Why should #CCGs spend money on #nappies?

As you may have heard, on 10 March, The White House (yes, the office of the President of the USA) launched a project about nappies #diapergap.  In the USA, 1 in 3 children are not having their nappies changed frequently enough.  This is a public health issue.  Babies and toddlers are experiencing severe nappy rash, UTIs (single-use nappies are being dried out and used again) and constipation (parents restrict fruit and veg in the diet so there are fewer soiled nappies) because they can't afford an adequate number of disposable nappy changes.

I'm not aware of any data on this in the UK but anecdotally we have been aware of this for many years.  It's one of the reasons why health visitors have welcomed Real Nappies for London and been willing to distribute our leaflets.  What we do is promote the use of washable nappies.  These nappies have an upfront cost but once bought there is no financial incentive to change infrequently.  They just need to go in the wash.  We are aware of course that some households, those in most need, may not have a washing machine or adequate drying space.  Affordable nappy laundry services could meet this need.

But there's another benefit to cotton nappies; they can help children gain toiletting independence.  This is not automatic, but it tends to help.  Again this is a public health and education issue.  We don't have national data for children arriving at school in nappies but Public Health England has made children being able to take themselves to the toilet 1 of 10 indicators of school readiness.  More shocking was a report on Channel 4 news in December 2015 in which a Stoke primary school teacher said that 35% of chilren arriving for school in September were still in nappies.

The promotion of washable nappies in the UK started 20 years ago with the first Real Nappy Week.  At that time disposable nappies enjoyed 95% of the market.  Over the last two decades there has been an incremental growth in the use of cloth nappies.  Most users are motivated by reducing waste.  Local authority recycling and waste prevention departments have funded schemes to make expectant parents aware that there are alternatives to disposable nappies.  In some parts of the UK this work is done by volunteers who have set up 'nappy libraries' so people can try before they buy.  The main thing for public health is that we talk about the need for a positive attitude to changing baby and potty training, the need for frequent changes and a healthy diet.

Nappy changing culture is a public health issues.  What's important is that something is happening in your area.  It doesn't have to cost much.  It's all about spreading word of mouth about the need for frequent nappy changing, where to get affordable cloth nappies (yes, some are very expensive) and good potty training information ie not "wait until your child is three and a half your child will potty train her/himself."

We are working with June Rogers, founder of the charity PromoCon to give parents the best information on how and when to potty train, based on the latest research and data.   This advice for parents has been edited by June.   Creative Homes, a social enterprise based in Lewisham, supported by the Design Council, is doing innovative public health work with families including potty training.

If you are a member of a CCG and want to talk about what needs to happen in your area to decrease the negative impacts of infrequent nappy changes and children arriving for school in nappies in your area please get in touch with Real Nappies for London.  We have a lot of experience of different things working in specific circumstances at a very low cost.
My email address: hilary@lcrn.org.uk

I’ve been forced to post this as I’ve been told by the DH that they have nothing more to say to me on the subject

Hilary Vick says the Department of Health (DH) needs to stand up to commercial interests and give parents fair access to information about alternatives to disposable nappies 

I’m very disappointed about the reply (see it at the end of this post) I’ve received from the DH.  I wanted to find out the possibility of sending information about reusable nappies to mothers in a particular London borough with their Maternity Exemption Certificates.  All expectant mothers receive this within a few weeks of registering their pregnancy with their GP.  It seems to me an ideal way to inform expectant mothers about reusable nappies.

By the way, you may be scratching your head as to why a local initiative like this needs approval from the DH.  I agree, this is ridiculous, especially as it's the local authority that covers the cost of nappy waste and children arriving at school in nappies - but that's how it is, I've checked. 

I admit I expected a negative response.  I expected them to say it couldn’t be done.  I didn’t expect the reason to be that people are informed enough already about real nappies by the DH via the Choices website.  It’s so ridiculous.  If you’re talking about giving parents choice about alternatives to disposable nappies it’s a nonsense.  

Not only do disposables take up huge space on the shelves in the supermarket, but supermarkets discount the product aggressively to lure sleep-deprived customers to their stores.  What's more Pampers can afford to give free samples in the Bounty packs given out by midwives throughout pregnancy and sponsor the National Childbirth Trust (NCT).  In addition most maternity units tell women to bring disposable nappies with them.  The other thing that normalizes disposables is that collection & disposal of nappy waste from households is completely free.  What's more  if you put in the words 'nappies' or even 'reusable nappies' into a web search, Pampers comes up top.  Indeed if you put in a search for 'potty training' Pampers comes up top frequently too.  

Where is the nappy page of the Choices website when you search for ‘nappies’ on the internet? If NHS Choices was a company looking for business and its income/survival depended on getting found they would be dead and gone. In fact I’ve just done a search.  The ‘Which’ guide to nappies came up on the 6^th page.  I gave up my search for the nappies page of the Choices website after page 11 when I found this story in the Daily Mail:

“Why I blame middle-class mothers for the six-year-olds sent to school in nappies”

PS  I don’t blame parents.  I blame the nappy companies that irresponsibly misinform parents about how and when to potty train because of the financial benefits for them.  I  believe in the free market and minimum state intervention but I think this is a case when even Adam Smith would say the state needs to reign in the greed of the free market.  But is the state itself now reliant on the income it gets from tax on nappy waste?  What a mess we’ve got ourselves into since a weak government caved into the demands of the disposable nappy industry and allowed it to frame the nappy debate in May 2005 “No nappy system is better environmentally.  It’s up to parents to choose the nappy that best suits their lifestyle.”

Here's our potty training advice.  It has been approved by a leading pediatric continence adviser, June Rogers MBE, BA, MSc, RN, RSCN

The Department of Health believes that new parents should be aware of the choice between disposable and washable (reusable) nappies.  However, there are no plans to provide information about washable nappies with the maternity exemption certificate.

 

The Department regards the choice between disposable and washable nappies as a matter of parental preference.  Information about nappies, including washable nappies, is available on the NHS Choices website and can be accessed by clicking on the following link:

 

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/nappies.aspx#close .

   

This link includes information about the difference between the disposable and washable nappies and includes an indicative cost breakdown for both.  In addition, the page includes a link to ‘Go Real’, the advisory site for washable nappies ( http://www.goreal.org.uk ), which contains a comprehensive guide to the benefits of using washable nappies.

 

I hope this reply is helpful. 

Please feel free to comment below and let us know your thoughts.