Reusable nappies: research

6 Synthesis and recommendations

This section summarises the key findings and conclusions, bringing together the insights from the evidence review and focus groups and proposing recommendations for future action to support adoption of reusable nappies.

6.1 Key motivations and barriers impacting on uptake of reusable nappies

The research highlighted, that whilst there are a range of motivations and barriers that feature in decision-making on whether or not to use reusables, perhaps the main challenge to wider adoption of reusables at present is the fact that disposables are now seen as a ‘default’ to the extent that many parents do not even consider that there is a choice to be made – it is simply not on their radar. This came through particularly strongly in focus groups with parents resident in Scotland. Strong social norms favouring use of disposables are compounded by their wide availability and history of marketing. Some evidence suggests that norms might be changing somewhat in particular social groups, however more research is needed to explore the extent to which this applies in Scotland.

Where explicit motivations for adopting reusable nappies are explored in the literature, environmental concern emerges as the primary motivation. Cost savings and concerns about chemicals in disposable nappies are also highlighted as key drivers. These motivators were reflected in our focus groups, however cost savings featured more strongly than environmental concerns amongst the reusable nappy users who participated. This may speak to the impacts of the current cost of living crisis on household finances.

The barriers to uptake of reusables, as highlighted in the evidence review, are numerous and highly interconnected. The extra time and work associated with reusable nappies (in washing and drying, planning and researching) feature strongly amongst the reasons why many find the idea of reusables unattractive. This is compounded by the pressures of new parenthood and the time poverty commonly experienced by parents of young children, especially as families grow. Initial costs of reusable nappies and perceptions about their performance (including hygiene aspects) relative to disposables are also frequently mentioned as barriers. Disgust associated with the idea of putting soiled nappies in the washing machine, and storing soiled nappies until they are washed came through strongly in focus groups. The focus groups also highlighted costs of laundering as a key concern as it was felt that drying reusable nappies indoors would mean having to put the heating on more, incurring greater energy bills. For this reason, participants were not convinced that reusables would be more cost-effective than disposables.

The focus groups highlighted that support from parents, family and friends as well as partners motivated participants to use cloth nappies, and conversely a lack of support acted as a barrier. Nappy choices were described as a joint decision with partners, or the decision of the person that assumes most of the childcare responsibility. Choosing reusable nappies was viewed as an active decision that must be considered far in advance of the baby being born, in order to prepare for use (knowing how to use, clean, and having them ready as soon as baby arrives). The importance of social support was also highlighted in the evidence review, with family and friends paramount. In the absence of support from family and friends, wider networks of trusted actors and peers were also highlighted.

6.2 Interventions to support use of reusable nappies

The evidence review highlighted a range of different types of schemes to support the adoption of reusable nappies. These included: nappy libraries, reusable nappy kit provision, voucher schemes, cashback or grant schemes, nappy laundry services, provision of reusable nappies on maternity wards, and other interventions including events, campaigns and information resources. The evidence base on the impact of these schemes is underdeveloped – we found only 13 studies in the academic and grey literature which provided evaluation evidence on schemes. Studies often suffered from poor quality research designs or lack of necessary information provided to judge the accuracy of reported impacts.

Due to the significant gaps in the evidence base on schemes to support uptake of reusable nappies, it is not possible to draw clear conclusions about which types of schemes are likely to be most effective. There were, however, indications from the literature that nappy laundry services, reusable nappy kit provision and voucher schemes may offer potentially promising results, however more research is required. Our focus groups highlighted that some types of schemes are favoured by parents over others. In particular, nappy laundry services were generally seen as unappealing due to the fact that parents did not like the idea of putting their baby in nappies that had been worn by another.

A separate mapping of schemes operating in Scotland found information on 18 schemes operating at the local or regional level, in addition to the national-level Baby Box reusable nappy voucher. The majority of schemes identified were nappy libraries, primarily run by third sector and community organisations. A small number of reusable nappy kit provision schemes and cashback/grant schemes, operated by or in partnership with local authorities were also identified. Limited evidence on the impact of schemes was available.

6.3 Equity, diversity and inclusion considerations

The evidence review and focus groups highlighted a number of points which should be taken into consideration when assessing the potential impacts of any future policy actions on different sectors of the population. Box 4 below details these considerations in relation to income, gender, rurality and ethnicity. In addition to considering the impacts of groups on these single dimensions, it is also important to note that these dimensions may interact, resulting in intersectional equality impacts i.e. inequalities experienced specifically by individuals at the intersections of two or more marginalised groups.

