The impact of COVID‐19 and housing insecurity on lower‐income Black women

Abstract

During the COVID‐19 pandemic, multiple groups faced increased risks for negative health and mortality. Using an intersectional framework, the current study explores how the global pandemic impacted lower‐income women living in the United States through access to housing. Findings indicate several challenges  remaining stably housed during the pandemic. Major themes included: (1) High‐Risk Survival Economies, (2) Landlord Stress, Deception, and Exclusion, (3) Landlord Harassment, (4) Low Levels of Formal and Informal Support, (5) Housing as a Health Risk Factor, and (6) Resilience. These themes are explored through four in‐depth narrative accounts. Implications for health and policy are discussed. Future research that examines and engages with both direct (e.g., material scarcity) and indirect (e.g., discrimination) pathways that connect housing to health are strongly encouraged.

INTRODUCTION

The COVID‐19 global pandemic has impacted health and well‐being in various ways, yielding broad effects as well as disproportionate burdens for African Americans, women, and lower‐income people (Reyes, 2020; Versey, 2021a). For example, distancing guidelines established throughout the pandemic to prevent the spread of the coronavirus contributed to lower incidence rates generally, yet disproportionately affected “essential” and frontline employment workers across multiple sectors, contributing to worse health outcomes and higher rates of death among these groups, particularly for Black and Latinx hourly‐wage workers (Gemelas et al., 2022; Kochhar, 2020).

Health, housing, and employment are fundamentally linked, since employment affords access to housing, and housing is a social determinant of health (SDOH) (van der Noordt et al., 2014). According to a SDOH model, structural forces – social and economic – differentially impact health and drive health disparities between groups (Braveman & Gottlieb, 2014). While this recognition is important, it is necessary to move beyond how SDOH create disparate outcomes to explicitly articulate and locate fundamental causes that give rise to SDOH (Link & Phelan, 1995; Phelan et al., 2010). In other words, the overarching context in which SDOH arise and are sustained is one that relies on white supremacy (e.g., structural racism) and exploitative economic systems (e.g., capitalism) that differentially shapes access to employment, equal pay, and housing for historically marginalized groups (Bailey et al., 2021; Gee & Ford, 2011).

For example, essential and frontline workers, employees required to report to work in person, are disproportionately people of color and women who work hourly wage positions. While half of all workers are women, two‐thirds (64.4%) of frontline workers are women, working in health care, social services, retail, customer service, transportation, and the fast‐food industry. Additionally, the majority of frontline workers are Black, Latinx, Asian‐American/Pacific Islander, or immigrants (Rho et al., 2020). Without the option to “work from home”, essential and frontline workers experienced less workplace flexibility, higher COVID‐19 exposure rates, and increased hospitalizations and deaths during the global pandemic (Yearby & Mohapatra, 2020). In this way, the COVID‐19 pandemic magnified inequity by exposing existing gaps in occupational, social, economic, and health systems that undermine health for marginalized groups; however, these fractures are not new.

A FRAGMENTED HOUSING SYSTEM

Housing is a protective factor for health and well‐being, yet access to housing is not equally distributed (Krieger, 2014). Housing insecurity, or the lack of quality and affordable housing, has increased while federal investments in adequate housing have decreased, contributing to the most recent housing crisis (Bashir, 2002; Bor et al., 2017; Lynch et al., 2021). Combined with global events ‐ such as the COVID‐19 pandemic – an already unstable housing system heightened instability for groups and individuals experiencing marginality, such as single women with children (Bullock et al., 2020; Versey 2021a, 2022b). Effectively, COVID‐19 accelerated precarity for groups already at risk, partially due to the lifetime consequences of structural racism and socioeconomic disparities (Dannefer, 2003; Gee et al., 2019; Hudson, 2016; Walsemann et al., 2008).

An ongoing housing crisis

At the end of 2020, approximately 12.4 million adult renters (one in six renter households) reported being behind on rent (Himmelstein & Desmond, 2021b). Although federal policies provided some relief for renters experiencing economic hardship (e.g., CDC eviction moratoria, Emergency Rental Assistance Program via the American Rescue Plan), these measures did not fully protect all low‐income renters on the brink of being unhoused (Versey, 2021a). Additionally, due to several loopholes – for instance, local states and cities could overturn eviction rules – groups most at risk for housing insecurity were most affected (Berkowitz et al., 2020). Therefore, COVID‐19 represents one of the most recent contributors to a housing gap decades in the making.

The historical impacts of redlining (i.e., the illegal practice of denying home loans based on neighborhood racial characteristics) and racialized discrimination that preceded the current state of housing in this country have been enduring. While the practice of redlining ended in 1968 with the passage of the Fair Housing Act, disparities in segregation, public housing, and homeownership remain. For example, the primary source of wealth in this country originates from home equity, and the intergenerational transfer of financial security that housing provides. Since Black residents were historically excluded from equal homeownership opportunities – and thereby wealth accumulation during most of the twentieth century – today, Black American wealth is 5% of white wealth, an inequity almost entirely attributable to federal housing policy (Oliver & Shapiro, 2019).

