This story was supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems. 

SPRINGFIELD, MO — The minivan leaves Springfield before the sun hits the limestone outcroppings of the Ozark Mountains, zipping past church-dotted roads and winding this way and that — deep, deep, deep into the hills. In its trunk are about a dozen boxes of Cuties and Huggies, sizes 4 and 5. 

A handful of cars are already queued up when the van pulls into an otherwise empty shopping center — with a tiny, blink-and-you’ll-miss-it food pantry — in Forsyth, a town of about 2,500. 

Kelly Brown unloads the boxes, her eyes on the cars in the line. Most are seniors coming for food — “I don’t need diapers, yet!” — but then she spots a child. About a quarter of children in this region live in poverty, and their parents, most of whom are working, can’t cover the cost of diapers — about $100 a month. In the back of Angela Colley’s Ford Excursion is her 3-year-old daughter in a booster chair. Brown bounds up to Colley’s window.

“Do you need any diapers for your kiddos?” she asks, wearing a black T-shirt that reads, “This shirt doubles as a cloth diaper.”

Colley’s eyebrows shoot straight up. Yes, she says, surprised. Brown quickly looks through their stores for a 74-pack of GoodNite pull-ups and stows it in Colley’s backseat. She hands the little girl a small stuffed cat. 

Colley is at the food pantry to pick up food for her family of seven. She said she didn’t know she could also get diapers for free. Her 3-year-old isn’t fully potty trained just yet, and affordable pull-ups have been nearly impossible to find since the pandemic began. When she can’t, she’s done what she must: slapped a maxi pad onto toddler panties and prayed it could keep her daughter comfortable for at least a couple hours. 

Colley has five children — ages 18, 10, 9, 8 and 3 — and she remembers a time when three of them were in diapers at once, running through as many as 10 to 12 a day each. Now, a pack will hold her daughter through the week, but in those days, the need for diapers brought her to her knees.

Their family wasn’t always struggling financially. Colley’s husband lost his job as a truck driver due to a health condition during the Great Recession. The family was evicted and became homeless. Her kids were just babies then. They could get food and clothes at a pantry or with food stamps, but diapers were a different story. So she began asking strangers for money to buy them.

(Click to expand the photos for caption information.)

“You cry — it’s very humbling to have to ask strangers for money for diapers,” Colley said. 

Once, she gathered up all her silver jewelry, gifts from her family, and pawned it for $20 — enough to buy one big pack of Luvs.  Another time, she found a pack of diapers for $8 at a thrift store, but all she could scrounge together in her car was $5 in change. She wept when she asked for a $3 discount that was denied. Later, she wrapped a towel around her child instead.

Diapers have rattled Colley’s conviction, sending her thoughts racing when her need was greatest: Am I even fit to be a mom? What if I don’t deserve these kids? Will my children get taken away from me? 

Nationwide, studies have found that diaper need is a greater contributor to postpartum depression than food insecurity and housing instability. A landmark 2013 study in Pediatrics, a peer-reviewed medical journal, was the first to quantify the psychological trauma diaper need has on parents, some who reported leaving their children in soiled diapers for extended periods when they couldn’t find any, leading to urinary tract infections and diaper rash. Other parents skipped meals to pay for diapers. Almost always, mothers suffer the greatest impact. 

“Because women are much more likely to be burdened by poverty … it becomes an issue that is not gender neutral,” said Megan Smith, the lead researcher in the Pediatrics study. “[Diaper need] was really just all-consuming for the mothers we talked to.”

During the pandemic, the cost of diapers ballooned about 14 percent on average, according to a Nielsen report. At the Family Dollar months ago, a pack was $9, Colley said. Now it’s $11. She spends $44 a month on pull-ups, even for a kid who is nearly 100 percent potty trained. 

The frustration over diapers has given way to anger more times than Colley can count. The questions from others are almost always the same: Why did she have kids, if she couldn’t afford the diapers? Her family was doing OK when they had their older children, and then OK again when her 3-year-old was born. But poverty is not an identity — it’s a state, one you can move in and out of. 

The inability to provide diapers is a silent struggle in this country. Unlike with food and clothes, diapers cannot be rationed or modified — the option is a disposable diaper or a cloth one, an expense that doesn’t qualify for federal aid under most public assistance programs, including food stamps. 

That’s where organizations like the Diaper Bank of the Ozarks step in. 

