Funded Projects

Addressing Diaper Insecurity in Southern Maine

Project Year

2024

City & State

Portland, Maine

Program Name

CATCH Resident

Topic

Access/Barriers to Health Care (LHI)

Program Description

The problem:   According to a 2023 National Diaper Bank Network's (NDBN) 2023 nation-wide study, 47% of families reported diaper need. The Jewish Community Alliance (JCA) reports diapers can account for as much as 14% of the post-tax income of Maine’s poorest families in the state of Maine. Diaper need disproportionately impacts immigrant/refugee communities, low-income families and families of color, and almost half of families report foregoing other necessities to afford diapers. Diaper need has implications on mental and physical health and well-being. Families experiencing diaper need are more likely to miss work and school, and behaviors like reusing diapers are associated with a higher rate of diaper dermatitis and urinary tract infections. A 2013 study also reported that women with pre-existing mental health conditions are more likely to experience diaper need and that significant diaper need can worsen maternal mental health due to a decreased sense of competence, which can have negative implications of child development (NDBN, 2023; Smith et al, 2013).   Maine’s rate of diaper insecurity is similar to national levels (NDBN, 2023); however, in 2016, diaper banks only supplied diapers to 3% of families who experienced diaper insecurity (Massangale et al, 2020). There are two Maine diaper banks that are NDBN members, both of which are located in the southern half of the state and in more densely populated areas; however, poverty disproportionately affects Maine’s rural counties, which includes the northern half and western border of the state. Portland, Maine also has a growing migrant population, about 10% of whom are international. The number of refugees and asylum-seekers is estimated to double in 2024 (Catholic Charities), and these communities experience greater poverty as compared to white families (MEJ, 2021).  Primary setting:  This project aims to incorporate both urban and rural participants across Maine. Families will be included from our urban pediatric resident outpatient clinic and from a rural outpatient pediatric practice in Farmington, ME. I will draw on previously established relationships within the health system to connect with local urban community partners in the Portland, Maine area. To create connections with rural community resources, we will seek to partner with our health system’s rural hospital-based food pantries (some of which provide diapers) and other active community organizations across Western and Midcoast Maine.  Project goal:  My project goal is to determine which Maine communities experience the most diaper need and identify barriers to and recommendations for improved diaper access. I will incorporate family and community partner perspectives via focus groups. Ultimately, I aim to determine how to advocate for a new diaper bank in Southern Maine or other access model, focusing on communities with the greatest need.  Proposed Interventions:  I will hold focus groups with patients’ families and community partners in rural vs. urban areas. For family focus groups, I will stratify by demographic within those areas (e.g. white, native-English speakers vs. international asylum-seekers and refugees), with support from interpreter services as appropriate.  Anticipated Outcomes:  I will obtain data on existing resources, which communities experience the greatest diaper need, and how effectively resources address that need based on rural vs. urban location and demographic. I will generate qualitative data from focus groups to create a list of barriers to accessing diapers, and understand how families and community partners view the roles of the community partner and healthcare provider in facilitating connections to resources - i.e. is there a need for a new diaper bank in Southern Maine and how can families access it? What does an effective handoff look like? What makes for an effective community partner? 

Project Goal

To determine how to most effectively advocate for a new and most effective diaper bank or other access model in Southern Maine, specifically focusing on how to reach communities with the greatest need.

Project Objective 1

By 9/1/24, I will determine which top 5 communities in the state of Maine experience the most need for diapers, and how their access to diapers varies based on rurality and social factors.

Project Objective 2

By 3/1/25, I will hold a minimum of four focus groups with patients in rural and urban/immigrant communities (with a goal of two in each location) as well as at least two separate meetings with community partners to identify barriers and facilitators to accessing diapers.

Project Objective 3

By 6/1/25 I will use data generated to create a list of at least six action items to advocate for a new diaper bank or alternate diaper resource model for patients and determine how to report out my findings.

AAP District

District I

Institutional Name

Maine Medical Center

Contact 1

Annabelle Batten, MD