Across the U.S., Black and Latinx families are more likely to rent than own homes. In fact, the gap between Black homeownership (38%) and white homeownership (65%) is wider today than in 1960 (Choi et al., 2019). Among renters, nearly one‐third of eviction filings are against Black renters, and the risk for eviction is 2% higher for women than men (Himmelstein & Desmond, 2021b). Black and Latina women with children are at the highest risk for eviction. In Black neighborhoods with higher poverty levels, eviction ratios are one in 33 for men, and one in 17 for women. Conversely, in high‐poverty white neighborhoods, the ratio is 134:1 for men and 150:1 for women (Desmond, 2016).Compared to all other groups, low‐income Black women (typically renters) face the highest risk of housing instability overall, experiencing higher rates of homelessness, and poorer health outcomes tied to being unhoused (Bovell‐Ammon et al., 2020; Bullock et al., 2020; Desmond, 2014). These statistics are meaningful in that they demonstrate how housing access is patterned by race and gender, and highlight the role of policy in shaping residential stability, wealth, and health.

Public health evidence suggests that the extensive history of housing discrimination, redlining, segregation, and now emerging disasters (such as COVID‐19) push extremely vulnerable groups into a greater sense of precarity, compromising health (Johnson‐Agbakwu et al., 2022; Morello‐Frosch & Lopez, 2006; Nardone et al., 2020; Mujahid et al., 2021). As such, a structural racism and intersectional framework is useful in describing large‐scale structural and discriminatory processes that disproportionately confer health risks for lower‐income Black women (Versey, 2021b).

Structural racism framework

Structural racism is a complex, multi‐layered system that confers advantages and disadvantages across racial groups, ranging from individual to macro‐level (Bonilla‐Silva, 1997; Gee & Ford, 2011; Jones, 2000). Structural racism is a fundamental cause of health, in that it reproduces the conditions that allow racial inequities to flourish (Phelan & Link, 2015). The mechanisms through which structural racism operates are co‐constitutive and interrelated, impacting health and psychological well‐being in multiple ways – through housing, education, employment, health care, and criminal justice (Bailey et al., 2017; Bailey et al., 2021).

In the same way that structural racism solidified and maintained neighborhood segregation throughout much of the 20th century, these forces are compounded in today's rental market (Dickerson, 2021). For example, the cost of rental housing has increased, and there is a shortage of high‐quality, affordable rental housing. Lower‐income renters typically devote more of their household income towards rent, leaving fewer resources for food, health care, child care, and transportation (Anacker, 2019). Higher‐income neighborhoods can restrict resident diversity by limiting the number of low‐income rental units using zoning and land‐use regulations, thereby reinforcing segregation. Though these policies are not explicitly race‐based, they disproportionately impact racially minoritized renters and female‐headed households.

Since structural racism already limits access to resources, the ability to withstand additional major negative events is compromised for certain groups. Therefore, this paper explores the experiences of lower‐income Black women during the COVID‐19 pandemic given the racial history of housing and housing‐related risk factors that threaten the safety, security, and health of renters in this country (Bailey et al., 2021; Marmot, 2020).

Intersectional perspectives in Black women's lives

A primary aim of this paper is to examine how housing insecurity impacts the lives of lower‐income Black women, since Black women were, and continue to be, among the most vulnerable to widening inequalities during the COVID pandemic (Chandler et al., 2021). At the same time, the rapidly growing number of unhoused (and precariously housed) women has been referred to as the “feminization of homelessness,” illuminating how female‐headed households are often at risk for multiple threats, yet the effect of these threats among Black women has not been thoroughly examined (Bullock et al., 2020). Therefore, we use an intersectional perspective to examine these issues. Intersectionality is a lens that illuminates both visible and invisible inequities shaped by power and oppression (Cole, 2009; Combahee River Collective, 1995; Crenshaw, 1989, 1991). We also use intersectionality to understand group‐centered processes – processes that impact multiply marginalized groups and their lived experiences in ways that cannot be fully captured by single‐issue analyses (also called intracategorical analysis; McCall, 2005). In this way, intersectionality contrasts oppression and privilege within groups (e.g., women), becoming a tool for intersectional and feminist theory (Bowleg, 2012, 2017; Collins, 2019).

Moreover, intersectionality helps to reframe the COVID‐19 pandemic as a risk factor impacting the global population, yet presents specific implications for some groups. Here, we examine lower‐income Black women as a group experiencing increased risk as a function of COVID‐19 and existing inequalities tied to housing. This paper addresses two main considerations. First, while everyone is vulnerable to COVID‐19 risks, lower‐income, Black women may experience additional risks tied to employment and housing precarity. Second, the immediate and long‐term implications of COVID‐19 are multidimensional. For example, a lack of access to safe and affordable housing places Black women and other women of color at higher risk for intimate partner violence and eviction. (Bullock et al., 2020; Evans et al., 2020; Leifheit & Jennings, 2019). Yet these risks have not been adequately represented in research, and importantly, COVID‐relief policy legislation. An intersectional framework applied to these issues will indeed “magnify inequity;” that is, raising housing instability as a key concern should yield implications for research and policy, both broadly and specifically for women experiencing housing‐related distress.

METHODS

Critical intersectional approach

As a tool used for critical theorizing, intersectionality challenges existing frameworks and policies to recognize individuals experiencing multiple forms of marginality; centering these experiences as units of analysis (Collins, 2019). Therefore, it is insufficient to singularly document women's experiences during the COVID‐19 global pandemic as experienced similarly or universally; they are not. Instead, an intersectional perspective encourages conceptualization and articulation about within‐group processes and outcomes. In other words, what women are most impacted by the global COVID‐19 pandemic? Who is most at risk for negative outcomes and compromised safety?