Welfare reform in the mid-1990s eliminated the cash assistance program the majority of low-income families relied on and replaced it with Temporary Assistance for Needy Families (TANF), a program that less than a quarter of low-income families can now access. Shortly after, in the early 2000s, diaper banks — which collect diapers and distribute them to families in need for free — started popping up. The National Diaper Bank Network was created to help support banks across the country in 2011, around the same time the Diaper Bank of the Ozarks was founded by Jill Bright, a retired British nurse who learned about diaper need at a conference and brought the concept back to Springfield. 

The bank started out in a closet of another nonprofit, with just seven partner agencies, distributing 50,000 diapers the first year. And then it exploded. For the first couple of years, distribution doubled annually. In 2021, it’s on track to distribute 1.2 million diapers through 105 partner agencies, covering one of the largest areas of any bank in the country — 50,000 square miles across 50 counties in the Ozarks — a region mostly made up of southern Missouri and northern Arkansas — into communities with only a couple hundred residents. It is the model for rural diaper bank distribution. 

And yet, “it’s not good enough,” said Kelly Paparella, the bank’s assistant executive director who, along with Brown, represent the two paid staffers at the Diaper Bank of the Ozarks (both named Kelly). “We’re really looking at the gaps — who are the people who really need the services? — because we know that there’s inequities.”

But, so far, the public and political will has not been there to address it, and banks like the one in  Missouri continue to string together a grassroots effort to reach into the poorest pockets of the state with barely enough resources to even get there.

The Diaper Bank of the Ozarks recently completed a study to see how many diapers it could distribute to meet just the supplemental need among low-income children in their region. The number wasn’t the 1.2 million they’ll distribute this year, an all-time high — not even close. 

It was 27 million.

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After the distribution in Forsyth, the Kellys hop back into their van and chart a course into the mountains toward Branson, a tourist town about 30 minutes away, known for its profusion of theaters, motels and family-style amusements — mini-golf courses, zip lines, thematic museums. 

At another food pantry run by a Christian organization, the line of cars is already a half dozen deep as the van pulls in, long before the distribution is set to start. They go car by car, asking if anyone needs diapers for their kids — or their grandkids. Meth addiction has cost many children their parents here. About 20 percent of the people the Ozarks diaper bank helps are grandparents on a fixed income caring for grandchildren. 

Brown and Paparella meet Heather Reeves, a grandmother of three children under 3, who can’t afford diapers with the income she gets from her disability payments. She relies on the bank to pick up diapers twice a month. 

They give a couple of packs of diapers to Sommer Guthrie and her boyfriend, Colby Ball, who stop by every month for their 3-year-old. Ball works at LongHorn Steakhouse and they live in a hotel with a roommate. Guthrie has tried to look for work, but the pay wouldn’t be enough to cover day care. When her son was a baby, she asked the folks at the food pantry if they had diapers, and to her surprise, they did. She’s been coming back consistently since. 

When the Kellys offer diapers to parents or grandparents, they can see the relief on their faces. That moment is why they describe this work as their calling. 

“I found a role in my piece to be able to tackle poverty because I, too, was just completely dumbfounded [when I learned about diaper need],” Paparella said. “Everyone knows diapers are expensive. We joke about it: You’re pregnant and immediately the first thing was, ‘Oh wait ‘til you have to buy diapers.’”

Often to the surprise of parents, assistance programs, like food stamps or WIC, the supplemental program for low-income women and children, cannot be used to buy diapers. Both are nutritional assistance programs, and diapers don’t qualify because they are considered a hygiene product. Medicaid won’t cover them unless a doctor deems them “medically necessary” to treat a specific ailment like diaper rash, which can arise from parents not having enough diapers in the first place.

Only TANF provides cash assistance for low-income families that could conceivably be used to purchase diapers. But TANF is difficult to apply or qualify for, and it’s increasingly shrinking — in Missouri, only about 9 percent of the state’s TANF funds are spent on cash assistance for families. 

And then consider the poverty tax: Diapers, when bought in bulk, are significantly cheaper per unit, but to do that, families have to spend more upfront, or have a membership to a big-box retailer like Costco. A single diaper may cost about $1.50, but in bulk the cost can drop to as little as a quarter per unit, said Kelley Massengale, the researcher who led the study in North Carolina. 

The result of that inability to buy diapers in bulk shows up in just how much diapers soak up in a low-income family’s budget. The poorest 20 percent of families in the country spent nearly 14 percent of their household income in 2014 on diapers, according to an analysis by the Center for Economic and Policy Research. For middle-income families, diapers absorbed about just 3 percent of their income. 