Box 4: Key equity, diversity and inclusion considerations for reusable nappy policies

Population group (1)

Low-income

Equality impact considerations

• The high initial costs of purchasing reusable nappies, and ongoing costs of laundering and drying are a barrier to their use. Costs for paid services (e.g. nappy laundries) may be prohibitive.
• Free or affordable provision of reusable nappies has the potential to reduce overall costs of nappies for low-income families and reduce the stress associated with ‘nappy need’.
• At the same time, low-income parents can experience increased barriers to adopting reusable nappies, beyond those related to costs. These can include time poverty as a result of e.g. working long hours/multiple jobs, increased pressures on single parents and parents with disabled children, and increased stigma around use of reusables. The complex interplay of barriers may limit adoption of reusables even where cost barriers are addressed.

Population group (2)

Women

Equality impact considerations

• Cost savings associated with reusable nappies do not take into account the costs of unpaid labour associated with laundering, planning and researching reusables. This labour is disproportionately performed by women.
• Attitudes to reusables vs. disposables are highly entwined with notions around quality of care. This can lead to emotionally laden responses to the nappy debate (e.g. shame, guilt, anger, pride), which due to gender roles around caring may be felt strongly by mothers in particular.
• Promotion of reusable nappies should be sensitive to these gendered aspects of nappy ‘care work’, considering potential impacts to women’s wellbeing, particularly in relation to the pressures of new motherhood and time constraints on mothers balancing parenting with other paid or unpaid work responsibilities.

Population group (3)

Rural Residents

Equality impact considerations

• Rural residents are likely to experience less access to schemes and in-person reusable nappy user events etc. Some types of nappy schemes, such as nappy laundries, may be more challenging or less cost-effective to operate in rural areas.
• Distributed networks of volunteers and postal services (as seen in the example of the Highland Nappy Network, Appendix D) may help increase access for rural families.

Population group (4)

Ethnic Minorities

Equality impact considerations

• Literature from the USA highlights how intersectional inequalities experienced by low-income parents of ethnic minority backgrounds can increase stigma associated with reusable nappies and the potential role that nappy choices may play as markers of care.

6.4 Recommendations

In this final section we propose actions to aid future policy development on reusable nappies and to encourage and support an increase in the use of reusable nappies in Scotland. Some of these recommendations relate specifically to actions that could be taken by the Scottish Government. Several would also require action on the part of other actors including health service providers, retailers, media, campaigners and scheme operators.

1. Work with parents to develop policy options

The research highlighted the varied barriers to adoption of reusable nappies. Interventions aiming to address one barrier without considering others may remain unattractive to parents. Engaging diverse groups of parents in developing policy options, or at least testing policy options with groups of parents, could help to take into account the lived experiences likely to influence uptake of schemes.

2. Support the development of the evidence base on reusable nappy schemes

There is evidence to suggest that schemes involving the provision of free reusable nappy kits, free laundry services and financial incentives like vouchers or grant/cashback schemes may hold promise for increasing uptake of reusable nappies. Trials or pilot projects involving robust design for evaluation would improve the evidence base for the effectiveness of such schemes in the Scottish context. Such studies could focus on area-based trial interventions, within particular cities or local authority areas for example.

3. Develop a Scotland-specific Life Cycle Assessment

Future policy appraisals and evaluations of scheme impacts could benefit from Scotland-specific data on the impacts of using reusables and reducing waste from disposables. Given the relative importance of electricity to the impacts of reusable nappies, and the impact differences found between utilising general UK electricity mixes and Scotland-specific electricity grid mixes (Sandison et al., 2023; Sandison & Yeluripati, 2024), a Scotland-specific LCA could better reflect impacts of using reusables in Scotland. This would draw on data on Scotland’s energy mix and on practices for washing and drying reusables in the Scottish context.

4. Increase the visibility of reusable nappies in health services, shops and the media

Focus group participants recommended early and repeated exposure to reusable nappies during pregnancy and beyond, as well as opportunities for hands on experience e.g. in antenatal classes, maternity wards, and through health visitors.

5. Avoid setting reusables against disposables

Where schemes are successful in encouraging adoption of reusables, parents were very likely to continue using disposables some of the time. Presenting reusables and disposables as compatible, rather than setting these in opposition to each other may help to combat perceptions of reusables as an alternative choice which involves a large undertaking of additional time and labour for parents.

6. Address gender inequalities in nappy care work by targeting partners

The gendered impacts of care work associated with reusables, as highlighted in the evidence review, suggest that interventions and campaigns should avoid taking a gender-blind approach to reusable nappy promotion which could serve to reinforce existing inequalities. There may be value in specifically targeting expectant dads to take an active role in decision-making, research and laundering of reusables.