We explore these questions and present our analysis through a situated knowledge frame, one that recognizes that knowledge is constructed by social position and situatedness. In other words, understanding how COVID‐19 impacts women's lives inequitably means that we should study the experiences of people who are on the margins to produce knowledge about a variety of experiences (Haraway, 1988).

Fighting displacement study

The Fighting Displacement Study (FDS) is a national qualitative study of women tenants and tenant‐advocates (N = 80). Data were collected between 2020 and 2021, during the height of the COVID‐19 pandemic. Participants were identified by direct outreach and snowball sampling, based on advertisements and recruitment flyers circulated through word‐of‐mouth and social media. Requests were also sent to eviction diversion programs, legal aid attorneys, eviction prevention agencies, and mutual aid organizations. Data were collected for the purpose of clarifying life events and processes preceding residential displacement for lower‐income renters.

Participants were required to be at least 18 years of age or older, English‐speaking, and self‐identify as a woman of color. While recruitment efforts attempted to reach multiple groups of women (i.e., who self‐identified as women of color), nearly all of the women in the current study identified as Black women (n = 78). For consistency, these women comprised the final dataset. Most participant interviews were collected across the following five cities: (1) Austin, TX; (2) Baltimore, MD; (3) Seattle, WA; (4) New York, NY; (5) Los Angeles, CA; and states (New York, California, Maryland, Texas, and Ohio), respectively.

All interviews were conducted virtually via an online video‐conferencing platform and recorded with permission from participants. Participants were compensated with $30 American Express e‐gift cards for their participation. The University Human Subjects Research Institutional Review Board reviewed and approved the study, protocols, and materials.

Participants

Given concerns about anonymity and confidentiality, only basic demographic information was collected. Participants’ ages ranged from 18 to 75, and the mean age was 41. All women were renters or former renters (for participants temporarily unhoused). The current study focuses on four women's accounts from the larger FDS dataset, all living in different major cities. The women represented in this study have endured varying experiences; researchers aimed to illuminate these narratives using a subset of data from women across four U. S. cities.

While there are no concrete rules for sample size in qualitive research (see Creswell, 2013), the four women's narratives were chosen to demonstrate both the breadth within themes (e.g., details), and the unanticipated similarity of responses across cities related to how the COVID‐19 pandemic was experienced.

Interviews

All respondents participated in semi‐structured interviews. Interview questions asked about housing history, current housing situation, employment, thoughts and concerns related to housing, current neighborhood, and health. Additionally, authors followed a narrative inquiry approach to preserve the validity of the data, highlight stories from participants, and better understand lived experiences related to COVID‐19 (Bell, 2002; Bleakley, 2005; Connelly & Clandinin, 1990). This approach allowed for the development of a mutual rapport between researchers and participants, facilitating a ‘deliberate intervention’ (see Bleakley, 2005) where researchers learned about the challenging realities faced, as described by participants. Interviews were structured to center participants’ narratives, including learning about how they made meaning of their life experiences rather than imposing a particular interpretation (i.e., by the researcher; see Anderson & Kirkpatrick, 2016).

For example, participants were first asked to share how their life experiences led them to their current housing situation to understand their relationship to housing before and during the pandemic. Questions included: “Can you tell me a bit about yourself and where you grew up? How have your housing situations changed or stayed the same? How would you describe the quality or condition of your housing situation? How does your housing impact your health or the health of those living with you? Do you find that there are enough places in your community with healthy options for food? If so, are they accessible?” Each interview was recorded, transcribed, and edited for clarity by both authors and research assistants. Each participant provided consent for the release of the recordings of the interviews under pseudonyms.

Coding

Using an approach for thematic analysis outlined by Creswell (2013), researchers (a) organized and prepared the data, (b) obtained a general sense of the information, (c) initiated the coding process, (d) categorized themes, and (e) interpreted the data. The first and second authors (HSV and CR) reviewed both the audio and transcription of the data and recorded field notes identifying recurring themes. Codes were developed from text extracts, organized into a codebook, and later grouped into themes. The codebook, a tool to assist analysis of large qualitative data sets, defines codes and themes by giving detailed descriptions and restrictions on what can be included within a code, and provides concrete examples of each code. When encountering new information, coders created new subordinate codes that corresponded to text‐extracts; all subcodes were categorized in the final round of coding.

Inductive thematic analysis (e. g., open coding) was used, and initial coding agreement was relatively high (κ = 85%) between the two coders; disagreements about codes were discussed, resolved, and then re‐coded in a focused coding phase, to collapse categories and more efficiently organize themes. All codes were finalized and organized into a thematic map. The five major themes that emerged were: (1) High‐Risk Survival Economies, (2) Landlord Stress, Deception, and Exclusion, (3) Landlord Harassment, (4) Low Levels of Formal and Informal Support, (5) Housing as a Health Risk Factor, and (6) Resilience. Block quotes framing themes were identified and are presented here.

RESULTS

All four participants were single, Black women who lived in rental housing. Themes articulated by residents identifying COVID‐19 as an accelerator of inequality are highlighted below.

High‐risk survival economy

Across interviews, a common theme was survival. Women discussed how their choices during the pandemic were constrained by financial resources and limited ability to attain and maintain stable housing. This high level of instability was coded as participating in a “high‐risk survival economy,” since many women tied their choices about health behaviors (e.g., purchasing food, medicine) and to an economic system that was based on surviving. In the extant literature on this phenomenon, so‐called risky behaviors (e.g., sex work and participating in the drug trade) are similarly linked to economic and social pressures referred to as survival economies (also “survival crime” or “constrained choice;” see Bird & Rieker, 2008).