That reality, though, is hard to convey in southwest Missouri, where the concept of giving away diapers for free is often met with questions about why parents aren’t “just” doing cloth instead, or why the parents aren’t working, why they had a child if they couldn’t afford the diapers. 

Laura Mowery, who heads one of the Ozark bank’s partner agencies, a mobile unit that carries diapers to rural towns, said the struggles low-income families endure have been oversimplified to the point that some people internalize beliefs about what families should be able to do. She did it herself at first when her church asked for diaper donations. 

“I myself swept it under the rug because I thought, ‘I’m not buying diapers. If you want them, go to work,’” Mowery said. “But let’s say you do have a kid and you are working — you’re working every day — but you have to pay your rent, and your utilities. Where’s your food money? Where’s your diapers? People really need to understand there’s more than just, ‘Get a job’ for these parents.” 

Two-thirds of families experiencing diaper need are employed. Some of them can’t work because, without diapers, they can’t put their children in child care. Day cares typically change children’s diapers every two hours, and parents are expected to provide enough diapers up front to last the day. A 2017 study of diaper bank recipients in North Carolina found that 7 percent said they had to miss work because of diaper need. When diapers were provided to those families, 15 percent of parents reported it allowed them to return to work or school and 18 percent said it allowed them to put their children in child care.

The Ozarks diaper bank provides diapers to child care centers to have on hand in case a parent doesn’t have the necessary amount. Paparella said they realized parents weren’t changing their kids at home to ensure they could still go. One day care center would put a Sharpie mark on infants’ last diaper change of the day, and sometimes, that same diaper came back the next morning. 

The bank’s cloth program, which Paparella leads and will talk about for hours if you get her started, also helps provide crucial services for parents. Cloth diapers, while reusable, can run from a couple dollars to $30 each, and parents need about two dozen. The bank gives parents all the cloth diapers they will need for free through the time their child is potty trained, eliminating the high cost barrier. 

Paparella runs a class at the bank educating about the cost savings in the long run with cloth diapers and the best ways to wash them (you can’t use softener, for one). The bank estimates that the 64 cloth diaper kits it gave out last year equate to about 600,000 disposable diaper changes. But cloth isn’t for everyone: Some laundry facilities and day cares won’t accept them, and they are difficult to transport on public transit if you don’t have a car or a washer and dryer at home. 

The Ozarks bank has tried to provide this education and expand as far as it can with the little resources it has. The first year Paparella joined the bank, for example, in 2017, it was serving 15 counties. Then 30 counties the next year. Now 65. Out here, where towns are far apart and most families still don’t know the diaper bank exists, their work is difficult. Most of the parents they saw on their trip to Forsyth and Branson were learning that diapers were available at the food pantries for the first time. 

“Just like it takes a village to raise a child, it takes all of the collaborations of organizations and agencies in those communities to reach families,” Brown said. “Some of our partners travel four hours one-way to come get diapers, so we are dependent on them to carry out that mission in their community.”

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Research on diapers is still in its nascent stages, but Massengale is helping conduct a nationwide study of diaper need with the help of 60 diaper banks, including the one in the Ozarks, surveying as many as 11,000 families. 

The data could pave the road for more policy, showing that “whenever there is a diaper bank in a community, it’s helping to meet this basic human need for families,” Massengale said. “It’s also saving our health care system dollars, it’s providing access to early childhood education, it’s keeping families in the workforce.”

But currently, diaper need has been met with all but indifference while more and more families report struggling to even have enough food for their children. There has been, however, a precipitous rise in policy that supporters claim protects children. 

In the past year, more states have enacted laws restricting abortion in 2021 than any other time in American history. After Texas, where a new law all but eliminates abortion access, Missouri’s patchwork of regulations is considered among the harshest in the country. 

Many people specifically cite their inability to sustain their families financially as part of the reason they seek out abortions. And yet, there is far less impassioned discussion about what needs to happen to support families after a child is born. 

Joanne Goldblum, the CEO of the National Diaper Bank Network — which now counts more than 225 members — estimates demand for diapers has grown 86 percent during the pandemic. Nationwide some diaper banks reported doubling their distribution; At one of the Ozark bank’s partner agencies in Ash Grove, a town of 1,400 a half hour outside Springfield, the number of families needing diapers has doubled, said Pattie Moulin, who runs the diaper pantry from the town’s United Methodist Presbyterian Church. Before March 2020 they were serving maybe 17 or 18 local families — now it’s 40. 

