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Diaper Access

Written by Dr. Sarah Anderson and Dr. Jill Barnas
Published on May 24, 2024
Research Highlights

Most households who cannot afford diapers have incomes below 200% of the federal poverty level (FPL).

In MO, 3% of infants and toddlers below 200% of the FPL received diapers from a diaper bank.

State governments have used Temporary Assistance for Needy Families (TANF), Medicaid, Early Head Start programs, and eliminating the diaper sales tax to increase diaper accessibility.

Poverty is a strong predictor of diaper need.

Nationally, half of households report struggling to afford diapers (NDBN 2023a). Among these households, two-thirds earn less than 200% of the FPL. Families use about 250 disposable diapers per month with younger infants needing more frequent diaper changes (AAP 2021). Disposable diapers cost about $0.30 per diaper, and households spend about $1,000 per year per child on diapers. This does not include goods such as baby wipes or diaper cream. A small study of caretakers with diaper need in AZ found that using cloth diapers resulted in long term cost savings and increased security with having a consistent diaper supply (Renkert 2023). Challenges with cloth diapers included high upfront costs, unfamiliarity with cloth diapers, laundering, leaking, and the infants developing rashes or being uncomfortable.

In MO, 13% of households live below the FPL (US Census Bureau 2021). The limit of the FPL for a family of 4 is $2,313 each month (MO DSS 2022). Women are slightly more likely to live in poverty (14% vs 12% for men; US Census Bureau 2021). Among children, 37% of Black children, 25% of Hispanic children, and 13% of White children live in poverty (Annie E. Casey Foundation 2023).

Income is not the only determinant of diaper access. In Durham County, NC half of the low-income census tracts did not have access to a retailer selling the 10 most common diaper sizes (Massengale 2022). Families in these census tracts were more likely to be Black, struggle to afford housing, need to repair their homes or cars, experience neighborhood violence, and have less educational attainment.


Lack of diapers harms parents and children.

Infant diapers are essential sanitary health items that require frequent changing. One study showed that 27% of low-income women who had diaper need delayed changing diapers when supply was low (Smith 2013). Not regularly changing diapers puts infants at higher risk for urinary tract infections and diaper rash which can result in higher healthcare costs for the families (Sobowale 2021).

A national survey found 25% of caretakers with diaper need missed an average of 5 workdays in the past 30 days because they did not have diapers to leave with their childcare facility (NDBN 2023). This is more likely to impact women as 20% of all working mothers with children under three years old work low-wage jobs. Of all working mothers with children under 18, half are single mothers (Wallace 2017). 


States use various approaches to address diaper need.

Most free diapers come from diaper banks. Diaper banks distribute diapers to partners (e.g. churches, shelters, health clinics) who directly give the diapers to families. There are 8 diaper banks in MO affiliated with the national diaper bank network (Figure 1; MO Diaper Banks). These banks distributed 8.7 million diapers in 2023 helping about 13,800 children each month (NDBN 2023b). Families receiving diapers from a community diaper bank reported improved child health, more money for utilities and medical care, less parental stress, and better school and work attendance (Massengale 2017). However, in 2016 among children living below 200% of the FPL in MO, 3% received diapers from a diaper bank (Massengale 2020).

TANF funds can be used to buy diapers, but is also meant to pay for housing, utilities, and other hygiene items (NDBN 2023b). For a family of three, spending TANF money on diapers would use about a third of the funds each month. The Supplemental Nutrition Assistance Program and Women, Infants and Children (WIC) are nutrition-specific programs, and the funds cannot be used to purchase diapers (NDBNc).

However, states use the money allocated for TANF to help supply diapers. In IN, TANF funds are used to provide families enrolled in WIC with 200 diapers every other month through a local diaper bank (Downard 2023). In GA, families enrolled in TANF can receive 300 diapers per month for a four-month period (GA DFCS 2023).

TN’s Medicaid program includes 100 diapers per month for children under two years old (TennCare 2024). This benefit was recently ap-proved by the Center for Medicaid Services and will be available starting Fall 2024. TN is the only state that has this benefit. In MO, Medicaid covers diapers for children ages 4 years old to 20 years old who cannot control their bladder or bowels (MO DSS 2020).

While most childcare facilities require parents to supply diapers, Early Head Start centers provide diapers. There are 3,860 infants and toddlers en-rolled in Early Head Start in MO (NDBN 2023b).

Eliminating sales tax also increases access to diapers. When diapers were exempted from sales tax in NY and CT, there was an increase in diaper sales and a decrease child pain medication sales (Swete 2020). Currently, five states have no sales tax and 19 states have exempted diapers from the sales tax (NDBN 2023d). In MO, diapers are tax free during the back-to-school sales tax holiday (MO DOR). This sales tax holiday starts on the first Friday of August and ends the following Sunday.