For example, “Dina,” a 37‐year old disabled (wheelchair‐bound) participant from Cleveland, OH notes that higher rents in her neighborhood due to gentrification and new real estate development prior to the COVID‐19 pandemic now place her family with fewer options to move compromising opportunities for continuing medical treatment. Dina also expresses that though she is struggling, she has managed to stay stably housed due to support from her partner. However, she notes that her (mostly Black) neighbors are actively being evicted from their homes (despite moratoria). Dina's account notes intersections between race and class that are important for understanding how inequality presents differentially in women's lives. This sentiment was not uncommon. Respondents expressed high levels of uncertainty tied to housing and life in general, and in some cases, feared eviction, worrying about “where they'd live next.” These findings were not necessarily surprising, given the way participants were recruited; yet the ties between remaining stably housed and surviving during the pandemic are not generally mentioned in conversations focusing on health outcomes associated with the pandemic.

A 28‐year‐old Kansas City, MO biological mother of three (and adopted mother to an additional three), “Trish,” details the risk(s) associated with material scarcity (defined here as a basic‐need form of scarcity, represented by material living conditions such as the availability of food, water, and space; Lynch, 2000). She describes the tension of choosing between housing/paying rent and other needs:

I was so scared that I was going to be too much behind in rent, so we made it happen. Like we went, we sold things. We weren't willing to sit two months without paying our rent and be scared. The landlord actually told us they would put us out. If we didn't get it [rental assistance] or qualify, now we're two months more in the hole, you know? So…we couldn't risk it. I mean, I don't want to be homeless, so we didn't risk it. We just started looking elsewhere.

Trish speaks of selling personal items to make ends meet, highlighting the day‐to‐day and month‐to‐month decisions made to ensure that basic needs are being met. The health and social costs of participating in a high‐risk survival economy were the most frequently mentioned across all interviews, whether experienced directly or indirectly. For example, Dina introduces food scarcity as another factor contributing to her difficult survival during the pandemic. As a disabled woman, she depends on healthy food sources being located within close proximity to her neighborhood, yet her closest grocery store was miles away requiring her to arrange for paid transportation to buy groceries since she doesn't own a car.

Food scarcity and hunger emerged as a second significant way in which difficult decisions were made during the pandemic (e.g., skipping meals so that children could eat). While food scarcity has not received much attention in the COVID‐19 health outcomes literature, it was indicated as a primary stressor and concern in the lives of women in our study, indicating a potentially missed side‐effect of the global pandemic.

Landlord stress, deception, and exclusion

Inequality during the COVID‐19 pandemic was also experienced through pressures and threats from landlords. Fears associated with the possibility of being evicted or leaving one's home unwillingly were expressed by nearly all residents. “Marissa” details frequent run‐ins with a landlord who demands payment for rent; she is behind, but is currently unemployed and believes her landlord is looking to evict her. To avoid stress resulting from these interactions, Marissa times her errands during hours when she is not likely to see her landlord:

I'm really kind of standoffish when it comes to anybody like, a confrontation or anything. My landlord is just not the nicest lady in the world, and so I get really bad panic attacks dealing with her. She triggers my PTSD a lot.

When asked to elaborate, she provides an example:

You know, I don't know when this rent can get paid, but it is going to get paid. So like until then, just know that I'm not ducking and dodging you. I just…I can't handle everything right now, so, you know, that's what it is. And then for maybe a month, she left me alone. And then she was just constantly, you know, calling me every day and knocking on my door. I remember I was in the shower one time and my youngest was here in the living room, just watching TV at like 8:00 at night. And she was just banging on the door. She kept banging on the door, she wouldn't leave. Of course, finally, I answer the door. I'm in a towel and she's yelling that she needs to talk to me, it's important, and I'm just like, 'Oh my God… I have very bad PTSD and you trigger it. I don't want to be homeless, but I also, like, I can't handle being talked to the way you talk to me.'

Reports of landlord harassment were common, prompting stress and anxiety about the being evicted. The all‐encompassing effort of planning around not encountering harassment is an anticipatory stressor that can be difficult to manage, compromising everyday and long‐term mental health (Grace, 2020). Similarly, Trish, shares worries about approaching her landlord for unit repairs for fear of retaliatory eviction:

There were some major plumbing things that came up along the way and I was just scared to tell her. I asked her initially if she would consider lowering the rent but then I worried [about eviction]. I mean, I already struggled to pay the rent and so I just asked her nicely, “Is there any way you'd consider lowering the rent or being flexible with payment?” And she said yes. And then she thought about it and came back and said, sure, I'll do it for a couple months and she lowered the rent by fifty or so dollars. Like it wasn't much but it was something you know…

Trish notes how a small act of compassion from her landlord helped to ease renter burden during the pandemic. All residents in our study described some degree of uneasiness or worry tied to losing their homes if they were unable to pay rent, spoke up about repairs, or requested flexibility in rent payment. Trish recalls being hesitant to even approach her previous landlord after having a hard time finding someone who would rent to her and her children in the first place. When she finally decided to request repairs for several issues in her unit, she was unable to locate the owner. According to the property manager, her rental home had “changed hands” several times and no one notified her:

Trish:     They couldn't find the owner. So, basically, she [property manager] told me that since we can't find nobody, we don't know what to do [about your leaking ceiling]. They said they couldn't fix the hole in my ceiling because they couldn't find the owner! You know what I'm saying?