The collision of those two things — a rise in poverty while abortion access shrinks — incites a complicated question about American ideology: Does the sanctity of life end after those first cries if, in practice, the United States fails to support children once they are out of the womb? In rural areas, where abortion is largely decried but aid is necessary, it gets even muddier. 

“We’re very pro-life [in this region],” Paparella said. “You want to protect the unborn baby, but we need to protect the baby that’s born afterwards.” 

Colley, the mom of five, is religious and doesn’t support abortion, but she can understand why someone would get one. 

“You just gotta understand how hard it is for people to raise children in this world these days with no support,” she said. “If we’re making anti-abortion laws, we need to support the children that are here more.” 

Yet, there has been almost no concrete action on diaper need at the federal level, despite a handful of bills that have been proposed to shuttle aid to diaper banks. It’s low-hanging fruit, advocates argue, that could help significantly reduce diaper need in the country. Most banks, like the one in the Ozarks, are run almost entirely by volunteers, who are led by a few paid employees and a budget of a couple hundred thousand dollars a year. 

Meanwhile, the need is neither new nor diminishing. It’s a window into poverty, Goldblum said.

“I know that diapers are not the answer to ending homelessness, but sometimes diapers can be the difference for one family,” she said. “I think that’s what’s powerful about this — we are talking about basic human dignity. We’re not talking about complicated issues.” 

There were moments in the pandemic when diaper need suddenly shot up to national prominence. Major publications carried stories about the cost of diapers rising; about big-box retailers running out of supplies; about a dad stealing a box for his kids, drawing a crackdown from his local police department and an outpouring of support from parents who came to his defense. It’s the kind of moment-in-time focus that also happened after the Great Recession, when President Barack Obama called for ending diaper need. 

This year, two bipartisan bills emerged, the first time Republicans have cosponsored legislation. 

Republican Sen. Joni Ernst cosponsored a bill with Democratic Sen. Chris Murphy that would provide $200 million in aid to diaper banks as a result of the pandemic. Republican Sen. Kevin Cramer joined Sen. Tammy Duckworth, a Democrat, in introducing companion legislation in the Senate to the End Diaper Need Act, a bill Reps. Barbara Lee and Rosa DeLauro have been pushing in the House for years. It would provide ongoing aid to diaper banks — $200 million a year through 2025 — as well as qualify diapers for use with a health savings account, and allow Medicaid recipients to receive diapers for older children with a medical necessity. 

All potential watershed moments, and then — nothing. The bills sit in the record, unmoving. Perhaps there’s still not enough bipartisan support, or political will, or too many other priorities. 

“This should be a lay-up,” said Audrey Symes, a volunteer lobbyist for the National Diaper Bank Network. “Why is it not happening? It’s not that expensive.”

Goldblum has come up against this reality endlessly in the two decades since she started a diaper bank in New Haven, Connecticut, one of the first in the country. Two decades of advocacy have turned up a handful of legislators willing to take on the cause, a couple proposed bills, some movement in some states, but not much else. Often, she is still explaining diaper need to people for the first time. 

“Legislators tend to think about the big picture and the truth is nobody very much thinks about the little things,” Goldblum said. “But something as small as a diaper — I’ve had people say, ‘This to me can make the difference between being able to make ends meet at the end of the month.’” 

Goldblum and the diaper banks have pushed for legislation that does not include diapers in food stamps or WIC because those are food assistance programs, they argue, that are already suffering from little funding as it is. They don’t want to see families weighing whether to use the money to feed or diaper their child. Instead they want to see individual set asides (the proposed legislation would be funded through the existing Social Services Block Grant, instead). 

But previous attempts at doing that have been mocked. The first federal bill addressing diaper need, introduced in 2011 by DeLauro, a Connecticut Democrat, proposed that the federal government distribute diapers through child care centers. Conservative radio talk show host Rush Limbaugh lambasted DeLauro’s proposal as an example of “nanny-state” legislation that “gives a new meaning to the term ‘pampering the poor.’” Limbaugh argued the bill also left out parents whose kids were not in day care. 

Lee, the Democrat from California, has tried a couple different directions, proposing removing sales tax on diapers — something 10 states now do, including California — sending grants to diaper banks and allowing parents to pay for diapers using pre-tax dollars in health savings accounts.

