Being a new parent is always a lot of hard work. Babies need constant feeding and care. There are sleep schedules to figure out. Symptoms to monitor. Soothing, shushing, and swaddling to master.

But for Jessica Frazier, her babies brought an extra layer of work. She poured her energy into figuring out how to afford an adequate supply of diapers. “I try to stick to a budget,” she explained. “It’s math. You have to break this stuff down, in every sense of the way possible.”

Frazier soon found she was changing her first newborn’s diaper eight to 10 times a day. She can rattle off store prices like an auctioneer soliciting bids. A pack of diapers only comes with 28 at Stop and Shop, she said, going for $8.99 a pop. That doesn’t include baby wipes, which go for $15.99 a case. It all adds up to a hefty sum. It costs a family about $1,000 a year to buy a supply of average-priced diapers for one child. For someone who works a full-time minimum-wage job, making just over $15,000 a year, that’s a huge expense.

So Frazier does what she can to bring the sticker price down. “I would find and cut coupons,” she said. “I do pay attention to who has sales.” She plans ahead, trying to make sure she doesn’t run out of the diapers she buys on discount. But, she added, “things don’t always work out.”

“God forbid if they have diarrhea,” she said. That will increase the daily diaper count to a dozen. Forgetting to buy them ahead of time means a trip to the corner store, which sells a pack of diapers for $10.

She tries to stock up on other things—for instance, purchasing meat in bulk and freezing it so it lasts months—but it doesn’t work the same with diapers. “Kids go through diapers every day, every other minute,” she said, and a baby who today is a size two may be a size three within a week.

There have been times when Frazier simply couldn’t get enough diapers to keep up with her kids’ needs. Recently she had to put her 2-year-old son in diapers meant for swimming [retail price: $10 for a pack of just 18] until she could get more. Other times she’s had to put cloth underwear on him until she could get to a store. “I’m cleaning up pee all day,” she said.

It’s meant making sacrifices. “I might need this gas, so I hold off on getting a diaper,” she said. “If I needed a new pair of sneakers it was, ‘Well, this is just going to have to wait.’” She would skip bills, trying to double up the payments later when she had more, even though that meant incurring an extra $5 for being late. Instead of getting an oil change for her car, she would add some extra oil to the engine.

Some things have had to be put on hold indefinitely. She often can’t take her kids to a movie they want to see because the tickets cost so much. Her 4-year-old daughter wants to do gymnastics and ballet, and Frazier isn’t sure she can afford either, let alone both.

“You can do without a car, you can do without soda in your house, you can do without them snacks, you can maybe do without that new T-shirt,” she noted. “But diapers you can’t do without.”

A third of American families struggle to afford enough diapers for their children. Three-quarters of those families also have a hard time getting an adequate supply of other necessities like soap, shampoo, and feminine-hygiene products. Diapers come with eye-popping price tags, but none of those items are cheap. And even if poor families are able to enroll in government safety-net programs like food stamps or Medicaid, they’ll quickly find the benefits don’t cover these necessities.

Fifteen years ago, Joanne Goldblum was visiting clients’ houses as a social worker in New Haven, Connecticut. Her background didn’t prepare her for what she witnessed. “What I saw was a level of poverty that, even as a social worker, I was surprised by,” she said. “I kept seeing over and over again this lack of basic[s]. Not having diapers, not having toilet paper, not having laundry detergent.” She watched parents take diapers off of their babies, empty the solids out, and put them back on to stretch their supply.

For 60 years, a larger share of poor families could at least access a small amount of cash assistance each month through a federal welfare program then known as Aid to Families with Dependent Children. That welfare money could go toward things like diapers, wipes, laundry detergent, toilet paper, and toothpaste. But in 1996, a Republican-led Congress worked with Democratic President Bill Clinton to completely change the program—renaming it Temporary Assistance for Needy Families (TANF), and inserting barriers like work requirements and time limits for eligibility. Today less than a quarter of poor families get cash assistance.

By the time Goldblum visited families, years after this welfare “reform,” most could only turn to food stamps or the Women, Infants, and Children nutrition program (WIC). But neither of those can be used to buy things like diapers or laundry detergent. “There were no state or federal subsidies that supported hygiene products or cleaning supplies of any sort,” she noted.

Our safety-net programs “think about the big things,” said Goldblum, who is now CEO of the National Diaper Bank Network, whose chapters give out free diapers to those in need. They “don’t think about the little things.”

In the first-ever peer-reviewed study of diaper need, conducted in 2013, mothers reported a variety of ways to cope. Nearly 8 percent did things to stretch out their supply of diapers when it was running low. Some families might leave a child in a diaper longer than they otherwise would, risking diaper dermatitis (diaper rash) or urinary-tract infections. On the other hand, a study of people availing themselves of the Diaper Bank of Connecticut found that diaper rash decreased by a third and the rashes cleared up far more quickly.

