SNAP: Hunger in America

Introduction

In 1951, the first food stamp bill was introduced to the United States. From there on out, food assistance programs in the United States have served hundreds of millions of people to date. The Supplemental Nutrition Assistance Program (SNAP) started in the 1970s and groups of doctors have proven that the program dramatically reduced hunger in America. Strict regulations surround the program and are constantly changing to help people from abusing the money they are given, only about 2% of people actually abuse the SNAP program. According to Feeding America, in 2017 “40 million Americans struggle with hunger, the same as the number of people officially living in poverty.” This alarming statistic is clearly a huge trigger for the welfare state of America and something needs to be done about it. Poverty and hunger cannot be solved in a day or a month, but over time and with the help of many strong policies and other actions, these two social problems can hopefully one day be diminished. This paper will show how food programs such as SNAP, WIC, and the National School Lunch Program are effective and useful in helping address hunger in America.

This paper will discuss and examine three major federal food assistance program— the Supplemental Nutrition Assistance Program (SNAP); the National School Lunch Program and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). In 2017, “58% of food-insecure households participated in at least one of the major federal food assistance program”(Feeding America).

Programs and Policies

SNAP provides necessary nutritional support for low-wage working families, low-income seniors, and people with disabilities living on fixed incomes. After unemployment insurance, SNAP is the most active federal program granting additional assistance during economic downturns. The federal government handles the complete cost of SNAP benefits and divides the cost of administering the program with the states, which conduct the program. SNAP is a unique policy due to its nonrestrictive qualities. SNAP is accessible to almost all households with low incomes. SNAP addresses the issue of hunger in America by helping support the funding needed to get food. In order to be eliglible, the closer one is to the poverty line the more assistance one will receive.

About 70% of people who receive food assistance through SNAP are families and households. Parents need aid to support their kids and get food on the table. The cost of living for a family of 5 is higher than the cost of living to support one. Policymakers put this thought into action when designing this policy. This is why SNAP has been a successful stable policy for over 100 years.  Not much has changed for the program other than the way the money is given out to participants. This goes to show the effectiveness of the program and the continuous need for it.

Another policy that helps limit hunger in America is The National School Lunch Program. The National School Lunch Program helps feed children all across the United States, “22 million children in the United States rely on the free or reduced-price lunch they receive at school, and every one of them is eligible for free breakfast as well.” (Feeding America, 2018). By definition “The National School Lunch Program (NSLP) is a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low-cost or free lunches to children each school day. The program was established under the National School Lunch Act, signed by President Harry Truman in 1946.”(FNS, 2018).

The last major federal food assistance program this paper will analyze is the Special Supplemental Nutrition Program for Women, Infants, and Children, also known as WIC, which serves 53% of infants born in the United States, (FNS, 2018). The Special Supplemental Nutrition Program for Women, Infants, and Children “serves to safeguard the health of low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating including breastfeeding promotion and support, and referrals to health care,”(FNS). The basic eligibility requirement for WIC is a family income below 185% of the

federal poverty level

. This program is massive and serves about half of infants born in the United States.

Demographics and Costs

Poverty and hunger sadly do not exclude anyone. According to The Supplemental Nutrition Assistance Program in Fiscal Year 2017, SNAP reached: 42 million participants in the United States, or 13% of the total population (1 in 8), (FNS, 2018). In December 2017, SNAP had 41 thousand people participating in the food assistance program with 20,376 participating households. The total cost of the program was $6,112 million (FNS, 2018). Close to 70 percent of SNAP participants are in families including children; almost a third are in households with seniors or people with disabilities.

In December 2017, 29,636 children were participating in the National School Lunch Program and of that 21,695 million were receiving Free-Reduced Lunches. 391.5 million total school lunches were given out in the program and of that 67.19% were free and 6% were at a reduced price. This cost the NSLP is $1,109 million (FNS, 2018).

