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A parent changes an infant on a changing table. A row of oversized diapers looms over the parent like a row of dominos about to collapse. The composition is on a dark purple background.

Diapers or dinner? An impossible choice

Without access to diapers, both parents and children face health risks.
Written by
Hoda Emam
Illustration by
Richard Mia
August 9, 2023
Read Time
10 min

On a rainy Saturday morning in San Diego, California, Viridiana Montero joined a small crowd at the Logan Temple AME Zion Church. They weren’t looking for God; they were looking for diapers.

Montero is a regular at the church’s weekly diaper distribution. She needed two packs of size 3 diapers to get through the week, but volunteer diaper distributors had already run out of size 3s. She took the next size up instead, along with a box of fresh fruit, and headed home. The size 4 diapers wouldn’t be a perfect fit, but they’d still keep the Montero family’s economic life — and her kids’ health — from unraveling.

A mother of three who works full-time in a kitchen, Montero says she spends more than half of her monthly income on rent. The rest must cover utilities, car payments, food — and diapers, which cost her more than $100 a month. But she says her income is too high to be eligible for federal help.

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Hear Viridiana Montero talk about navigating the diaper crisis without federal support:

In the United States, disposable diapers cost nearly $1,000 per year, per child, and nearly 1 in 2 families in the United States need diapers they struggle to pay for, according to a study by the National Diaper Bank Network. Some families facing a diaper crisis can get help from federal assistance programs like the Supplemental Nutrition Assistance Program (SNAP) or Women, Infants, and Children (WIC), but more families fall in a precarious and often invisible gap: Like Montero, they make “too much” to qualify for federal aid, but they don’t make enough to meet their children’s basic needs, including diapers.

Montero’s diaper bill is so high, she’s afraid it might drive her into debt. “It will force me to use my credit cards,” she said. She’s trying to toilet train her daughter more quickly to help reduce the strain on her budget, but studies show that rushing toilet training isn’t good for children (or their parents). Montero feels stuck: Sometimes she cannot work because she cannot afford the food and diapers required at the in-home daycare center she uses. She wonders how to survive without going deep into debt. “It seems like I’m digging a hole to try to get out of a moment[ary] solution.”

Lack of access to diapers risks pushing working parents and their families into poverty in other ways, too. In nearly a quarter of the households reporting diaper need, parents say they’ve missed work because they did not have the diapers required to send their children to a childcare facility. A lack of diapers can affect parent and child health: babies who use the same diaper for too long risk skin irritations, urinary tract infections (UTIs), and disrupted sleep, while studies show that parents who are short on diapers face increased risks for post-partum stress and other mental illness.  

Race also plays a part in inequities in diaper access. In Milwaukee, one of the poorest and most segregated cities in the U.S., diapers are among many basics that are harder to access in communities of color. “We have really, really deep systemic issues here in Milwaukee. And we know that lack of access to basic essentials, like diapers and period supplies, is just kind of woven into all of that,” says Megan Johnson, executive director and founder of the Milwaukee Diaper Mission.

Johnson said access to diapers and period supplies are interrelated — and often all-or-nothing. “Menstruators who are mothers have to decide whether they’re going to purchase period supplies for themselves, or diapers for their baby,” she says. Often, they “have to put a box of tampons back on the shelf because they only have enough money for the diapers.”

A popular solution to diaper need are diaper banks. For nearly 30 years, diaper banks have tried to fill the gap between what working-class families need and what federal or state assistance will pay for. Today, more than 225 diaper banks operate across the U.S., providing a short-term solution for families whose budget forces them to choose between necessities like food and diapers.

Pastor Virgil Ward, who runs the diaper bank where Montero goes, said these families make up most of his clients. “So, if I’m having all these kids and I’m financially strapped, and I can’t get one thing that I must have for my kids, what do I do?” said Ward.         

Hear Pastor Virgil Ward talk about how he centers respect and dignity for families facing diaper crisis:

Megan Fischer started the Sweet Cheeks Diaper Bank in Cincinnati, Ohio, with the same question in mind. Cincinnati has some of the highest rates of child poverty in the country, and Fischer estimates roughly 16,000 children in the region need diapers at any one time.

“I just thought if you had a SNAP card, you walked in a grocery store and anything in that store, you could get,” she says. “I had a toddler and … a newborn at the time, and I just kept thinking, ‘What do you do if you love the kid you’re taking care of and you can’t give them a clean diaper every single time they need it? What would they feel like? And how are … people around me experiencing this every day?’”