Interviewer:     Wow.

Trish:     So, she says, “You can either move or, you know, fix it yourself, basically.” And I'm like, I'm renting, I shouldn't have to fix nothing myself, you know? So, yeah. That was a pretty bad experience.

Interviewer:     I can imagine.

Trish:     But yeah, it's a struggle. Like I said, I just live day by day, I don't know what's gonna happen the next day. I don't know.

Trish's account highlights the reality of needing to take housing accommodations that are less than adequate, and the difficulty involved in requesting repairs to the entities that are responsible for ensuring that rental units are habitable. In Trish's case, the “hole in the ceiling” extended to the roof, requiring her to attempt the repair herself. Trish's story was not an isolated incident. Several participants indicated living in substandard conditions because they were afraid of eviction or landlord retaliation. As other participants allude to, landlords hold power to evict tenants (albeit illegally in some cases), creating a constant state of fear and worry in the minds of tenants. These seemingly invisible micro‐aggressions were described as daily stressors and significant mental health burdens.

Low levels of formal and informal social support

Respondents in our study expressed that support to navigate financial and housing gaps during COVID‐19 was lacking. According to Dina,

So, I..I don't have any [housing] discounts or anything, and my partner lost his job during COVID. So he, we… lost a main source of income. Like, he'd been there 16 years and they used COVID to kind of, like, weed out the older people that they were paying more money. So he's now making half ‐ not even half ‐ of what he was making…and it's been tough.

Although Dina notes that she does not (or did not previously) qualify for traditional housing assistance programs (e.g., Section 8; housing vouchers), she recalls a community action partnership program that was instrumental in helping her make ends meet when her partner lost his job during the pandemic:

I applied for it… it's our community action partnership program, and what they do is they help you with the rent. You know, if you couldn't pay your rent during COVID. Well, when my partner lost his job, we couldn't pay the rent. So, I applied and what happened was, it took them two months to respond to me, and I was so scared that I was going to be two months behind in rent, right? But ultimately, they came through. The sad thing is, they had it [money] but they just didn't give it to people like they should have in a timely manner.

Women in our study and reports nationally describe the application process to receive rental assistance as burdensome and slow, creating additional worry about monthly financial security. The issue of providing timely rental assistance during COVID has been noted elsewhere (Ong et al., 2022). Somewhat similarly, Marissa expresses her frustration as a single mother and not having a social safety net to rely on during times of need. Marissa eventually decided to quit her hourly‐wage position to focus on supervising classroom instruction for her youngest daughter, whose elementary school classroom had transitioned to remote learning.

Interviewer:     I see. So, you became unemployed because of remote learning and needing to be home to supervise your youngest child?

Marissa:     Yes, my older children are in sixth and ninth grade this year. So, you know, they're a little more independent. I don't need to walk them through everything like I do with my youngest one.

Interviewer:     I see. So, you quit your job to facilitate online learning. So, do you have family that you could depend on? Someone who could help out?

Marissa:     Yeah, yeah, I do have family. I don't necessarily depend on them. Like, the year leading up to the COVID was like, really, really hard for me. So, like, yeah, I have family…they actually live here [OR], but they don't really help. They would probably make the situation worse by being here all the time.

Interviewer:     That's understandable. So, take me through where you are in terms of your current housing situation. And then, like, what led up to where you are now?

Marissa:     Okay. Yeah. So, like I said, when COVID first started, I was, like, in a rough place. I was right in the middle of completing six months of intensive, outpatient drug treatment. And I did complete it in June. And then I started working…like the end of February. So I was really new getting back out into the workforce. I finally had, you know, kind of gotten my head straight and I was, you know, doing really good. And it was nice at first honestly… it just kind of like, brought me closer to my kids with, you know, like getting sober and all of that stuff. So then I finished that [outpatient treatment], and I was still working like Monday through Friday. It was great. Then, I ended up getting this place…because it's hard to find anywhere to rent here and rents are really expensive. And so, although I was doing really great job‐wise, I still couldn't afford to live or rent anywhere. So, my old…an ex of mine had this place, and he ended up going to prison. So, he was letting me stay with him, and I just, you know, kind of got it by default because the rent was decent. And I said, you know, it's a two bedroom, it's a little small for us, but it's better than nothing, right?

Marissa's account highlights several important points, including that her current housing was obtained through an informal happenstance situation, rather than through a formal application process, primarily because the housing in her area was too expensive. This is particularly striking, considering that Marissa was working full‐time during the time she was looking for housing. Though she had family living closeby, Marissa decided that they would “make the situation worse” and opted not ask for help or living support, despite a difficult transition entering and completing a drug treatment program. For some women, achieving “stability” can be complicated, and as research suggests for current and former substance users, housing can be a key factor in establishing safety and recovery (Woodhall‐Melnik & Dunn, 2015).

Trish revisits the issue of social support in her life, describing how not having anyone to depend on can be isolating, especially during a global pandemic. As a single mother of six children, she also details how difficult living day‐to‐day can be under financial constraints:

Interviewer:     Okay. So, you're still currently searching for housing, is that right? Is it just you and your children?

Trish:     Yes.

Interviewer:     All right, that's fine. I was just asking because sometimes people will go to a family member's house…

Trish:     I have no…I have no help. At all.

Interviewer:     Okay.

Trish:     There's nowhere.I can go. I can't. Actually, me and my kids are staying at a motel now.