She said some of her fellow members of Congress have laughed at the idea, “They said, ‘OK Barbara, diapers? Why diapers?’” Lee said. It’s the same people who passionately decry abortion, and yet diapers has not been able to drum up the same attention, she said. 

DeLauro knows this road well. This year, legislation to expand the child tax credit to the poorest families, something she’s been championing for decades with little bipartisan support until quite recently, finally passed. Parents have reported using the funds — up to $360 a month for the youngest children — for diapers. 

But the child tax credit expansion is currently just for a year, and, besides, it’s not a targeted solution to diaper need, she said.

“People feel it’s not a front-burner issue,” DeLauro said. “With the child tax credit, it wasn’t opposition, but it was indifference. That may be the case here.” 

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In Branson, Kelly Paparella gets a phone call. 

A mom in her cloth diaper program, Desiree Abbott, has just been to the doctor with her 10-month-old son and learned he’s allergic to coconut oil, the replacement for diaper rash cream that Paparella suggests parents use with cloth diapers. (It’s one of the main ingredients in most creams, and it’s better for the diapers). She doesn’t have any disposable diapers for the baby.

Abbott is living in a hotel with her husband, Steven Bryant, the baby and their 2-year-old. 

“So, the address, we’re gonna text it to you, OK?” Paparella tells her from outside the food pantry. “You can just click it and get on over here, and you guys can get some food and diapers today.” 

Abbott is only 25, but she and Bryant, 26, have faced more adversity in the past couple of years than most people see in a lifetime.

When her eldest son was born, she worked three jobs and cared for her sick grandfather. She was just a teenager. Her son was eventually adopted by her uncle. Last year, when Abbott was seven weeks pregnant with her youngest, doctors found an infection in the bone behind her left ear that caused partial facial paralysis. As she underwent treatment, she showed up to her job at McDonald’s with a picc line in her arm. 

“I can’t not provide for my kids,” Abbott said. She lost a job this year as a housekeeper because she missed work while her middle son was in the hospital battling severe pneumonia. 

They tried cloth diapers to save some money, and now even that isn’t quite working

Before Abbott arrives, Paparella prepares herself. What luck, she tells Kelly Brown, that they happen to be in Branson on the same day. But her job is tricky — she isn’t just distributing diapers. Sometimes, she’s acting as the connective tissue and different forms of aid. Paparella wants to help parents be self-sufficient, and some of that means keeping them accountable, making sure they are reaching out for all the help that’s available to them. That requires building trust.

She spots Abbott right away when her car pulls up to the line outside the pantry. Strapped to the top of her old red Nissan is a big black stroller. The two boys are in the back in their car seats, wearing matching tie-dye shorts and tank tops.

After volunteers pack the back seat quite literally to the roof of the car with diapers and wipes, Bryant takes the boys out and to a nearby park while Paparella talks through options with Abbott. 

They have two nights left in their hotel, and then they have to go somewhere else. Some people have suggested she leave the kids at Isabel’s House in Springfield, an emergency services shelter. But Abbott is worried it could cost her custody of the boys. It could signal she isn’t fit to care for them. 

Paparella also urges Abbott to leave the kids at Isabel’s House. It won’t put her custody in jeopardy, she tells her.

“To put myself in your shoes,” Paparella tells her, gently, “I would understand completely, because when I first learned about that, I was like, ‘Oh my goodness, how do you build trust with somebody to allow your kids to be staying with them?’ When you meet the staff and when you see what’s going on in there, they want and encourage you to want to come all the time. That’s why I want you guys to move to Springfield.” 

Paparella has been trying to encourage them to move out of rural Missouri, to where the aid is more concentrated, where she can reach them. She wants Abbott to be connected to every resource available, because “one thing I understand, in everything that you’ve ever said is, this is your life,” Paparella tells her, motioning with her index finger at Abbott’s family in the distance. 

Abbott and Bryant’s lives are so clearly built around their children. It’s purposeful: Bryant didn’t grow up with his dad, and being a father felt like a calling for him long before he became one. When he and Abbott found out they were pregnant with their first child, he carried the positive pregnancy test in his pocket. On his left bicep is a tattoo that reads “Ohana.” Family. 

When they’ve had diapers, things are OK, they can provide. When they haven’t, they’ve fallen into periods of severe depression.

It’s so upsetting, Bryant struggles to find the words to describe it. “It’s emotional,” Abbott says. “At that point, it makes me think, maybe my kids are better with someone else.” 

Diapers for them are a symbol of who they are as parents. Without them, who are they?