For the first time, the federal government is directly addressing diaper need, which leaves one in three American families struggling to afford enough diapers for their children. To start chipping away at the problem, the Department of Health and Human Services just announced the creation of the Diaper Distribution Pilot to hand out diapers to low-income families. The Administration for Children and Families will give $8 million in grants to six states—Arizona, Iowa, North Carolina, South Carolina, Washington, and Virginia—and one tribal consortium, the South Puget Intertribal Planning Agency, in Washington State. Recipient agencies will work with existing diaper banks and social service agencies to get diapers into the hands of parents struggling to afford them.

ACF Assistant Secretary January Contreras hopes that, thanks to the pilot program, “less families have to choose between paying bills and keeping their children in clean diapers,” she said. “It’s an important anti-poverty measure. It’s an important public health measure.”

It could be a huge relief to mothers like Jessica Frazier. Frazier planned every cent of her budget to try to ensure that she had enough diapers and wipes for her children. And yet, even so, unexpected things like a child’s coming down with diarrhea or her forgetting to buy a bulk package ahead of time and having to run to the corner store would set her back. When we spoke in 2018, she had recently had to put her 2-year-old son in swim diapers until she could get more of the regular kind because she had run out. Other times she had to put him in underwear, which he would pee right through, until she could get to the store.

She was constantly making sacrifices to make her money stretch to cover the diapers she needed, which she estimated were at least eight to 10 a day for her newborn. She bought meat in bulk and froze it. She put off buying sneakers and paying bills. Even so, sometimes other things had to take precedence. “I might need this gas, so I hold off on getting a diaper,” she said. Some things she gave up altogether, like taking her children to the movies or enrolling her daughter in gymnastics and ballet.

“You can do without a car, you can do without soda in your house, you can do without them snacks, you can maybe do without that new T-shirt,” she said. “But diapers you can’t do without.”

There are currently few resources or programs to help parents cover the cost of diapers, which can be astronomical: about $1,000 a year for average-priced diapers, or 14 percent of after-tax income for families in the lowest-income quartile. Diapers cannot be purchased with food stamps or benefits from the Women, Infants, and Children nutrition program, and few families are able to enroll in cash assistance through the Temporary Assistance for Needy Families program, given its onerous constraints. While there are diaper banks throughout the country, they rely on private donations and have a tiny impact: At most, they reach 16 percent of children whose parents need help getting diapers.

The inability to afford enough diapers creates more than a financial burden. Parents often stretch the supply they have, leaving a child in a wet one longer than they otherwise would, which can lead to rashes and other problems. Nearly 8 percent of parents in a 2013 peer-reviewed study reported stretching their supply, with some leaving their children in diapers longer and others even bleaching, drying, and reusing the garments. One study found an association between parents who said they were struggling to afford diapers or were visiting diaper banks and their children going to the doctor at a higher rate for diaper dermatitis or a urinary tract infection. Another found that children in families with diaper need sleep poorly. On the other hand, a study released by the Diaper Bank of Connecticut found that when families started receiving diapers from the bank, diaper rash declined by 33 percent.

Diaper need also creates a mental health stress for parents, which in turn impacts their kids. Over half of 70 women interviewed by a researcher said getting diapers was their biggest stressor, more than paying for food, housing, or electricity. One researcher found that diaper need was the variable that best predicted postpartum depression symptoms. Natasha, a mother in Maine whom I also spoke to in 2018, borrowed money to buy diapers, but that just put her in debt to family and friends. When diapers were in short supply, she and her boyfriend would fight more. “It stresses us out and then we start to bicker or fight,” she said. “It is a strain if you can’t provide for your children.”

The federal pilot program sprang from diaper banks themselves: They were “sounding the alarm” about the problem, Contreras said, and members of Congress heard them. Contreras also has some firsthand experience seeing the severity of diaper need: She ran a legal aid organization for eight years, where she often served young mothers. “When you are constantly serving parents who are on the edge of survival, you can’t help but learn,” she said.

HHS wants the pilot program to address more than just diapers. It can remove a barrier to work or education, as many child care facilities require parents to provide a week’s supply in order to bring their children. One study found that nearly 60 percent of families with diaper need had missed school or work because they didn’t have enough for child care. The program is also meant to create an “entry point” for families to get connected with other programs. “This isn’t only for families to walk away with diapers,” Contreras said. “They’re going to walk away with the information about other resources and services that can be supporting that family and their children.”

That, in turn, will allow the ACF to get a better picture of what other needs families have when they are also struggling to buy enough diapers. The seven grantees in the pilot program were selected to ensure geographic balance, allowing the agency to see how it will work in different parts of the country.  The pilot will be evaluated, with data collected on whom it’s serving and what difference it’s making, and expansion could come further down the road.

“The need for diapers is universal,” Contreras said. “It doesn’t matter if you’re a parent in a rural town or a big city or a tribal community—every parent needs to be able to have diapers for their babies.”