The inability to afford diapers for babies and toddlers is a significant source of stress for low-income families. As discussed in a previous Network blog post, gaps in federal safety net programs currently prevent them from addressing this challenge. However, innovative strategies to address diaper need are emerging. None of the strategies discussed below provides a comprehensive solution, but each one either reduces the cost of diapers, provides assistance with paying for diapers, or provides diapers at no cost.
While federal programs do not explicitly provide assistance with purchasing diapers, one local government is leveraging Temporary Assistance to Needy Families (TANF) in a small pilot program to provide working families with assistance to obtain diapers. The Department of Human Services of the City and County of San Francisco has entered into a contract with a nonprofit organization to provide diaper bank services to TANF families. The diaper bank uses its purchasing power to negotiate a bulk rate, and families receive a voucher through CalWORKS. Funding for the program is drawn from federal, state, and county sources.
At the state level, three primary policy interventions to address diaper need have been implemented. The first is an exemption from state sales taxes for purchase of diapers, often paired with an exemption for menstrual supplies. The National Diaper Bank Network tracks pending bills to create exemptions in additional states. The tax exemptions have been criticized as a blunt instrument, in that relief is not targeted toward low-income families, but is received by every person who purchases diapers. Because of the loss of tax revenue that would occur if it were to pass a sales tax exemption for diapers, the state of California attempted to pair the exemption with a sales tax increase on hard liquor. That political compromise was unsuccessful in the 2017 legislative session. Another bill pending in California would add diapers to a list of expenses that are necessary to support welfare-to-work program activities, and provide $30 per month to assist with diaper expenses. California has also studied other potential interventions, tailored to the regulatory environment in the state. Missouri considered direct funding for diaper banks, but budget shortfalls prevented those funds from being spent.
A second policy intervention at the state level is not targeted exclusively at alleviating diaper need. Its primary goal is reducing smoking among pregnant and postpartum women. The state of Tennessee is one pioneer in the use of diaper vouchers as an incentive for women to participate in a tobacco cessation program known as Baby and Me—Tobacco Free. The Baby and Me—Tobacco Free program is funded in part by tobacco Master Settlement Agreement funds, and leverages local health department clinics and WIC programs to reach a large number of pregnant women who smoke. Diaper vouchers were chosen as an incentive in the hope of achieving health co-benefits. Published research indicates that the program was associated with significantly decreased odds of having a low birth weight infant. Other states have similar programs. Research for this blog post did not discover any research on the impact of the diaper vouchers on parental stress and mental health.
A third policy intervention was just enacted in Nevada. It includes appointment of a committee to study diaper need and authorizing the Department of Health and Human Services to take any necessary action to increase the availability of diapers and diapering supplies to certain low income families.
In light of the difficulty of passing federal legislation to address diaper need, the White House also asked the private and nonprofit sectors to develop innovate strategies to address diaper need, with encouraging results in 2016.
One could argue that diaper need is just one symptom of the underlying need for policies to help families address the financial challenges of caring for babies and young children. The evidence of the contribution to public health that could be made by strong laws that provide for paid family leave and affordable, high quality childcare is compelling. It is true that strategies to address diaper need to date only partially address that issue, and do not solve the larger challenge. Yet, incremental change is still worth celebrating if it contributes to the physical and mental health of both children and parents, contributes to the financial stability of families, and inspires further innovation.
This post was prepared by Jill Krueger, J.D., director of the Network for Public Health Law—Northern Region Office.
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