A Right to Diapers

Article Outline

• Copyright

Recently, I was invited to attend a day-long conference at the Yale Law School on Diaper Rights: Health, Hygiene, and Public Policy. The goals of the conference were to help generate a national discussion on the needs of low-income families who are unable to afford basic hygiene items such as diapers and to shape a legislative initiative to move public support for diapers into the same realm as food stamps and subsidized housing. Participants from across the United States included government officials, health professionals, family advocates, academics, and industry representatives.

Previously, I had rarely considered having diapers a right. Nor did it ever fully occur to me how great the need for diapers is from a public health perspective and how the lack of access to diapers can negatively affect not only an infant’s hygiene but also the child’s health and well-being, family dynamics and resources, and the level of risk for child neglect and abuse. I quickly realized, however, that this issue indeed merited a high-level discussion with the goal of shaping public policy.

As practitioners, we all know that seeing a child in dirty diapers day after day raises a red flag for concerns about neglect and family well-being. And while many of the families we care for receive some assistance for housing and food through the Women, Infants and Children program, no federal program provides a line especially dedicated to the added expense of diapers. Diapers may be deemed medical necessities for adults and older children with special needs, yet no such recognition exists for infants.

The cost of keeping a child in diapers for a year is high. For a family that lacks transportation and needs to purchase diapers at an inner-city corner store rather than at the distant Wal-Mart, the price could easily double or triple. This gap in the safety net clearly has basic health implications for the young child and family. When diapers are changed infrequently because caregivers are trying to conserve, children are at increased risk for urinary tract and skin infections and communicable diseases. Babies who cry for long periods because of a soiled diaper are at greater risk for abuse, and toddlers with persistently soiled diapers may be rejected by other children.

To address this problem, numerous non-profit volunteer programs across the United States have formed diaper banks that work like food banks to collect donations and distribute them at food pantries, day care centers, and social service agencies. The Diaper Bank in New Haven, CT, delivers nearly 900,000 diapers annually through social service agencies, churches, and hopsitals (http://www.thediaperbank.org/). Unfortunately, isolated volunteer programs are not sufficient when many more families are being forced to choose which basic needs they can meet with their limited resources. More data are needed to determine how a lack of access to diapers raises health care risks and places an economic strain on those families in need. And, within the context of fiscal and moral responsibility, new legislation must be developed to provide for this need for children while enabling parents and families to achieve self-sufficiency.

At the conference, many action items were identified including: further data collection on diaper needs, not only for infants but also for the physically challenged and the elderly; a review of current federal regulations to determine whether diapers may be an allowable expense under Child Care and Development Block Grants; and an investigation into whether diaper distribution programs could be proposed under the home visitation program of the Patient Protection and Affordable Care Act, Public Law 111-148, Section 2951. Plans also are being made to introduce legislation and launch a public campaign, perhaps on Mother’s Day of 2011.

We all know that a dry baby is a happy baby. When we work with families, we are always thinking about basic needs, particularly when it comes to food and housing, but we may be less likely to think of (or to want to speak out loud about) the needs for basic hygiene and diapers. The intergenerational need for diapering is clearly another basic need for families that requires our full attention.