Interviewer:     Okay. Um, so tell me a little bit about that, if you're comfortable. Because it's a temporary situation in the motel? Are you getting adequate access to food? Are there any sort of programs that you've been able to tap into that have been useful?

Trish:     Well, I get food stamps, so yeah.

Interviewer: Okay.

Trish:     And I just stretch it out, you know. That's really the only assistance I have.

Interviewer:     Okay. Hmm, so what do you think…what do you think is the biggest, sort of barrier to getting or finding another place?

Trish:     It's first having a down payment and then also finding a place.

Interviewer: Okay.

Trish:     Yeah, you know the rent deposits are outrageous. You know they want $2,200 or something crazy for just a 1‐bedroom!

Interviewer: Yeah.

Trish:     It's really something. And with me being a single mama you know, and raising six kids; that's plus three other kids that's not mines [but my sister's]…[begins crying]. You know? You know what I'm saying? It's kind of hard.

Trish's narrative addresses the nuanced and complicated ways that the pandemic impacted, and continues to impact, her life. Having few formal and informal supports, she was forced to find another job (i.e., she now works at the motel where she is staying temporarily) with several children to care for and little idea about long‐term stability. Aside from food assistance, she has no other support. These women's accounts highlight less visible ways inequality is magnified through weak social safety nets.

Housing as a health risk factor

Respondents reveal that the physical structure of a home can be a negative risk factor for health, especially when it is not well‐maintained or kept in good repair by the landlord. “Tanya,” a 45‐year old single mother, reports that her apartment was originally a dream that quickly devolved into unhabitable conditions. At the time that her rental application was approved, she was on the brink of being unhoused and optimistic about the new residence. However, soon after moving in, several issues emerged:

I found that…the building is infested with black mold. I mean, it's in our HVAC system. It's on our walls. It's in our ceilings. We're also infested with rats and mice. They're in our walls. They're nesting in our walls. We have roaches. We have bed bugs. We have spider beetles. We have grain weevils. We have ant nests, beetles, and spider beetles bite, so we're constantly dealing with something.

Tanya goes on to elaborate about plumbing issues that affected the habitability of her apartment specifically:

He [the superintendent] said, “It smells like a sewer in here.” I was like, I know and I can't figure out what it is. So he looked down at the floor and it was like, a yellow‐brownish film and he got real close and he looked. He was like, "Ma'am, I need to tell you this, because you're gonna be disgusted and grossed out by this, but that's raw sewage." I was like, what?? He said, “Yes ma'am, that film is raw sewage. It's not a leak, you have raw sewage coming into your bathroom.” And I was so upset…I was just like, so my son and I have been walking through raw sewage to get in and out of the shower so we can go to work and to use the bathroom?

Tanya reflects that while her apartment was severely affected, other tenants complained about similar issues before and during the pandemic, threatening the health and safety of an entire residential building. These issues were often described as inescapable, since they were happening in one's own home, where a significant amount of time is spent. Tanya also reveals how she used this experience as a catalyst for becoming a housing organizer, reaching out to neighbors in her building who may have experienced similar issues that may be affecting their health unknowingly.

Then, the heat went out and no one came to fix it. I was scared to sleep because I thought that I was going to suffocate on my own mucus. My chest got so filled with mucus and we had to sleep like that for four nights. It was so cold, and the windows were broken. I could not close these windows so we were cold, freezing cold, for four days, four nights….So that's how I wound up becoming a housing advocate. Because it's not just in our unit, like, it's happening throughout this building and I can't, I've lost count of the number of tenants in here that have the same complaints, black mold growing on their ceilings, black mold growing down their walls, black mold growing across their carpets up onto their beds. It's ruined their clothes. We have had, had confirmed, two people who have died in their apartments from the black mold, from the exposure.

Across all interviews, respiratory issues were the most common health complaint. In fact, the interview with Trish took place while she was at the doctor's office with her son, who was experiencing complications from his asthma, due in part to a suspected COVID‐19 exposure, as well as inadequate housing. Participants in our study were concerned with finding affordable housing and adequate housing; yet many felt as though they had to sacrifice to get both or relinquish one altogether to remain housed.

Resilience

Somewhat surprisingly, despite significant challenges, some women expressed narratives of resilience. For example, Tanya describes her experience with housing as a learning experience that she hopes to leverage and help others as a tenant/housing advocate:

The reason why I got into housing advocacy was for myself. That's why I say I kind of fell into it. I kept going down to the office and filing complaints about the things that were going wrong in my apartment. And I got tired of being laughed at. I would tell the assistant manager that there was sewage in my apartment, and the manager…they would literally laugh in my face and turn around and walk away.

She further explains that the patience that facilitates her resilience was strengthened when she met other tenants experiencing similar issues. Prior to receiving her unit, she experienced several obstacles and denials throughout the application process, and uses this knowledge to help and advocate for others.

I think that is the motivating catalyst to keep me going, the fact that as bad as the situation is here, you know, I was able to start [housing] organizing with another friend of mine. Yeah, she lives upstairs…. she's a great person. She and I have both been dealing with the same issues and, you know, we were talking one day in the workout room and I was like, this can't continue. Somebody has to step up and say something.