Hear Megan Fischer talk about about the consequences of diaper need she sees in Cincinnati:

Diaper banks are an ad hoc solution, not a systematic one, but they are also a lifeline for families around the country. Viola’s Baby Benefit Boutique, run by Viola’s House in South Dallas, Texas, is buzzing with music and families on a hot spring afternoon. Nylha Hickman, community outreach manager at Viola’s House, says visits to the diaper bank at the boutique — which provides free diapers for children age three and under — have jumped 46 percent since last year, to 128,000. “Eighty percent of women in our area have to choose between diapers and food for their family,” Hickman says, “and we have taken that decision away.”

Hear Nylha Hickman talk about the domino effect of diaper crisis on parents’ health:

Dr. Megan Smith, a researcher on diapers and public policy at the Connecticut Hospital Association, said her research shows that parents who can access diapers easily fare better than parents who can’t. “Having a sufficient supply of diapers not only freed up cash to pay for utilities, school uniforms for children, or after-school sports, but from a neuroscience perspective, it freed up some space in the brain of a parent to actually be able to focus on bonding with the babies — you know, singing, reading and rocking a baby and sort of that kind of bonding,” Smith says.

In Tennessee, Lydia Yousief runs the Elmahaba Center, a grassroots nonprofit which focuses on the needs of the Arabic- speaking community. Her center serves working-class families employed in factories and hotels near Nashville. “Moms express all kinds of physical issues with their baby because of the lack of diapers, UTIs being a common one,” Yousief says. On the third Saturday of every month, she hands out diapers and wipes, as well as baby clothing, in a store parking lot. “Our families, even with government ‘assistance,’ still struggle because government assistance is just a stepping stone, but is not holistic,” she said. 

Hear Lydia Yousief talk about how her diaper bank helps working-class parents keep their kids safe:

And in California, Jessica Ornelas does double duty as a diaper bank liaison and a daycare owner. In-home daycares often require parents to send kids with a half-dozen or more diapers each day; Jessica helps parents whose kids enroll in her care center to fill out the paperwork diaper banks require. She then takes the paperwork to the diaper banks, and if they are approved, she picks up the diapers needed for their childcare days, saving parents precious time and fuel costs and letting families get kids into care faster. “Just bring your baby and we’ll figure out the paperwork,” she says. It’s more important, she adds, that “that parent ended up not losing their job because they had to wait for daycare to be approved.”

Diaper banks are far from a perfect fix, but advocates and lawmakers are pushing for more systemic solutions. One option that has worked is the elimination of sales tax on diapers. Currently, diapers are tax-free in 22 states. “If you’re a low-income family, then you’re spending almost all your income on basic needs …. For many of those families [diapers] can be up to 14 percent of their income,” says state Sen. Nancy Skinner, who chairs the California state senate’s budget committee and its women’s caucus. “When the margins of the family budget are that thin, sales tax on diapers can feel punishing.”           

California exempted diapers from sales tax in 2020; the state also offers $30 per month to assist with diaper costs for each child under three years old. A state fund also provides financial support for diaper distribution through diaper banks, though the fund is set to expire in 2024.

Connecticut lawmakers are considering including diapers in Medicaid coverage. State representative Jillian Gilchrest, who co-chairs the committee that oversees Medicaid for the state, said a proposal for studying the issue currently has momentum. “If we’re going to do it,” she says, “this is our window.”

Tennessee, meanwhile, could become the first state to allow Medicaid to cover the cost of diapers. The change, which would cover diapers for the first two years of a child’s life, was passed by the state legislature in April and awaits federal approval; the benefit could be available as early as January.

For a long time, the kind of insecurity that faced parents like Viridiana Montero in San Diego was understood best by the people who run and use diaper banks.

Hear Viridiana Montero talk about the wide reach of the U.S. diaper crisis:

Thanks to supply chain challenges during Covid, that is beginning to change. Today, even families who enjoy greater economic stability understand the fragility of access to basic goods. Ironically, a moment of widespread scarcity during the pandemic may — finally — lead to more equitable diaper access.

“It’s this weird American thing where we have to have experienced something to be able to empathize. And I don’t know why that is,” says Joanne Samuel Goldblum, the CEO and founder of the National Diaper Bank Network. “Most U.S. Americans … can appreciate that a baby needs diapers, and that regardless of whatever choices have been made, that child deserves to be clean and dry and healthy.”

Correction: An earlier version of this article misidentified the status of the Connecticut lawmakers’ study on diapers and Medicaid; it has been proposed, not authorized.

Hoda Emam
Hoda Emam's reporting on diaper inequity was undertaken as a USC Annenberg Center for Health Journalism 2023 California Health Equity Fellowship Grantee.
Richard Mia
Richard Mia is a Canadian freelance illustrator working globally.

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