Working to Die? How Black Women Health Care Workers Survive A Pandemic

Rhonda Blake, a 32-year-old Black Caribbean woman, stays motivated yet worried as she looks at the concerned faces of her clients at a local nursing facility in Staten Island. Rhonda has lost four patients in the last two days— all of whom were exhibiting symptoms of the coronavirus pandemic.

Like Rhonda, Isabel Marybeth, a 48-year-old African American woman, is at the forefront of providing medical and support services. Isabel has worked as a home-health aide in New York City for two decades and is normally in charge of providing in-home services to the elderly and disabled such as cooking, bathing them, cleaning their house and giving them medication. 

As a both nurse-aide and live-in aide, she is afraid of accidentally passing the virus to her clients while protecting herself from possible infection. Neither she nor Rhonda can work from home. And they likely would not receive pay during their self-quarantine. 

Both Rhonda and Isabel’s experiences draw our attention to a marginalized population of health care workers that has been largely overlooked in national mobilization’s against the coronavirus pandemic: Black women health care workers.

What remains largely absent from discussions about “health care heroes” and COVID-19 are the structural constraints that many Black women navigate as they give care while fighting to survive illness and inequalities.  

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We need a reproductive justice approach to the pandemic in order to address the violent forces that have deprived marginalized communities from the basic resources and services necessary to save their lives during and beyond a pandemic.

Personal care and health care support occupations remains a sprawling sector of the U.S. health care delivery system that includes personal care, nursing and home health aides. These workers provide medical services and help with the basic tasks of daily living to approximately 12 million people in the U.S.—labor that is carried out by a work force that is predominately women of color.

Personal care and health care support remain a feminized industry with women making up 84.6 percent of personal care aides and 87.2 percent of home health aides, according to a 2017 HHS report.  Fifty-one percent of personal care aides are people of color and 32 percent of nursing, psychiatric and home health aides are Black.

Nurse aides and home-care services do not share the prominence of doctors and hospitals, and are thus devalued and underpaid. Home-care workers are often hourly workers at or just above minimum wage. They average $11.52 an hour, and 45 percent of them who work full-time are on public assistance.

According to the city Department of Consumer and Worker Protection in 2017, full-time home care aides earned an average of $27,000 in New York—one of the most expensive cities in the country. Even as women of color shoulder the brunt of the labor of providing critical care services for the sick and elderly, many lack a living wage and basic sources to care for their own families and communities.

The pandemic magnifies pre-existing inequalities and the burden of care labor along racial, class and gender lines. Women of color are overrepresented in low-wage jobs, which often come with unpredictable schedules, limited hours, and lack sick pay and overtime pay.

In particular, Black women and families have increasingly higher rates of maternal and infant mortality and often lack the economic resources to afford adequate food in a given month. They also continue to face economic challenges and legal barriers that undermine their access to quality health care and accessing reproductive health services as well as their ability to afford childcare.

The COVID-19 pandemic compounds these barriers by diverting financial resources from essential reproductive health services as government officials use COVID-19 preparation to undermine protections for social welfare services such as the Supplemental Nutrition Assistance Program.  

These inequalities are cruel reminders of the ways the state exploits Black women’s labor as it undermines the quality of their in ways that pave the way for their premature deaths.

Even as many Black women health care workers are tasked with the labor of directly responding to the pandemic, they lack the protections necessary to do so. Amidst looming shortage of personal protective equipment such as masks, gowns and goggles, many do not have materials needed to protect themselves and their clients from an infection. 

The nature of this kind of care worker further puts Black women health care workers at greater risk given that they encounter diseases and infections daily, especially while working in close proximity to one another and their patients. While doing intimate and grueling work, aides like Isabel and Rhonda—who at times work 16-hour days with populations most susceptible to the illness—are particularly vulnerable.

What gives Isabel and Rhonda hope as they provide a range of medical services and emotional support is knowing that there is a community of workers invested in risking their lives to care for elderly, sick and dying.

It is the networks of women of color health care workers who are on the front lines advocating for a coherent policy response that can meet the needs of vulnerable communities who face increased risk of exposure, risk of infection, and likelihood of death.

It is the persistent demands for protective equipment alongside pay equity and social protections such as increased flexibility in Medicare regulations that currently impede remote home-care services.

It is actively recreating economic structures and communities of care that address the intersecting inequalities Black women have long faced. 

This is the only way can meaningfully exercise our right to life free of constraints and violence.

The coronavirus pandemic and the response by federal, state and local authorities is fast-movingDuring this time, Ms. is keeping a focus on aspects of the crisis—especially as it impacts women and their families—often not reported by mainstream media. If you found this article helpful, please consider supporting our independent reporting and truth-telling for as little as $5 per month.


Jallicia A. Jolly a PhD candidate in the American Studies department at the University of Michigan as well as a predoctoral fellow at Amherst College and Yale University. She works on HIV/AIDS, Black women's health and activism, and reproductive justice. Her writing has appeared in Rewire.News, HuffingtonPost, Black Youth Project, UMichigan's National Center for Institutional Diversity and For Harriet.