Some narratives of resilience were less explicit; women talked about “hanging in there” and “keeping faith” despite being discouraged, though whether these statements reflected true resilience (rather than hopeful optimism) is unclear. When asked what they wanted people to know most about their experience, several participants just wanted their stories to be told. Dina stated, “I just want people to know that we exist; and its hard out here, but we're making it. And we need help. People really need help.” Dina describes finally receiving rental assistance as a “good moment” for her, that allowed her to regain some stability after her partner's job loss. Similarly, Marissa describes experiencing a “win” after many months of applying for rental assistance and Section 8 vouchers:

So, finally I found a program…maybe it was through a service? Anyway, they're like a non‐profit that paid for my rent over the summer because of everything. And I really needed it, because I was doing what I could as far as, like, you know, paying fifty dollars here and there and just trying to…put some kind of dent in it. So thankfully, I didn't have a huge bill or get evicted. And so that's approved and it's getting paid this week or early next week. So I'm really happy about that.

The total amount [of back rent] was like, $1100. It was from October until now. It was causing me huge anxiety, which I already have, but yeah, that's kind of what happened. It's just all of these life things that …come up in your life. It's like they're made so much worse by the COVID. I'm realizing that things in life that would happen normally, and you just deal with them as they come, are now like, magnified by like 100! It seems like it's not just with me, I think it's with a lot of people.

Marissa's persistence in pursuing rental assistance resulted in her  receiving funds to satisfy her outstanding debt. Ultimately, sound policy decisions can impact the lives of people under financial constraints, when executed in a timely manner. The magnification of negative life events “by like, 100” is an illustration that some lower‐income women experience several cumulative burdens during times of great uncertainty.

DISCUSSION

Our findings indicate that among a sample of Black female‐headed households, there were several challenges finding affordable housing and remaining stably housed during the COVID‐19 pandemic. Interview responses detailed five major themes spanning from participation in survival economies to resilience. Low levels of social support, negative mental and physical health, and landlord harassment were frequently reported by participants in the study, illuminated here through four women's accounts.

The COVID‐19 pandemic has magnified and widened existing inequities, bringing attention to ways in which access to housing, social policies (e.g., increasing the federal minimum wage), emergency rental assistance, and national policy (e.g., eviction moratoria) can be used as safety nets. In the long term, housing, eviction risk, and tenant protection require the sustained attention of researchers and policymakers. Therefore, this work has implications for informing coordinated efforts across grassroots, local, state, and federal levels and may form the basis of a larger conversation about lower‐income housing needs.

In a broad context, social inequality reveals system‐level fractures that can be experienced individually, increasing distress, anxiety, fear, vigilance, and insecurity, particularly if basic needs are under threat. Given the data presented, the COVID‐19 pandemic likely exacerbated health disparities for Black women as some reports have suggested (Chandler, 2021; Rushovich et al., 2021; Walton, 2021) the current study identifies housing instability as an additional stressor that contributed to the burden of COVID‐19, shedding light on how limited resources can compromise health and well‐being.

New insights

While this study provides support for investigating intersections between race, class, and gender in relation to housing, some directions for future study are worth mentioning. A key takeaway from this research is that financial insecurity carries a high emotional toll, and additional worries related to housing, evictions, and having a safe and affordable place to stay during the pandemic added to that burden. Our participants identify uncertainty about current and future housing, landlord‐tenant interactions, and the habitability of their homes as major stressors, concerns that were not unique to any one participant or city. In fact, reports indicate that renters in large cities face greater precarity now, compared to before the pandemic. In New York City, more than 40,000 renters have been sued by landlords for back rent since the pandemic began, representing the highest concentration of eviction cases in the state, roughly accounting for half of all eviction filings for New York (Desmond et al., 2018). In other high‐cost states (e.g., California), lower‐income renters and renters of color report difficulties staying current with rent payments. Though more than 534,000 California renters applied for emergency rental assistance between March 2021 and March 2022, the majority did not benefit from rent relief due to language barriers, difficulties in processing applications online, and delays in approval (Ong et al., 2022).

Together, these factors suggest that even when assistance is available, it may not fully serve those in greatest need. Additionally, the resources required to address lawsuits and legal challenges, responding to landlord claims, applying for rent relief, finding a job, and potentially moving homes during a global pandemic have all but been ignored in the academic literature. This research adds to the conversation about the impact of COVID‐19 generally, but also highlights how ineffective policy may further disadvantage groups experiencing precarity.

Related, women in our study report frequent instances of landlord discrimination and harassment. According to prior research, women are more likely to experience negative landlord‐tenant experiences as they are more likely to be leaseholders, likely to be avoidant when behind on rent, and may be seen as “problem tenants” if they have multiple children or report domestic violence incidents (Bullock et al., 2020; Desmond, 2014). Therefore, the anticipatory stress or fear of losing one's home through eviction, retaliation, and/or other means is equally important to consider, particularly for women's health.

From a psychological perspective, additional research is needed to understand psychological stress tied to housing, especially for individuals with limited access to it (Williams, 2018). Most stressors indicated in our study were structural and compounded (e.g., more than a single stressor at a time), including access to suitable housing, access to rental relief, and discrimination, issues that have historically and disproportionately affected lower income‐renters, single mothers, and women of color. Female‐headed households often face multiple challenges and a weak safety net, yet there is a paucity of research disentangling how multiple insecurities – financial and housing insecurities specifically – are experienced in ways that compromise health. Future research focused on stressors and underrepresented groups should seriously consider using theoretical frameworks (e.g., structural racism, intersectionality, fundamental causes) that account for these factors.

