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Mark Lennihan, Associated Press
Pampers disposable diapers are on display Monday, Oct. 31, 2005 in a New York pharmacy. Thirty percent of low-income families lack an adequate supply of diapers, according to study published in Pediatrics, a top academic journal focused on children's health issues.
The need for diapers is so great, and week after week more agencies contact us about clients who need diapers. We’ve decided that we want to be able to help as many families as we can. —Theresa Felten, resource center director at A Precious Child

Standing in the diaper aisle at a Colorado Walmart, Isabel Ear summons elementary arithmetic to figure out which diapers to buy for her 6-month-old twins Liam and Lianna. At 17 pounds each, the twins can fit into either a size two or three diaper. Each option has its advantages, according to Ear. “If I get the bigger size, the diapers will fit better, but if I get the [smaller] size I get more diapers," she says. And more diapers means saving money. She reaches for two packages of the smaller size diapers and places them in her cart. Given her financial situation, quantity trumps most other considerations.

Ear and her husband, of Thorton, Colo., support their five children on the $2,000 a month salary he earns doing sales for a cellular phone company. They've found that on average the twins go through about $40 of diapers per week, an expense they've been able to cover by cutting back on their grocery bill. But sometimes, especially now that the twins are growing and eating solid foods, they run out early. When this happens, there isn't any wiggle room in their budget to buy more diapers, so Ear will pack up her children and take a bus to a nearby food panty, which provides three-day emergency diaper supplies for families in need.

Like the Ears, families around the country are struggling to afford diapers, according to an August 2013 study published in Pediatrics, a top academic journal focused on children’s health issues. Thirty percent of low-income families lack an adequate supply of diapers, according to the study. While diaper need is ubiquitous, it is rarely discussed among health or public policy experts, according to Joanne Goldblum, study co-author and founder of the National Diaper Bank, which promotes awareness on this issue. The study shows how the inability to afford diapers, and the strategies used when supplies run low, can have significant physical, emotional and financial consequences for parents and their children.

Health and well-being:

When their diaper supplies get low, researchers found that many families use strategies to make diapers last longer. One way of doing this is to leave the child in a wet diaper until they’d had a bowel movement or to change the baby by removing solid waste from the diaper and reusing it if it is dry, Goldblum said.

While Goldblum has no doubt that parents who use diaper-stretching strategies don’t intend to harm their kids, the practice is dangerous. When a child wears a wet diaper or dirty diaper for too long, it is more likely to contract skin rashes and urinary tract infections (UTIs), according to the study. Difficult to detect in non-verbal children, untreated UTIs can cause serious kidney damage that can lead to scarring, poor growth and high blood pressure among afflicted children, according the American Academy of Pediatrics.

Diaper need doesn’t just put babies at risk, according to the study; parents’ health can also be compromised. Researchers found a high correlation between inadequate diaper supply and mental health issues: parents who reported diaper need are also more likely to struggle with depression. Research by Rand Conger, a sociologist at UC Davis, suggests this is fairly common. His work shows how parents under economic stress are more likely to display punitive behaviors like yelling when interacting with their children. The combination of financial worries and stressful interactions with their children can also make them more susceptible to feelings of inadequacy and incompetence.

Economic tailspin

Diaper need can also make it harder for parents to pay their bills or even get to work, according to the study. Most child-care providers, even government subsidized facilities, require parents to supply diapers for their kids, Goldblum said. If a family doesn’t bring its own diapers, the facility may refuse to admit the child.

Many of the mothers surveyed reported missing work because they didn’t have disposable diapers for their children’s caretakers. Others reported that diaper need resulted in them missing training programs required to be eligible for Temporary Assistance for Needy Families (TANF), a federal program that provides cash assistance to low-income Americans.

Losing TANF assistance only exacerbates diaper need among low-income families. For many, TANF cash is the only way they can buy diapers for their children as other government assistance programs such as SNAP (food stamps) and WIC do not cover diaper purchases.

What about cloth?

Critics of this study, including Los Angeles Times editorial writer Karin Klein, argue that disposable diapers are a convenience, not a need. Instead of supplying low-income families with disposable diapers, she suggests encouraging them to use cloth diapers. “Washing diapers definitely isn't fun,” she writes in her op-ed, “I’ve gone that route during times when family finances weren’t great and was happy to drop the routine when I was able to — but it’s doable. Generations of parents have proved this one.”

And while cloth diapers may be a cost-reducing solution for families (particularly those with a parent who can stay home) it’s not a practical solution for most low-income families, Goldblum said. Most child-care centers won’t admit children who wear cloth diapers and many low-income parents depend on day-care centers to take care of their children while they are at work.

Cleaning cloth diapers can also prove problematic for low-income parents, according to Goldblum. Most families with diaper needs rent their homes, she said, and “renters typically don't have washing machines and many laundromats don't allow people to wash diapers,” she said. Even if a family is able to find a laundromat that allows diaper washing, transporting soiled diapers via mass transit can be problematic. Goldblum tells the story of a Seattle mother who was asked to get off a bus because the smell of her son’s diaper upset other riders. “How would people react to a parent carrying a sack of dirty diapers?” Goldbum wonders.

Diaper banks

To address the issue, nonprofits dedicated to providing low-income parents and their babies with clean, well-sized disposable diapers are popping up around the country. Founders of these organizations operate based on the assumption that a small supply of diapers is a tangible way to reduce parental stress and improve child outcomes.

But most organizations' ability to fulfill their mission is limited. For example, at A Precious Child, a Broomfield, Colo., diaper bank that Isabel Ear occasionally uses, clients are only eligible for a week’s supply of diapers every quarter.

Theresa Felten, resource center director at A Precious Child (which also provides clothing and sports equipment for low-income children) acknowledges that a week’s worth of diapers every quarter doesn’t address the ongoing need of most of their clients.

“The need for diapers is so great,” she said, “and week after week more agencies contact us about clients who need diapers.” As an organization, it struggles to balance immense need with scarce resources. “We’ve decided that we want to be able to help as many families as we can,” Felten said, “We’d like to do more, but we need more diapers.”

Around the country, diaper banks are struggling with this issue. "It will take 6.57 billion diapers to keep every American baby living in poverty clean and dry this year. That's based on 3 million children under age 3 living in poverty in the United States, and a conservative six changes a day," Goldblum wrote in a column for CNN.

And while the need is immense, she's optimistic it can be met it people understand the particulars. "If we are to attack the problem, the first step is to acknowledge it. In my experience, when people learn about diaper need, they want to help," she said.