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Low-income mothers in New Haven who can't afford enough diapers to keep their babies clean and dry are more likely to report trouble coping with stress, depression or trauma, according to a study published today in the journal Pediatrics.
The survey of 877 New Haven mothers found that nearly 30 percent said they didn't have enough diapers to change their children as often as they would like, and the problem was more common among Hispanic women and caregivers over age 45, usually grandmothers. Women who reported diaper need were nearly twice as likely to experience mental health issues, although the nature of the link is unclear.
The authors hypothesize that the link could be direct, or it could be part of more complex interaction between mental health and poverty.
"It could be that moms who have more mental health difficulties have trouble obtaining diapers," said the lead author, Megan Smith, an assistant professor of psychiatry, child study and public health at Yale University. "We're not assuming causality."
A total of 73 percent of the women surveyed had used food stamps in the previous year, and 89 percent were receiving support from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but neither of these resources can be used to buy diapers or other hygiene or cleaning supplies. And since most child care centers require parents to provide disposable diapers, women who can't afford an adequate supply may be less able to work or go to school.
"It shouldn't be considered an extra for children to have clean, dry diapers," said Joanne Goldblum, a co-author of the study and executive director of the New Haven-based National Diaper Bank Network, which helps community-based agencies across the country provide diapers to needy families. "It's so basic that nobody thinks about it."
Babies who aren't changed regularly are more likely to have trouble sleeping, and to get urinary tract infections or severe diaper rash, she said. They may also be at greater risk of abuse. "We don't have the scientific evidence that shows that dirty diapers lead to abuse," said Goldblum. "But we have evidence that dirty diapers lead to crying, and that crying lead to abuse."
Mothers may experience more parenting stress and less confidence in their parenting ability if they can't provide their babies and toddlers with such a basic need, Smith said. "And if your baby is irritable and fussy, then bonding and attachment are much more difficult," she added.
An adequate supply of disposable diapers costs about $18 per week, the authors report. For a parent working full time at minimum wage, that represents 6 percent of gross income.
"Mothers described to us not being able to pay their utility bills, for example, because they needed to buy a case of diapers," Smith said.
"So they were definitely skimping and cutting back on other areas for their families in order to provide diapers."
Some women borrowed diapers or money from friends or family when supplies ran low, some obtained diapers from agencies, and 8 percent reported stretching their diaper supply. Often that means removing a diaper, emptying out the solids, and putting the diaper back on the child.
While cloth diapers may be less expensive than disposables, most child care centers require disposable diapers. In addition, cloth diapers may not be a practical option, especially for families that don't have a washer and dryer. Some laundromats don't permit washing diapers, and washing them by hand takes time, hot water, space for drying—and detergent, which can't be bought using WIC or food stamps.
"The most important thing from my perspective is that small things impact big things," Goldblum said. "We can't address the bigger issues of poverty and child development if we don't address the most basic issues, like diapers."
The authors said that to their knowledge, this is the first peer-reviewed study to quantify diaper need. They hope that by defining the issue and providing a framework for measuring diaper need, the study will encourage more children's health care and social service providers to start asking some of the same questions.
In the future, Smith said, they hope to investigate how diaper need hinders access to quality day care, and whether providing diapers might be a useful incentive to participation in various services. She also hopes to study the higher-risk sub-populations they have identified, such as older caregivers and Hispanics, both groups who may be less connected to available services.
The study is part of the New Haven Mental Health Outreach for MotherS (MOMS) Partnership, a community-academic collaboration between Yale University and seven local and state agencies. Smith said she first learned about diaper need from mothers participating in the partnership.
"I assumed that diapers were covered by things like food stamps and WIC," she said. "This is really how you operationalize poverty for low-income mothers. We talk a lot about food and housing, but not a lot about other specific, tangible, basic needs."
This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).