Single-use disposable diapers have a major impact on climate change due to greenhouse gas emissions from landfills, especially those that are unlined, and particularly when such diapers are not well-managed and dumped in water courses and open spaces or burnt. The aim of this study was to explore the current usage and disposal practices of disposable diaper users in Samora Machel, a township in Cape Town, South Africa. The findings were to be used to inform the design and implementation of a pilot diaper collection model to follow. This urban/peri-urban area comprises lower-income, high-density communities in formal basic housing, with many backyarders and informal shacks. The dumping of diapers in open spaces and sewage systems causes severe problems. Therefore, we employed a theoretical socio-ecological system approach to guide the understanding of these complex environmental issues; the data collection methodology entailed a community-based participatory study process. Four hundred and eight (408) questionnaires consisting of quantitative and qualitative answers were codeveloped with members of the community and completed by trained community-based fieldworkers. A community walkabout and two focus groups provided rich data. The results show that complex waste streams such as disposable diapers and the related environmental issues are testing the limits of current management approaches; managing disposable diapers in underserved low-income communities creates a major burden for these already fragile communities. Single solutions will not suffice for these complex problems, so innovative waste management systems need to be codesigned with communities and relevant stakeholders to ensure sustainability, equality, and social justice.