in messaging creation.


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