In 2015, 15 million mothers were eligible for WIC, while only 7.94 million participated in receiving benefits from WIC. “The estimates of program eligibility consider poverty level, adjunctive income eligibility (e.g., due to participation in the Supplemental Nutrition Assistance Program [SNAP], Medicaid, or Temporary Assistance for Needy Families [TANF]), national estimates of nutritional risk, and national- and State-level estimates of the duration of breastfeeding. The estimates of program coverage are derived using USDA Food and Nutrition Service’s” (FNS). This group of eligible mothers consists of all races and ages. Coverage rates are highest for Hispanic 62.7% and lowest for non-Hispanic 42.2% and coverage for Black only non-Hispanic was 57%.  Those in the Western region had the highest coverage rate of 605 and those in the Mountain Plains region had the lowest coverage rate of 43.5%. (United States Department of Agriculture, 2016).

History of SNAP

The foundation for SNAP was first built in 1933 as part of the Agricultural Adjustment Act (AAA). The program was referred to as the Federal Surplus Relief Corporation. This program was established in the midst of the Great Depression when prices for crops fell dramatically and farms across America were struggling to deal with the excess supply.

To formalize this food distribution and to avoid duplicating efforts by local relief agencies, Secretary of Agriculture, Henry Wallace, created the Food Stamp Program in the United States. The initiative called the “Food Stamps Plan,” was implemented in 1939 under the administration of President Franklin D. Roosevelt as a key component of the New Deal program. Food assistance was made available to low-income individuals through the purchase of food stamps and the provision of additional bonus stamps that could be used to purchase specific foods identified as being in surplus.

Up until 2008, SNAP underwent a lot of trial and error between presidencies to make the program stable and uniform. In 2008, legislators focused on restructuring the food stamps program to place greater emphasis on nutrition. While this program provides money for food, nutrition is now a huge goal for the program as well and SNAP is now the most important health and nutrition initiative currently in the United States. There are now many proposals ensuring the program promotes healthy eating and nutrition.

On February 7, 2014, President Obama signed the 2014 Farm Bill (also known as the Agricultural Act of 2014) into law. The legislation made many changes to SNAP, which the Food and Nutrition Service (FNS) has begun to implement. The 2014 legislation re-authorizing SNAP does not permit benefits to be used to purchase alcoholic beverages, tobacco products, hot food and any food sold for on-premises consumption. Therefore, soft drinks, candy, cookies, snack crackers, and ice cream are all eligible items for purchase with SNAP benefits. In the years ahead, stakeholders will be discussing how to improve nutrition among program participants now and in anticipation of the next Farm Bill. In 2015, the USDA awarded $31.5 million in funding to local, state, and national organizations to support programs that help participants in the Supplemental Nutrition Assistance Program (SNAP) increase their purchase of fruits and vegetables.

Implementation

The goal of SNAP is to reduce hunger in America and help get working and non-working families the food assistance they need. SNAP gives families the opportunity to buy their own groceries and get the nutrients they need. The closer a family is to the poverty line the more benefits they receive in order to get an adequate diet. If a family has a higher income they do not need the same assistance as someone who is closer to the poverty line. The federal government has “spent about $70 billion on SNAP and other food assistance programs.  93% percent of SNAP spending went directly to benefits that households used to purchase food, and 6.5 percent went to state administrative costs, including eligibility determinations, employment and training and nutrition education for SNAP households, and anti-fraud activities,”(Policy Basics, 2018). Funding from the government goes right into the main bulk of the policy. There is no waste of money that’s left to be spent. Only 6.5% goes towards administrative costs because there is really nothing other than paperwork to be done for the program.

Policy members have chosen to address the problem this way because it is efficient. Having a card that loads every month with specific benefits ensures participants are reducing program fraud, ensuring ease of use of food benefits by program participants, and to reduces the stigma associated with using food stamps for purchases. Having a card eliminates the stigma surrounding food stamps. Going to the food store with stamps was embarrassing for participants because it was obvious participants needed assistance. With a card, the feeling of embarrassment and the stigma around the stamps is eliminated. This enclines participants to use the program more and get what they need out of it. The application of a card is flexible and is why the policy works so well.  This allows families the freedom of buying what they like with a controlled amount set up by the federal government. The card is a uniform and simple way to implement the benefits of the policy.

For WIC, eligible participants are given a electronic benefits card to be used for a number of resources “ including health screening, nutrition and breastfeeding counseling, immunization screening and referral, substance abuse referral, and more,” (WIC Benefits, 2018). WIC also supplies food packages that have specific nutrients for WIC participants. This ensures women are getting the vitamins and supplements they need in order to have healthy breastmilk and healthy stomachs to support their child.

