Reusable nappies: research

Appendix C: Nappy scheme evaluations in academic and grey literature

Scheme name and sources: West Sussex Real Nappy Initiative (Husaini et al., 2007)

Country: England

Scheme type: Nappy laundry service

Scheme description: Scheme offered free nappy laundry service

Behavioural impacts: 500 families participated (1999-2000)

Economic, environmental and social impacts: Estimate cost saving of ~£20,000 to local authority, and an equivalent saving of 48 EUR/family/year for families.

Estimated saving of 8000 tonnes of disposable nappies.

Evidence quality considerations: Methods and assumptions for impact assessment not reported.

Scheme name and sources: Uzzell & Leach (2003)

Country: England

Scheme type: Provision of reusable nappies on maternity ward. Free nappy laundry service

Scheme description: Reusable nappies were made available to new mothers staying on a maternity ward. Study participants were sampled before and after the introduction of reusables on the ward. A subset of both the before and after groups were offered a free 6-week trial of a commercial nappy laundry service.

Behavioural impacts: Provision of nappies on the maternity ward did not increase uptake of reusables at 6 weeks post birth. Parents who tried reusables out in the maternity unit reported finding them easier to use than anticipated. Those in the groups offered the laundry service were more likely to report using mainly reusables at 6 weeks post birth that those not offered (25% vs. 2-13% depending on intervention group).

Economic, environmental and social impacts: Not assessed

Evidence quality considerations: Strong research design utilising comparator group (before vs. after) to assess impact of access to reusables on the ward, and control group (offered vs. not offered) to assess impact of laundry service.

Scheme name and sources: North Ayrshire Birth to Potty Scheme (North Ayrshire Council, n.d)

Country: Scotland

Scheme type: Free reusable nappy kit provision

Scheme description: Parents can request trial pack (3 free nappies, 2 wraps, biodegradable liners, laundry bag) and/or birth to potty pack (20 nappies, liners and laundry bag).

Behavioural impacts: >200 families have used the scheme

Economic, environmental and social impacts: Estimated that families save up to £1300 per child.

Evidence quality considerations: No evaluation of behavioural impacts beyond uptake numbers. No comparison to counterfactual. No details given on assumptions for impact estimations.

Scheme name and sources: Darebin Nappy Trial (Siemensma & Hunter, 2007)

Country: Australia

Scheme type: Free reusable nappy kit provision

Scheme description: Parents who normally used disposables (n=14) used disposable nappies for 14 days, recording information such as time spent, nappies used, leaks. Then used reusables, provided as a full modern nappy pack, for 14 days, recording same data. Participants’ water use was monitored.

Behavioural impacts: 2 participants did not complete the reusables trial. Of those that completed, all 12 said they would continue to use reusables, and would recommend to new parents. On average, participants also used one disposable nappy per day during the reusables trial.

Economic, environmental and social impacts: During the reusables trial, parents spent slightly more time per day on nappies (29 min, compared to 24 min with disposables), and experienced more leaks (0.5 leaks per day compared to 0.2 per day with disposables). Water use was 15% higher during the reusables trial.

Evidence quality considerations: Self-selected sample. No follow up after 28 day trial period.

Scheme name and sources: Mazzelkontjes pilot scheme (Kok, 2018)

Country: Netherlands

Scheme type: Free reusable nappy kit provision. Subsidised nappy kits to buy. Nappy library

Scheme description: Participants (n=69) took part in a pilot run across 3 municipalities, each operating a different type of scheme. One municipality offered a choice of subsidised nappy kit leasing or purchase, another offered only subsidised purchase, another offered a free reusable nappy kit.

Behavioural impacts: Of the 69 participants, 10 were disappointed with reusable nappies and reverted to disposables, 19 continued to use reusables exclusively, 40 continued to use reusables in combination with disposables. Greatest continued use at the end of the pilot was in the municipality offering free kits (31/32 continued to use reusables; 27 of which in combination with disposables).

