Tabatha Pettigrew never feels more humiliated as a mother than when diapers run low for her two youngest children and she has no money to buy more.
Anxiety builds and she stresses about how she can make what's left last until her next $600 monthly public assistance check. The 32-year-old dreads the walk of shame when, as a last resort, she will knock on neighbors' doors in hopes they have some to spare. Worst of all, she feels like an inadequate parent because she can't provide such a basic necessity.
"It is a big issue if you don't have diapers and don't have money to get any," said Pettigrew, who lives in a Baltimore transition facility for women with past substance abuse problems. "You just feel stuck."
It's an emotional struggle many moms living in poverty say they face. Infants and toddlers use eight to 12 diapers a day, costing families $70 to $80 a month, much more than many say they can afford. Public assistance doesn't cover the expense as it does food, child care and housing. Parents find themselves turning to less-than-ideal ways to stretch their supply, such as leaving them on their babies longer than they should or even bleaching diapers for reuse.
In recent years, a small movement has developed to address the issue, in part by opening diaper banks, where needy families can get free diapers. Operating much like food pantries, such banks have been organized in dozens of cities, including what is believed to be the first in Baltimore, called diaperSHARE.
Stemming from the diaper bank movement, the National Diaper Bank Network also seeks an economic reprieve for needy families by supporting local, state and federal legislation to either make diapers tax-free or secure government funding to help cover the cost.
This initiative has been derailed by tight budgets and rhetoric about irresponsible welfare moms. But advocates say the high cost of diapers has a ripple effect on poor families, and eventually on society, leading to health problems for the baby, such as diaper rash, and for mothers, including depression. There also are economic consequences, because most child care providers won't accept a baby without an adequate supply of diapers, so mothers cannot work.
"Families really suffer when they can't afford an adequate supply of diapers," said Lynn Erdman, a registered nurse and CEO of the Association of Women's Health, Obstetric, and Neonatal Nurses, a group that has pushed for ways to ease what's being called diaper need. "It has become one of those hidden needs in this country."
The nurses association worries about the health ramifications when mothers delay changing or reuse diapers. Minor diaper rash can easily turn into a major skin condition or a urinary tract infection, Erdman said. Babies can wind up in emergency rooms or a doctor's office for a condition that could have been prevented.
In the first peer-reviewed study on diaper need, researchers at Yale School of Medicine found the cost of diapers causes a higher level of stress than any other basic need parents struggle with in caring for their children. Aside from the economic consequences, there is the guilt they are somehow a bad parent. Infrequent diaper changing also can harm bonding between a mother and child when a stressed parent struggles to soothe a fussy child.
"Having to worry about things like diapers can really take up a lot of space in a mother's head and not leave them time to think about other activities to form attachments with their babies," said Megan Smith, assistant professor of psychiatry and child studies at the Yale School of Medicine and one of the authors of the study.
The Yale study found that nearly 30 percent of the mothers they surveyed could not afford diaper changes and one in 10 mothers reported stretching diaper use, which is most likely to lead to diaper rash and urinary tract infections. More than 30 percent said they had increased feelings of stress and depression because of diaper need.
Other studies have shown that babies whose parents have high levels of stress or depression are at greater risk for social, emotional and behavioral problems.
Efforts to help families with the cost of diapers through legislation has met with little success.
Rep. Rosa DeLauro of Connecticut introduced the federal Diaper Act in 2011 that would have amended the Child Care and Development Block Grant Act of 1990 to allow certain child care centers to use federal funds to provide diapers to needy families. The legislation did not pass, but the U.S. Department of Health and Human Services issued a letter saying that states wouldn't be restricted from applying the grants in this way. However, advocates said, many don't because it is costly.
The bill had its critics, including radio talk show host Rush Limbaugh, who said it "gives a new meaning to the term pampering the poor," according to a transcript on his website. Others questioned why families couldn't use cloth diapers.
Most child care centers and laundromats don't allow cloth diapers and many poor families don't have washers and dryers at home, advocates said.
Efforts in California, Connecticut and Illinois to eliminate the state sales tax on diapers were derailed by tight budgets.
In Maryland, baby diapers are taxed at the state's six percent sales tax rate, while other items analogous to diapers are not taxed because they qualify as medicine, including baby oil, baby powder, sanitary napkins and tampons. Adult diapers and incontinence pads also are not taxed.
Advocates hope that with time, people will become more aware of the diaper issue and it will gain more support.
"I think a lot of it is trying to get people to recognize the problem," said Alison Weir, director of policy, research and analysis for the National Diaper Bank Network. "If you are not changing diapers regularly, you are not thinking about diapers."
In the meantime, diaper banks are helping to get diapers to needy moms. The National Diaper Bank Network works with about 260 community-based diaper banks that collect, store and distribute free diapers to struggling families. In 2014, the network distributed nearly 35 million free diapers. Founding sponsor Huggies donates more than 20 million of those diapers annually.
The banks are usually staffed by volunteers and count on donations from the community. Some banks deliver diapers while others may be housed within food kitchens or other community places.
In Maryland there are diaper banks in Annapolis, Hagerstown and Millersville as well as the new one in Baltimore.
Baltimore's diaperSHARE was accepted by the National Diaper Bank Network in August. It is an extension of ShareBaby, a nonprofit started by moms who collect baby items — strollers, clothes, toys —to take to needy families at places like Dayspring and House of Ruth in Baltimore, Sarah's House in Fort Meade and Light House in Annapolis.
Kate Nolan Bryden, now co-director of diaperSHARE, first learned how desperate some families were for diapers from a Facebook post on a page for mommies, when a woman asked followers to pray that she made it through the weekend with enough diapers.
"The stress and pain in her voice was so evident," Nolan Bryden said.
The organization is still ramping up its diaper efforts and recently had its first donation drive outside a local store. Its goal is to build up enough of a supply to regularly cover families' diaper needs. For now, it gives what it can.
Last week, four of its members brought diapers to Dayspring for Pettigrew, who has three children, including a 1- and 2-year-old who are not yet potty-trained. Another mom, 34-year-old Precious Gaines, also got diapers for her 8-month-old twin sons. Gaines said the babies' father often brings diapers but they run out.
The moms talked about using diapers that were too small because that was all they had left. Both said they would like it if public assistance coverd the cost.
Pettigrew acknowledged crying over diapers.
Gaines said she sometimes feels as if she is letting her babies down.
"They look at me as the protector," Gaines said. "I am supposed to protect you and I can't even buy you diapers. I am not doing my job."
As they received diapers from diaperSHARE, both were grateful for a little reprieve from the stress.
"With this one small thing," Nolan Bryden said, "you can chip away at the hardships these families face."