The theories behind these policies are that if food is supplied to families they have a better chance of getting back on their feet. When a child is in school, how would they be able to focus without breakfast or lunch? With the National School Lunch Program, the assistance is supplied to help that child succeed. When children perform better in school this gives them the platform and grades they need to then get better jobs and eventually help support our economy. This chain effect starts young, when a child is healthier they are happier and can focus better.

SNAP is now a seasoned program since it was first introduced into the government in 1933. First SNAP started with food stamps, but as technology advanced the benefits card was introduced to make the process easier. In the beginning of this program, participants would have to purchase food stamps to get more and now the government now fully funds this program for eligible participants. The approach of SNAP is generally the same from the beginning of time it just has been reworked and renewed to perfect the implementation process.

SNAP is administered at the state level but is funded federally. Each state gets to decide what the application process is for each family but most of the time households apply to the program if they are eligible, document eligibility including their income and residency, and have an interview which can be done over the phone. Households that are found eligible then get a benefits card that is loaded each month. These cards are able to be used in most supermarkets. Households “must reapply for SNAP periodically, typically every six to 12 months for most families and every 12 to 24 months for seniors and people with disabilities,” (Policy Basics, 2018).

WIC is funded federally, although “states, in turn, allocate the federal funds they receive to local WIC clinics that provide food vouchers and services to participants”(Policy Basics:WIC, 2018). The program for WIC has been around for so long because of its stable continual with healthier birth rates, more nutritious diets, stronger connections to preventative health care, and improved education.

The labor and service costs of SNAP is low. 6.5% of program funding goes toward state administrative costs while less than 1 percent went to federal administrative costs, (Policy Basics, 2018). Only about 8% of WIC funding goes towards administrative costs.

Relevance

The three policies discussed in this paper are relevant to fit our understanding of hunger in America. When citizens have the aid of food assistance they are able to worry less about putting food on their plates and have more time and energy to work and support their families.

The main issue associated with hunger in America is not the cost of food but the lack of resources families have in order to pay for food. Food paired with the cost of everything else families need, such as for paying for child care, clothing, living accommodations, and the time needed to work, take away from money to buy food. This is where SNAP and other food assistance programs come in. SNAP is not a program designed to eliminate hunger in America but it is a program designed to help and assist those in need of food to help better the welfare state of America and give those in poverty more nutritious and well-rounded diets. 2 out of 3 participants of SNAP are families, which is where WIC and the National School Lunch Program come in to assist as well. These three programs are the biggest and most important food assistance programs in America and in 2017 have helped over 5o million Americans.

The National School Lunch Program and WIC both serve to better the children of America. With the assistance of these two programs, impoverished children can get a comparable head start to children who come from affluent families. This levels the playing field for impoverished children’s physical and mental health and ultimately promotes better health outcomes in the future. These programs are proven to be effective since they were started. Statistics have backed up these programs to show they actually work and are beneficial to helping poverty and hunger in America.

Effectiveness and Efficiency

SNAP has been proven to be effective in many areas. When responding to the recession “policymakers deemed SNAP to be effective for this purpose because of its broad reach among low-income populations and its high efficiency,” (Rosenbaum, 2013). SNAP gained a huge load of cases after the stock market crashed in 2008. The Recovery Act helped SNAP balance the number of new cases as the economy began to recover. Also, SNAP is growing slower than the economy which means that is is not contributing to the national debt of the country, (Rosenbaum, 2013).

By helping assist families in getting the food they need, more time can be dedicated to working and more money can be spent on food. For every one dollar spent by SNAP users, $1.70 is put back into the economy. “Economists consider SNAP one of the most effective forms of economic stimulus.  Moody’s Analytics estimates that in a weak economy, every dollar increase in SNAP benefits generates about $1.70 in economic activity,”(Rosenbaum, 2013). This statistic proves another benefit of the SNAP program.

In my opinion, the most advantageous aspect of SNAP is the availability of participants able to utilize the benefits of the program. Once a family applies for aid and they are qualified, they will receive the benefits. All the household has to do is keep up with sending in papers about their finances supporting their cause or need for aid. Another advantage of SNAP is the ability of the program to

Conclusion

Based on the analysis of food assistance programs in America as discussed in this paper, we can assume these programs are highly efficient and beneficial to the welfare state of America.