Economic, environmental and social impacts: Not assessed

Evidence quality considerations: Some comparison between pilot sample and comparator group (survey respondents who use or had previously used reusables) attempted, but comparability limited. Sample sizes across the 3 municipalities varied widely, limiting comparison of schemes. No long-term follow-up.

Scheme name and sources: Real Nappies for London Scheme (RNfL) (Warner et al., 2015, 2017, 2018)

Country: England

Scheme type: Voucher scheme

Scheme description: RNfL launched in 2007. Residents of participating London Boroughs can request a voucher towards the costs of reusable nappies. Voucher value from 2007-2012 ranged from £30-54 depending on borough, and during 2012-2016 averaged £45.

Behavioural impacts: 2007-2012: 9,653 vouchers issued (7,047 redeemed). 2012-2016: 4192 vouchers issued (3188 redeemed).

Economic, environmental and social impacts: Evaluations estimated local authority savings totalling ~£968,257 in Landfill Tax and disposal costs (vs. cost of £92,113 to administer scheme), for 2007-2016.

Estimated total of 10,903 tonnes of disposable nappy waste prevented (2007-2017).

Additional benefits identified included: promoting pro-environmental behaviour, community cohesion, social inclusion, cost saving to families.

Evidence quality considerations: No monitoring of behaviour of those redeeming voucher. Impact estimations assume parents redeeming vouchers use reusable nappies from birth to toilet training. Does not assume exclusive use of reusables (rather a saving of 4.7 disposables per day). No comparison to counterfactual.

Scheme name and sources: Scotland’s Baby Box voucher scheme (Scottish Government, 2017a, 2017c, 2021)

Country: Scotland

Scheme type: Voucher scheme

Scheme description: Scotland’s Baby Box is available to all expectant parents in Scotland. The box provides parents with essential items and information for caring for babies in their first 6 months.

The Baby Box includes a voucher towards reusable nappies since 2019.

Behavioural impacts: Attitudinal impacts: Piloting of the baby box in 2017, after removal of a reusable nappy from the contents, identified nappies as a missing element. 62% supported inclusion of a reusable nappy voucher.

Evaluation of the baby box in 2021 found that midwives and health visitors perceived the reusable nappy voucher to be the least useful item in the box, however it did not feature in the five items most commonly reported as least useful by parents.

Economic, environmental and social impacts: Not assessed.

Evidence quality considerations: Not designed to evaluate impact of the voucher scheme specifically – no assessment of uptake included.

Scheme name and sources: Salhofer et al. (2008)

Country: Austria

Scheme type: Cashback/grant/ other subsidy scheme

Scheme description: Subsidy schemes operate in a number of local waste authorities (e.g. Vienna scheme offered 1000 EUR subsidy on 250 EUR purchases of reusables). Method of administration not detailed.

Behavioural impacts: Proportion of babies for whom a subsidised package of reusables was purchased ranged from 1.4% to 3.3% in 2004 depending on region. Uptake higher in some communities (up to 10.5%).

Economic, environmental and social impacts: Impacts not assessed, beyond reporting of anticipated waste reduction per capita based on an uptake of 10-20% which was not met.

Evidence quality considerations:

Scheme name and sources: Renkert & Filippone (2023)

Country: USA

Scheme type: Free reusable nappy kit provision

Scheme description: Pilot project aiming to alleviate diaper need. Low income families (n=28) were provided with a full reusable nappy kit (24 nappies plus wraps, liners, wipes etc).

Behavioural impacts: 22/28 participants still using reusables at end of project. Most (18) using combination of reusables with disposables. High uptake and maintenance amongst refugee groups, more challenges recruitment and maintenance of reusable use amongst N. American participants

Economic, environmental and social impacts: Reduced nappy costs for participants. Benefits for participants included reduced stress associated with diaper need, but additional work for parents, and reports of increased nappy rashes. Environmental impacts not assessed.

Evidence quality considerations: Evidence of self-selection bias in the participant sample - those from cultures where reusables are the norm, most of whom already had experience of using reusables, were more likely to participate.