Although there are likely intermediate factors, anticipatory stress and discrimination operate through a biological arousal pathway (Williams & Mohammed, 2013). A robust body of research indicates that  experiencing discrimination threat can increase a sense of insecurity and potential harm, leading to emotional arousal, maladaptive behaviors, and increased risk for negative health (Krieger, 2014). These outcomes are higher among groups experiencing chronic precarity (Whittle, 2020; Williams et al., 2018). Therefore, further research about anxiety, rumination, and fear induced by anticipatory stress is an area fruitful for future exploration (Hicken et al., 2013, 2014; Irani et al., 2020).

Policy implications

While policy change has been credited with creating health disparities, it can also be used to reduce them (Hernández & Swope, 2019). Housing is a basic need, yet many residents struggle to find and hold on to stable housing. Large‐scale investments in housing that prioritize affordability, single mothers, minimum‐wage earners, lower‐income renters, and very low‐income renters are likely to benefit population health overall. Providing safety and stability though housing has significant impacts on health, as some integrative and evidence‐based models (e.g., Housing First) have shown (Dickson‐Gomez et al., 2017; Tsemberis, Kent, & Respress, 2012; Woodhall‐Melnik & Dunn, 2015). When individuals have trouble paying rent, they may double up (e.g., move in with friends or relatives), move frequently, remain in abusive or unsafe relationships, or engage in risky behavior to become more financially stable (Rollins et al, 2012). On the other hand, when residents have stable and affordable housing, they can reduce these risk factors, and have additional resources to invest in health‐promoting activities – healthy eating, health care, utilities, and recreation. Therefore, economic inequality, stress, and disadvantage is facilitated, at least partially, through housing disparities (e.g., disparate access to housing), as well as via small and large‐scale policy. However, knowing that is “housing is health” has done little to move the needle in terms of a large‐scale restructuring of affordable housing in our country (Bovell‐Ammon et al., 2020; Fullilove, 2010). While COVID‐19 highlighted some disparities associated with housing, these issues cannot be addressed without a significant shift and rethinking how housing is provided. Investments in affordable housing and rental assistance programs are needed.

Additionally, while “social distancing” and remaining at home was a prescription for public health safety throughout the pandemic, doing so was not feasible for many residents, especially hourly‐wage workers, overcrowded households, or for residents who lived in unsafe housing. Some participants in our study stayed in their existing housing throughout the pandemic; however, that housing was not always in a habitable condition. Landlords and corporations who rent, profit from, and manage rental properties bear a responsibility to make timely repairs, and ensure that rental homes are free of health hazards. Tenants have a right to live free from exposure to pests, mold, mildew, and sewage matter in their homes, and landlords and property managers should ultimately be held accountable for violating livability standards. Tenants may also benefit from understanding tenants’ rights, and knowing legal steps to take to enforce landlord accountability.

For participants who did move during the pandemic, they often moved to less stable housing arrangements (e.g., motels, temporary living conditions) given higher costs of renting during the pandemic and fewer rental units available. Serial moves (and moves prompted by eviction) can have enduring effects on health and well‐being, particularly for pregnant mothers and school‐aged children (Cutts et al., 2015; Himmelstein & Desmond, 2021a; Oishi & Schimmack, 2010). Therefore, efforts to keep residents stably housed during and after the pandemic should be a main priority. Reduced‐fee or free legal counsel, for example, can significantly reduce evictions and saves money in shelter costs (Desmond, 2014).

Finally, these findings should be interpreted within a larger context examining how structural racism and policies that disproportionately target poorer women provide a foundation for creating and sustaining health disparities. Lower‐income Black women are most likely to experience housing instability, compared to other groups (Desmond, 2014, 2016). Therefore, an intersectional approach was both useful and necessary to understand the issues facing this group specifically. Race‐gender Health disparities continue as evidenced by the current study; as such, the effects of structural racism are not only historical, but they continue to impact housing through social environments, the built environment, exposure to environmental hazards, limits in educational and employment opportunities, and access to quality health care – all factors that are spatially patterned by where residents live (Williams & Mohammed, 2013).

Some limitations of the current study, including a homogenous sample of Black/African American women with children, may reduce the generalizability of these findings. Therefore, we are unable to compare Black women in our study to other groups (e.g., men of color). However, cross‐group comparisons were not the focus of the current the study, nor is it the aim of intersectional research generally. As noted in current standards emphasizing the benefits of a critical qualitative research approach, population generalizability is not necessarily a goal; generalizability of a phenomenon is (Levitt, 2021). The data presented are highly concordant with previous qualitative studies of the housing‐health relationship and intermediate pathways impacting marginalized residents, providing a useful counter to previous criticisms of qualitative data (Levitt et al., 2021).

While not conclusive, these findings do indicate that single, Black women with children faced significant challenges during the global COVID‐19 pandemic. Additional research in this area may help to clarify these issues.

CONFLICT OF INTEREST

We have no known conflict of interest to disclose.

Biographies

H. Shellae Versey is an Assistant Professor of psychology at Fordham University, where she leads several projects exploring the intersection between race/racism, gender, and health. She also writes on neighborhoods and older adults, framing housing as an essential component of well‐being, health, and flourishing.

Charity N. Russell is a graduate of Wesleyan University. She completed her undergraduate education in psychology and education studies. Charity is a former NIH/NIDA summer intern in Biomedical Research, and she is currently pursuing medical school to serve individuals battling addiction or trauma.

Versey, H.S. & Russell, C.N. (2022) The impact of COVID‐19 and housing insecurity on lower‐income Black women. Journal of Social Issues, 00, 1–21. 10.1111/josi.12555