Although a suggestion to be made to SNAP can be for the program to really crack down on what food participants can buy. Right now the electronic benefit card lets participants of SNAP buy most things in a grocery store but if restrictions were tighter, this could also benefit preventative health care in America. SNAP does work hard at giving participants nutritional support, but for instance, WIC gives help to pregnant and young child mothers assistance with supplemental foods, health care referrals, and nutrition education. WIC really goes in dept to the services it provides to its clients. Most people who are impoverished and are on SNAP are probably on other social service benefits too and could benefit from more nutritious food. The National School Lunch Program has a list of restrictions to help better the diet of the meals given out to children. SNAP could look to these two programs to help better the nutrition part of the policy to help better the nutrition of those in poverty.

References

• Cai, L., & NCHAKO, C. (2018, December 03). A Closer Look at Who Benefits from SNAP: State-by-State Fact Sheets. Retrieved from
  
  https://www.cbpp.org/research/food-assistance/a-closer-look-at-who-benefits-from-snap-state-by-state-fact-sheets#Alabama
  
• Facts About Hunger and Poverty in America. (n.d.). Retrieved from https://www.feedingamerica.org/hunger-in-america/facts
• National School Lunch Program. (n.d.). Retrieved May 3, 2019, from https://www.fns.usda.gov/nslp/national-school-lunch-program
• 
  NATIONAL- AND STATE-LEVEL ESTIMATES OF SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC) ELIGIBLES AND PROGRAM REACH IN 2015
  
  (pp. 1-3, Rep.). (n.d.). doi:https://fns-prod.azureedge.net/sites/default/files/ops/WICEligibles2015-Summary.pdf
• Part, T. (2013, August 08). Retrieved May 03, 2019, from https://www.youtube.com/watch?v=Jw7uT1jOt0o
• Policy Basics: The Supplemental Nutrition Assistance Program (SNAP). (2018, February 14). Retrieved May 2, 2019, from https://www.cbpp.org/research/policy-basics-the-supplemental-nutrition-assistance-program-snap
• Rosenbaum, D. (2017, October 11). SNAP Is Effective and Efficient. Retrieved from https://www.cbpp.org/research/snap-is-effective-and-efficient
• The History of SNAP. (n.d.). Retrieved May 6, 2019, from https://www.snaptohealth.org/snap/the-history-of-snap/
• WIC Benefits. (n.d.). Retrieved May 6, 2019, from https://www.snaptohealth.org/wic-2/wic-benefits/

Neonatal Abstinence Syndrome is a term used to define a group of problems a newborn will exhibit due to exposure for drugs like opiates, narcotics or anti-depressant during pregnancy.

As almost every drug that passes through the mother’s bloodstream is passed on to the placenta. Therefore any illicit drug abuse will lead the foetus to utero exposure of these substances which will make it physically dependent, same effect that will do the mother herself.

Therefore, after the baby is born, this dependence still continues, but since he is no longer maintained through the placenta which passes on anything his mother has in her bloodstream, after some time, depending on the drug’s active ingredient half-life, this supply of substance will be no longer available. This lack will lead the neonate’s central nervous system to become overstimulated causing withdrawal symptoms.

Why is NAS a concern?

The abuse of illicit drugs from a mother, not only puts the newborn at risk for NAS but even many other syndromes. These risks are mainly increased due to high chance that being a drug user, the pregnant mother may be reluctant to seek prenatal care, and therefore any conditions or complications the mother may be going through during the prenatal stage are not being screened by any medical specialist.

A fact to consider is that most drug users, usually don’t abuse of only one substance, which usually would lead to several complications during treatment of the newborn for withdrawals. Moreover, if the mother is an intravenous drug user, there is high probability of passing on to the child any infections acquired following use of infected needles, namely; HIV/AIDS.

Apart from the NAS symptoms the neonate may have other problems related to this drug use which include; poor intrauterine growth, premature birth and birth defects.

More problems were observed from the abuse of recreational drugs before and during pregnancy and findings through studies found that some drugs frequently cause specific problems in babies, for example; the use of heroin and opiates, like methadone, is likely to cause substantial withdrawal in the baby, with certain symptoms lasting between four to six months. Methadone users’ babies have a higher probability of seizure episodes than others.