Others have reported taking off a wet diaper, bleaching it, drying it, and then reusing it. “We’ve heard a wide variety of the types of things folks do to stretch their dollar further,” said Janet Stolfi Alfano, executive director of the Diaper Bank of Connecticut. “Anything from newspaper to duct tape, we’ve had families drive to our office and change their baby on our floor.” One young father was advised by a family member to feed his children less so they used fewer diapers. Another 10 percent in the 2013 study borrowed either diapers or money to buy them from family or friends.

That’s what Natasha, a mother in Maine, did when she ran short on diapers with her three young children. “I would have to borrow money,” she said. “I was sort of in debt almost because I had to pay everybody back.” She’s also given up things for herself to keep her kids in diapers. “If I need to do laundry, but they need diapers, they come first,” she said.

She estimates that she spends about $60–$100 a week buying Walmart-brand diapers. “I always heard everybody telling me children are expensive,” she said. “But I always thought in the sense of clothing and just providing food and stuff like that for them.” The inability to buy enough diapers had never crossed her mind. In the early days when she would run short on diapers, she would be “in panic mode,” she said. “It puts a weight on our family.” She and her boyfriend fight more when diapers are in short supply. “It stresses us out and then we start to bicker or fight,” she said. “It is a strain if you can’t provide for your children.”

The 2013 study found that diaper need affects parents, not just children. Poor mental health is significantly associated with being unable to get an adequate supply of diapers. “Diaper need was the variable that best predicted post-partum depressive symptoms,” explained Megan Smith of the Yale Child Study center, one of the researchers on the study. “If you’re a parent and you know a way to soothe your child is to change their diaper…and you can’t change their diaper, your feeling of competence and feeling of efficacy as a parent is incredibly diminished.”

The inability to afford enough diapers can also create a vicious cycle. Most daycare centers require that a parent bring a supply of diapers for their infant. But other than Early Head Start, most don’t provide diapers themselves. Without daycare, many people can’t get to work to earn the money they need to buy diapers. According to a 2017 study from the National Diaper Network (co-funded by the disposable-diaper brand Huggies), nearly 60 percent of families in diaper need report having missed work or school because they didn’t have enough diapers for childcare.

Years ago, Goldblum worked with a Head Start center in New Haven. “The executive director used to talk about Monday-morning diaper rash,” she recalled. Families spent the weekend rationing diapers to have enough to send their children to daycare at the start of the week.

Some parents turn to cloth diapers, which could save money in the long run because they are reusable, but the higher upfront costs are often a barrier for lower-income families. Further, most daycare centers won’t accept cloth, and laundering can be difficult without a washing machine or a pricey diaper service. Perhaps unsurprisingly, more than 90 percent of American families use disposable diapers.

And diapers are just one of many costly necessities that cash-strapped families struggle to buy. There are baby wipes. There’s laundry detergent to wash a family’s clothes. Toothbrushes and toothpaste. Deodorant and menstrual products. Smith has found that many families can’t afford thermometers or children’s Tylenol, so when they think their children might have fevers they have to take them to emergency rooms to have their temperatures read.

When Frazier’s daughter decided to start using the toilet at an early age, it meant shelling out less for diapers and wipes, but it didn’t mean lower overall costs. “Now I got to buy laundry detergent because I got to wash up a little bit more, because we’re going through underwear,” she said. An economy-sized bottle of detergent—good for 54 loads—costs her nearly $30.

Frazier’s children have eczema, so she needs to buy them specialized soaps that are less likely to be on sale. Then there’s the toothpaste and the toothbrushes that have to be replaced every three months. Her daughter now uses mouthwash and both children use dental floss. She can buy toilet paper in bulk and on sale for $10 if she plans ahead, but if she forgets and runs out, it can cost her 50 percent more.

“These are all costs that don’t go into your food stamps or your WIC,” Frazier noted. “Don’t get me wrong, they’re definitely great,” she said, expressing gratitude for those benefits, “but when it comes to personal hygiene, there is no room.”

“There are just…large gaps in the federal anti-poverty programs,” said Ife Floyd, senior policy analyst at the Center on Budget and Policy Priorities. Targeted programs—such as rental assistance or food stamps—often fail to cover a full month’s expenses, so when families do get cash assistance, they might have to use it to make up the difference. Some might have access to food banks or diaper banks, but others might not. “It’s really a patchwork of resources that are available to families across the country,” Floyd said.

