Research conducted by a team led by Dr. Megan Smith of the Yale University Schools of Medicine and Public Health concludes that the inability to afford enough diapers for their children is a powerful source of stress for low income mothers, and is associated with the need for mental health treatment. In the study, nearly 30 percent of low-income mothers reported diaper need. Attempts by parents and care-givers to stretch a supply of diapers may lead to diaper rash and urinary tract infections for the baby. The impact on the baby’s physical health may affect the parents’ mental health. Diaper need is thus a modifiable mental health risk factor for mothers.
Access to diapers also impacts the economic health of families, because child care providers typically require families to provide diapers for their children in care. Inability to afford diapers can become a vicious circle, if parents are then unable to utilize daycare, and thus unable to work. While the cost of diapers varies, a ballpark figure for a year’s supply of disposable diapers is $1000. This is a steep price for a low-income family, but it could be a relatively low-price benefit to improve health for parents and infants.
Most federal safety net programs are designed to address a specific basic need, such as food, health care, or housing, but not diapers. While a proposed Hygiene Assistance Act would have created a diaper benefit demonstration project, it did not advance through the legislative process. Funding access to a disposable product may be unattractive to policy-makers, even though cloth diapers are impractical for low-income families who do not own washing machines. Moreover, the environmental impact of disposable diapers may not be substantially greater than that of cloth diapers.
Whatever the reason, it is difficult to address the challenges of low-income families in affording diapers through current federal laws:
With its focus on eligible women, infants, and children, the WIC program might seem like a natural home for assistance to purchase diapers. But WIC is a supplemental nutrition program authorized by the Child Nutrition Act (most recently reauthorized as the Healthy, Hunger-Free Kids Act) and to date, Congress has not expanded the program to address diapers. When authorized by state guidelines, one diaper may be provided as needed during an appointment.
SNAP has a similar focus on supplemental nutrition assistance for low income households, though it has a secondary purpose of expanding markets for US agricultural products. With a legislative home in the Farm Bill (most recently the Agricultural Act of 2014), SNAP has also proved resistant to calls to expand to provide assistance to purchase diapers.
Medicaid provides medical coverage for eligible low-income families, but diapers for infants and toddlers have been treated to date as a basic necessity for all, rather than as a medical necessity. Litigation has established that Medicaid will cover the cost of diapers as a medical necessity if worn to address incontinence in children or adults.
Earned Income Tax Credit
The Earned Income Tax Credit provides a tax credit for working low income families. While not specifically intended to provide diaper assistance, the EITC refund may be used to purchase diapers. The lump sum payment may not lend itself to diaper purchases throughout the year.
Temporary Assistance to Needy Families provides financial assistance for eligible low income families. TANF has certain work requirements. While not specifically intended to provide diaper assistance, TANF benefits may be used to purchase diapers, among a myriad of other needs.
Child Care and Development Block Grant
The Child Care and Development Block Grant provides federal funds to assist states in regulating child care. Priorities include protecting the health and safety of children in child care, providing transparent information about the quality of care, and family-friendly eligibility policies. It was recently reauthorized as the Child Care and Development Block Grant Act of 2014. An earlier bill to include diapers and diapering supplies was not incorporated.
Early Head Start and Head Start
Early Head Start provides early child development and family support services to low-income infants and toddlers and their families, and pregnant women and their families. Early Head Start provides diapers for children during the parts of the day when they are in care, but not while they are at home.
This blog post identifies some of the barriers to addressing diaper need through the federal safety net. A subsequent blog post will describe innovative efforts to increase access to diapers, including public-private partnerships, nonprofit diaper banks, and state and local laws and pilot projects. Some of these emerging solutions were inspired by the Yale research and the research team’s partnership within its local community in New Haven, Connecticut.
This post was prepared by Jill Krueger, J.D., director of the Network for Public Health Law—Northern Region.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.