The use of marijuana reduces birth weight and size of the newborn, likewise with use of amphetamines, which in turn even increases the chance of premature birth and may be the cause of intracranial bleeding in the neonate. Cocaine abuse is mostly associated with poor foetal growth and may be even related to a higher risk of sudden infant death syndrome (SIDS).

These similar problems at birth are not only seen with illicit drug use, but even use of alcohol and cigarette smoking does damage the foetus. Complications with regards to alcohol abuse called foetal alcohol spectrum disorders (FASDs), include slow growth both during and after pregnancy, specific deformities of head and face, heart defects and mental retardation. Smaller babies, premature births and stillbirths are at a higher chance of encounter to smoking women.

Symptoms

Nearly all substances lead to some sort of effect on the newborn, but NAS symptoms may differ with the type of drugs, doses taken, how long the mother abused from these drugs and whether the baby was born premature or full-term.

Incidence of NAS varies with strength of drugs; Heroin and Methadone are more likely to cause NAS, although drugs like Cocaine, Amphetamines, Barbiturates (Anti-Convulsive) and Narcotics may also lead to withdrawal symptoms. Alcohol use during pregnancy can also cause withdrawals in a baby.

Neonate can start to appear symptomatic as early as 24 hours to 48 hours after birth, when strong drugs with short half-life were used, or as late as 5 to 10 days with weaker and longer half-life drugs. Withdrawal symptoms as a consequence of alcohol abuse during pregnancy may begin within a few hours after birth.

Common symptoms may include; excessive/high pitched crying, diarrhoea / vomiting, irritability to light/sound, trembling (jittering), seizures, sweating, fever, hyperactive reflexes, excessive sucking, poor feeding and slow weight gain, rapid breathing, insomnia, increased muscle tone and skin irritation.

A neonatal is diagnosed with NAS when he/she exhibits a combination of these signs, since several signs may also be experienced by newborn having other problems, the baby will have to be closely checked to confirm NAS. A history of the mother’s drug use during pregnancy, as accurate as possible, will be required to proceed with the necessary tests. This is argued about its reliability especially when mother, or worse, both parents are illicit drug abusers, but for the sake of the newborn, a background of what substance the child maybe withdrawing from is of extreme importance to start the right treatment to manage withdrawals as soon as possible.

Diagnosing withdrawals in a newborn may require tests like; urinalysis, toxicology screen of first bowel movements (meconium) and typically an NAS scoring system is used. By means of assigning points to certain signs and symptoms and their severity, this NAS scoring system apart from helping to diagnose, it also aids in grading the severity of the withdrawal and may even help in treatment planning.

Therefore once born and transferred to the postnatal ward, the baby is assessed for signs of withdrawals by the midwives using the NAS scoring chart. If the repeatedly four hourly assessments will get a score of 8 or higher, a doctor will be notified and it may be necessary for the baby to be transferred to the Neonatal and Paediatrics Intensive Care Unit (NPICU) to start any necessary treatment for the withdrawal symptoms observed.

Treatment

Treatment for NAS will be determined by a paediatric physician and will be specifically based on the neonate’s gestational age and overall health, the extent of disease, the baby’s tolerance for specific medications and therapies and expectations for the course of the disease.

Neonates suffering from withdrawal are irritable and frequently hard to calm and to get comfortable. Snugly wrapping the baby in a blanket, gently rocking the baby and reducing lights and sounds usually helps a bit to manage this irritability exhibited.

A higher-calorie formula may be recommended for the extra calories necessary due to their increased activity. Intravenous (IV) fluids are sometimes necessary to avoid the newborn becoming dehydrated due to severe vomiting or diarrhoea.

Depending on the severity of the withdrawal symptoms, babies may need medications to help relieve the discomfort and other complications of withdrawal, seizures in particularly. The drug of choice is usually a drug similar to the one the mother used during pregnancy, which therefore is the substance the baby is withdrawing from, then dosage is slowly reduced when withdrawal symptoms are managed. Benzodiazepines are usually used for alcohol withdrawals and methadone for heroin and other opiate withdrawal.

Prevention

An attempt to break the cycle of reproductive morbidity or mortality starts from identifying substance abuse. Most of the birth defects mentioned to be cause of illicit drug use, could be possibly less if the mother stops using drugs as soon as she finds out she is pregnant or if possible before. Preferably both men and women should stop abusing of any drugs before conception itself to further reduce the chance of birth defects which can occur not only through the gestation stage, but even at gametogenesis.