The inability to afford a diaper is a trauma for families in need, but it also provides a way for those who haven’t experienced hardship to understand what poverty feels like.

“Trying to explain to people what it’s like to be hungry, it’s really hard to do,” noted Jessica Bartholow, policy advocate at the Western Center on Law and Poverty. “But trying to get ahead of a baby’s dirty diaper—everybody knows that, the panic, the stress.” All parents know what it’s like to want to do the best for their children but to feel like they’ve come up short. “It’s an experience we share no matter what your income is.”

That small window into life in deep poverty has moved some to support larger policy changes, especially since diaper banks and other private charities won’t ever fix these problems. “It won’t happen through the generosity of individuals alone,” Goldblum said. “It can’t. It’s too big a problem.”

One approach to the problem has been to argue for exempting diapers from sales tax, as many states do for other medical and basic necessities. “We think diapers are a basic need, and most states don’t tax basic needs,” said Alison Weir, general counsel at the National Diaper Bank Network. It’s not a particularly big loss for state budgets, said Weir, but she estimates eliminating a 7 percent sales tax would allow a family to buy 14 more diapers in a month. Given that most struggling families fall short by about 20 diapers a month, the tax break gets close to eliminating the gap.

Advocates of this approach have seen success in Connecticut and Washington, DC, each of which exempted both diapers and feminine hygiene products (although the DC plan still awaits proper funding). Nearly half the states have considered similar measures, although, Weir noted, in most places a bill will get a hearing, only to have a mostly male legislature stall it, sometimes without the legislation ever getting a vote. “It is a revenue generator, and a lot of states are feeling the pinch budget-wise,” she said.

There’s also a robust movement to exempt feminine hygiene products across the country. Nine states have recently done so, while seven others have considered it.

But while paying less for each package of diapers helps, many families still struggle to come up with the cash in the first place. Advocates and lawmakers have been working on policy changes that could provide that relief, too.

In 2014, California Assemblywoman Lorena Gonzalez Fletcher read an article about diaper need. After realizing the community she represents had no diaper bank and little financial assistance, she came up with a bill to give all families whose children got childcare subsidies $120 a month for diapers through a number of vehicles: WIC, Medicaid, and TANF. “In the beginning people laughed, kind of giggled about it,” recalled Bartholow, who worked with Gonzalez Fletcher on the bill. But the assemblywoman became a champion for the issue, eventually focusing on the connections between work attendance and being able to afford diapers and bring them to childcare. The laughter faded away as advocates made it clear that diaper need causes real pain. “Sure, baby butts are cute, and everybody loves to talk about them,” Bartholow said. “After that, unmet diaper need is a horrifying story.”

Last year, the state legislature passed a bill that was signed into law that gives mothers of children under age 3 who are enrolled in the state welfare program $30 a month to buy diapers. “It’s narrow, but impactful for the people receiving it,” Bartholow said. When her organization tells low-income families about the new benefit, “people cheer,” she said. “People are so excited about it. I think they feel heard.” So far, California is the only state to earmark this kind of aid, but others have considered it. Last year, Illinois lawmakers looked at providing a monthly $80 diaper subsidy to families in deep poverty.

The challenge with using TANF as a vehicle, though, is that so few families are served by it. And in some states, the hurdles to getting enrolled in the program grow higher and higher. In California, the plan reaches two-thirds of poor families; in Louisiana, it reaches just 4 percent. TANF aids less than 10 percent of the needy in 15 states.

The issue has also been considered at the federal level. In 2011, Representative Rosa DeLauro (D-CT) introduced a bill to let states buy diapers through Community Development Block Grant (CDBG) funds, but soon realized the CDBG program is already stretched thin. The bill in this session of Congress, backed by DeLauro and Representative Keith Ellison (D-MN), would give states TANF grants to develop diaper-distribution systems. (Though the measure hasn’t even had a hearing in the Republican-led House.) President Barack Obama also raised the issue during a 2016 panel at South by Southwest, following it up with an initiative to get private companies to send diapers to nonprofits, and requesting money in his proposed budget to study the link between diaper need and maternal depression.

In some countries, parents are given a cash allowance and/or the basic necessities when their children arrive. In Finland, expecting mothers get a box from the government full of diapers, bedding, clothing, and bathing products—and the box itself can serve as a small crib. The idea has only started to percolate here, with New Jersey giving out its version of baby boxes last year.

Still, while new policies that address diapers specifically could help a lot of families keep their babies healthy and their own selves sane, the real problem is that they live in poverty. “At the end of the day, if families aren’t so desperately poor they don’t need diaper banks, they don’t need specific diaper benefits,” Bartholow pointed out. “The forever solution isn’t a diaper bank on every corner, the solution is no families in poverty.”