This is the second in a series, On the Edge, examining the issues facing families with children in Western North Carolina.
When families don’t have access to diapers, it’s not a pretty picture.
Alicia Heacock, co-director of Babies Need Bottoms, the only diaper bank serving Western North Carolina, said parents who can’t afford diapers may have to resort to unpleasant substitutes, including “trash bags, plastic bags, or paper towels in lieu of a diaper.”
“It’s not good for kids,” Heacock told BPR, adding that caregivers may also sometimes “try to wash and reuse disposable diapers,” which poses a health risk.
A 2023 study from the National Diaper Bank Network found that nearly half of American families with young children struggle to afford diapers, marking a 14% increase since the organization first conducted the study in 2010. Among families with diaper needs, 66% were low income.
Babies Need Bottoms reported an even sharper increase in diaper needs among families in the region.
“When the pandemic hit, we had like a 400% increase,” said Meagan Lyon Leimena, co-director of Babies Need Bottoms. “I mean, it’s just like a straight line on a graph. We’ve seen a skyrocketing need, and at this point we’re just trying to sustain.”
Although federal poverty-assistance programs such as SNAP and WIC help North Carolina families pay for food and formula, there are no government benefits at the national or state level that subsidize the cost of diapers for children without medical need.
Diapers for a single child can cost well over $1,000 a year, Leimena told BPR.
The expense puts extra strain on families already stretching their budgets. In addition to an average price of 20 to 30 cents per diaper, parents also have to pay sales tax on the item. Twenty-four states exempt diapers from sales taxes, but North Carolina taxes diapers at a minimum of 4.75% — the regular state sales tax — and Buncombe County residents pay the standard 7% sales tax on diapers.
“Diaper banks exist because there are no other resources to pay for these expenses. So we consider ourselves part of the social safety net,” Leimena said. “There are huge swaths of the country or of counties that are underserved or not served at all.”
An ‘invisible’ problem
Despite the prevalence of diaper needs, the problem is often “invisible,” according to Kelley Massengale, a Durham-based researcher for the National Diaper Bank Network.
“Diaper need is something that a lot of times people don’t think about, especially if they’ve not diapered a child or never had the experience of wondering how they are going to diaper a child if they couldn’t afford the diapers.
“And when you don’t think about it, it’s not something that people actively work to address. We have policies that help families meet many other basic needs — or at least partially meet those needs, whether it’s housing, utilities or healthcare. We don’t have any policies in our country that help all families who need diapers to access them,” Massengale said.
The health and social concerns that stem from diaper insecurity are wide-ranging, Babies Need Bottoms co-director Alicia Heacock explained.
When diapers are in short supply, caretakers tend to keep their young children in dirty diapers for unhygienic amounts of time, which “puts kids at risk for skin and pelvic infections,” she said.
It also makes children “fussier,” impacts their ability to sleep, and can cause developmental problems, which in turn creates more stress for the rest of the family, Heacock said.
Diaper shortages may also lead to social isolation for both children and caregivers, as it’s much more difficult to bring your kid to story time or the library with a dirty diaper, explained Leimena. It can even keep a child from being able to attend day care.
“Most child care facilities require at least a day’s worth of diapers ahead of time,” Leimena added. “If you don’t have those diapers, you can’t send your kiddo to day care. If you cannot access child care, you cannot work or attend school or potentially even leave your home.”
Distributing diapers in the WNC mountains
Since its inception in 2017, Babies Need Bottoms has distributed over 1.3 million diapers through a network of more than 60 community partners. In mid-November, the nonprofit expanded into a new warehouse in East Asheville. The upgraded space allows for much larger diaper donations.
“We’ve had to say no to a truckload of diapers that was offered to us as a donation because we didn’t have space for them,” said Leimena. “So I was saying no to like 200,000 diapers, which was deeply painful. And so now we can say yes to donations that come our way.”
A delivery bay and plenty of space for volunteers in the warehouse also helps streamline distribution, which has risen to 40,000 diapers a month.
The Verner Center for Early Learning, an early-childhood education provider, partners with Babies Need Bottoms. The center receives funding from the state’s Early Head Start program, which provides free child care to about 250 families in the region that are low income, defined as making 200% or less of the Federal Poverty Level (roughly $36,620 for a two-person household).
Even though diapers are included free of charge as part of Verner’s weekday preschool program, caregivers still struggle to afford diapers outside of those hours, especially during the holiday season, said Whitney Rea, the director of family and community partnerships at the Verner Center.
To help offset that need, the center offers a pack of 25 diapers, furnished by Babies Need Bottoms, to each caregiver on a monthly basis. Almost all the caregivers sign on to receive this supplement.
“A lot of the time, like seriously, families have to choose between gas … or they have to choose between certain foods or diapers,” Rhea said. “And sometimes they do everything they can just to get their child to school so that way they will get those free diapers during that time.”
In addition to meeting the direct need for diapers, making the item more accessible can also reduce the number of hard choices caregivers have to make in their day-to-day lives and budgets, Heacock noted.
When parents don’t have to pay as much for diapers, they can spend money on other necessities like gas, bus passes, car repairs, and insurance.
“We hear things like having diapers helped a family move into a new home. They were able to scrape together a deposit with the money they saved,” Heacock said. “Another parent shared that she was able to buy a cap and gown for graduation with the money she was saving from the diaper program.”
Providing coverage through policy change?
In 2022, the federal government launched the Diaper Distribution Pilot. The program has distributed grants to 21 states and tribal nations, including North Carolina, which received a $1.2 million grant through the North Carolina Community Action Association (NCCAA).
Sharon Goodson, president of the NCCAA, said she is excited by what could come out of the pilot and sees it as a form of economic mobility for families who are struggling.
“We’re grateful to have a pilot,” she said. “We know that there’s an impact, with diapers keeping babies healthy and also ensuring parents don’t have to miss work. We believe this pilot can help link people to jobs and other opportunities so they can not just survive, but thrive.”
Over the next year, the grant money will cover the more than 530 children on the waitlist for Early Head Start, the program that funds nonprofits like Verner Center’s preschool program and provides children with diapers, wipes, and ointments while they’re at school.
Parents and guardians can also sign up to receive up to 100 diapers by participating in agency programs like job readiness training, parenting classes, and financial empowerment courses.
Money will also go to the Diaper Bank of North Carolina to help the nonprofit deliver supplies to 14 underserved counties in the Eastern part of the state, including Wayne, Hertford, Halifax, and Lenoir.
A new version of the End Diaper Need Act has also been introduced in Congress after failing to pass in 2021. The updated bill proposes $200 million per year in funding for diapers and diaper supplies from 2024 to 2027.
In addition, the law would provide 200 “medically necessary” diapers each month for medically complex children through the Medicaid Home & Community-Based Services Waiver Program. It would also allow such diapers to become qualified medical expenses, making them eligible for purchase through a family’s health savings account, or HSA.
Medicaid expansion offers another potential solution to the diaper crisis in North Carolina. Tennessee is set to become the first state in the nation to supplement the cost of diapers through its Medicaid program, TennCare.
“I’m really excited by what’s happened in Tennessee,” Massengale said. “It’s been a leader in that, and I’m hopeful that in North Carolina we might look to our neighbors to see what is possible for improving access to diapers for families.”
Leimena said a policy move — eliminating the sales tax on diapers in North Carolina — would address the issue.
“Repeal the diaper tax,” she said. “Our state legislature can do this. It would be so easy. At least I think it’d be easy … let’s at least give families a little break at the grocery store when they’re buying their diapers.”