Whilst with most birth defects the termination of drug abuse from mother does only lower their probability, in the case of NAS this could be completely prevented, therefore is encourage to stop any abuse and seeking prenatal care. Drug screening at this stage prevents fully the transmission of any substances through the placenta to the foetus avoiding any future dependence. Health education is currently focusing on these problems as to prevent this growing social problem phenomenon to become oversized.

Prognosis

Children of drug dependents, do not only go through a rough period in the first days of their life due to the utero exposure of illicit substances, but also various longer lasting, or worse, lifelong medical disabilities will be incurred due to the exposure to different types of drugs. Adding up is the fact of the social challenges as son/daughter of a drug addict, for example, being socially left out from school friends or other groups. Moreover, looking at the economic aspect, which may be due to the persisting drug dependence of either or both parents, could easily be critical and lead to a low standard of living.

Definitely the prognosis widely varies with all these variables, but surely if this drug addiction of any of the parents won’t cease, it will be of no help for the baby, hopefully in good health, to have an amusing future ahead. Long-term problems in children, who were exposed to illicit substances during gestation, may symptoms related to adverse neurodevelopmental outcomes leading to low IQ scores from births to methadone and cocaine users.

The perception, speech and intellectual functions were found to suffer some disturbances to youngsters who were exposed to opiate drugs. Major part of the children born to a illicit substance abusing mother have been reported to suffer from behavioural problem, such as; low levels of learning and adapting to new situations and high sensitivity to their environment causing irritability, agitation, aggression, poor social skills. Marijuana use during pregnancy was associated with increased impulsivity, delinquency and hyperactivity exhibited in the exposed kids. None of the treatments used to treat NAS was proved to affect any final outcome of this prenatal exposure.

Epidemiology

Internationally, from the UK Advisory Council on the Misuse of Drugs it is suggested that 6,000 babies, i.e. 1% of UK births, are born to drug abusing mothers each year. Due to their availability and recreational use cocaine, methadone and other illicit substance are now being preferred to the past higher ratio of heroin abusers. A broader image shows us that as much as European women use opioids during pregnancy as analgesic treatment, the number of pregnant women abusing of other drugs is somewhat similar.

In Malta, although on low scale it’s still increasing in incidence from year to year. This is most likely due to the more common day to day recreational drug use around teenager and slightly older generations. Along with the availability, dependencies on certain substances have increased, leading to abuse from mothers even during pregnancies and the newborn suffering from NAS as an end result. From a conversation with a nurse from NPICU revealed me that the number of NAS in Malta is around 0.4% of all births in our country, but a number which is disturbingly on an incline.

Conclusion

Neonatal Abstinence Syndrome and any other birth defects are usually topics that no one would like to converse about, as usually talking about these fragile human beings, born with some sort of problem, either being congenital or lifestyle-induced during gestation, does make both parties feel uneasy.

Nonetheless avoiding to talk about these won’t lower their incidence, it is actually the opposite, proper health education is one way where one can teach what someone’s habits can lead to. It is a known fact that there is little we can do with congenital conditions, but we can reason out that a least we should not help the number of premature births or still births increase.

NAS is one of many conditions, which I personally think that recent changes in our lifestyles can easily lead us to newborns having similar problems. Main reason being, the increment of habitual/recreational drug use and availability amongst 14-30 age bracket, is probably one of the highest ever seen. Not considering the exaggerate number of alcohol abusers, which also can lead to similar conditions. In addition to the other problems linked to promiscuous sexual relationships leading to higher risks of infection which can easily be transmitted and later inherited by a newborn.

Anti-drug abuse campaigns do already show some of the consequence these substances will do to your body. But maybe sometimes things look amplified and interest is lost whilst listening or even looking at a leaflet. More evident data should be used to incept the thought in the minds that these conditions are not out of this world, and clearly outline any possible remedies to prevent themselves and their babies from going through unnecessary pain.

I would like to conclude saying that nowadays life presents us with enough and may be too many challenges. If we can minimize these with some thought and assertiveness, we can make at least our nuclear sized life a better place. Temptations during hard times do arise, but it is not fair on anyone to suffer from our bad decisions, especially those that should be a symbol of our love to life.