Figure 1. Map of counties served by a diaper bank in blue. Counties not served in grey. Data from MO Diaper Banks and Diaper Banks of the Ozarks 2021. Map created with mapchart.net


Works Cited

Annie E. Casey Foundation. (2023). Children in Poverty by Race and Ethnicity in Missouri. Retrieved from Kids Count Data Center: https://datacenter.aecf.org/data/tables/44-children-in-poverty-by-race-and-ethnicity#detailed/2/27/false/1095,2048/187,11,9,12,1,185,13/324,323

Diaper Bank of the Ozarks. (2021). 2021 Annual Report. Retrieved from Diaper Bank of the Ozarks: https://ccozarks.org/wp-content/uploads/2022/07/Diaper-Bank-of-the-Ozarks-2021-Annual-Report.pdf

Division of TennCare. (2024, May 21). CMS Approves TennCare III Amendment. Retrieved from Division of TennCare: https://www.tn.gov/tenncare/news/2024/5/21/cms-approves-tenncare-iii-amendment.html

Downard, W. (2023, September 7). State project aims to give diapers to safety net recipients. Indiana Capital Chronicle. Retrieved from https://indianacapitalchronicle.com/2023/09/07/state-project-aims-to-give-diapers-to-safety-net-recipients/

Jana, L. A., & Shu, J. (2021, May 17). Buying Diapers. Retrieved from healthy children from the American Academy of Pediatrics: https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Buying-Diapers.aspx

Massengale, K. E. C., Erausquin, J. T., & Old, M. (2017). Health, Social, and Economic Outcomes Experienced by Families as a Result of Receiving Assistance from a Community-Based Diaper Bank. Maternal and child health journal21(10), 1985–1994. https://doi.org/10.1007/s10995-017-2317-9 https://pubmed.ncbi.nlm.nih.gov/28710698/

Massengale, K. E. C., Comer, L. H., Austin, A. E., & Goldblum, J. S. (2020). Diaper Need Met Among Low-Income US Children Younger Than 4 Years in 2016. American journal of public health110(1), 106–108. https://doi.org/10.2105/AJPH.2019.305377 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893346/

Massengale, K. E. C., Jones, M. A., Liao, J., Park, C., & Old, M. (2022). Priority Areas for Child Diaper Access: Low-Income Neighborhoods with Limited Retail Access to the Basic Need of Diapers. Health equity6(1), 767–776. https://doi.org/10.1089/heq.2021.0192 https://pubmed.ncbi.nlm.nih.gov/36225666/

Missouri Coalition of Diaper Banks. (2023). Diaper Bank Locations. Retrieved from Missouri Coalition of Diaper Banks: https://modiaperbanks.org/locations/

Missouri Department of Social Services. (2022). 2022 Poverty Guidelines: 48 Contiguous States (all states except AK and HI). Retrieved from Missouri Department of Social Services: https://dss.mo.gov/fsd/csbg/Guidelines-2022.pdf

MO Department of Revenue. (n.d.). Back-to School Sales Tax Holiday FAQs. Retrieved from MO Department of Revenue: https://dor.mo.gov/faq/taxation/business/back-to-school-sales-tax-holiday.html

MO HealthNet. (2020). MO HealthNet PA Criteria. Retrieved from MO Department of Social Services: https://dss.mo.gov/mhd/cs/dmeprecert/pdf/diapers.pdf

National Diaper Bank Network. (2023, July 30). Diaper Tax. Retrieved from National Diaper Bank Network: https://nationaldiaperbanknetwork.org/diaper-tax/

National Diaper Bank Network. (2023, August). Missouri Diaper Facts. Retrieved from National Diaper Bank Network: https://nationaldiaperbanknetwork.org/wp-content/uploads/Missouri.pdf

National Diaper Bank Network. (2023, June 15). The NDBN Diaper Check 2023: Diaper Insecurity among U.S. Children and Families. Retrieved from National Diaper Bank Network: https://nationaldiaperbanknetwork.org/wp-content/uploads/2023/06/NDBN-Diaper-Check-2023_Executive-Summary-FINAL.pdf

National Diaper Bank Network. (2024). Federal Issues. Retrieved from National Diaper Bank Network: https://nationaldiaperbanknetwork.org/federal-issues/

Renkert, S., & Filippone, R. (2023). The Carework of Cloth Diapering: Opportunities and Challenges for Mitigating Diaper Need. Human Organization, 142-152. doi:https://doi.org/10.17730/1938-3525-82.2.142

Smith, M. V., Kruse, A., Weir, A., & Goldblum, J. (2013). Diaper need and its impact on child health. Pediatrics132(2), 253–259. https://doi.org/10.1542/peds.2013-0597 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727676/

Sobowale, K., Clayton, A., & Smith, M. V. (2021). Diaper Need Is Associated with Pediatric Care Use: An Analysis of a Nationally Representative Sample of Parents of Young Children. The Journal of pediatrics230, 146–151. https://doi.org/10.1016/j.jpeds.2020.10.061 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9269865/

Swete, Chelsea and Lippold, Kye, The Distributional Impacts of Taxes on Health Products: Evidence from Diaper Sales Tax Exemptions (June 10, 2020). Available at SSRN: https://ssrn.com/abstract=3671021 or http://dx.doi.org/10.2139/ssrn.3671021

U.S. Census Bureau. (2021). S1703 Selected Characteristics of People at Specified Levels of Poverty in the Past 12 Months. Retrieved from U.S. Census Bureau: https://data.census.gov/table/ACSST5Y2021.S1703?t=Official+Poverty+Measure:Poverty&g=010XX00US_040XX00US29&d=ACS+5-Year+Estimates+Subject+Tables

Wallace, L. R., Weir, A. M., & Smith, M. V. (2017). Policy Impact of Research Findings on the Association of Diaper Need and Mental Health. Women's health issues : official publication of the Jacobs Institute of Women's Health27 Suppl 1, S14–S21. https://doi.org/10.1016/j.whi.2017.09.003 https://pubmed.ncbi.nlm.nih.gov/29050653/


**This Note has been updated since its original publication. Previous versions are not up-to-date, but can be accessed here: Diaper Accessibility (December 2021) Diaper-Accessibility-V2  (January 2022) Diaper Accessibility_3_final (1)  (March 2022)

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