The start of the COVID-19 pandemic led to an unprecedented international health crisis. Black families in the U.S. were disproportionately impacted by the U.S. response to the pandemic, with the highest rates of contagion and mortality, the highest percentage of frontline workers across industries, and increase in ongoing community challenges (HIV/AIDS epidemic, incarceration, community resources). Frontline workers experienced uniquely demanding work environments with regular exposure, limited flexibility, and the worry about exposing young and/or frail loved ones, specifically in multigenerational homes. For professional Black women in health care settings, many of whom function as head of household or single wage earners for multigenerational households, the impacts of the pandemic shut down created and intensified these challenges. This dissertation uses Ecological Systems Theory, Black Feminist Thought, and a Social Determinants of Health Framework to explore the experiences of Black women who left the paid workforce to become full-time caregivers for dependent children and frail family members. Specifically this dissertation sought to examine:

1. What impacts did the COVID-19 pandemic and pandemic-related shutdowns have on Black families, particularly on Black women, who were employed full-time in frontline jobs and responsible for family caregiving?
2. How did Black women understand and experience the intersections of psychological, physical, and traumatic effects of the COVID-19 pandemic with systemic racism, discrimination, and oppression?
3. How did single Black mothers who are the sole wage earners for their households provide for their multigenerational families under duress?

This dissertation used a qualitative, oral history method, which fits with the cultural histories of Africans for centuries and for African Americans since the start of slavery, to preserve the voices and stories of communities. Fourteen women recruited from targeted Facebook groups completed two semi-structured interviews at two-week intervals. Interviews were conducted on Zoom, recorded, and transcribed verbatim for analysis. From these 14 interviews, three cases were selected to for analysis to ensure representation across the sample on common themes. One composite case study was constructed to show representation, and two additional case studies show unique cases. These were each coded line-by-line for common themes, and then stories were constructed using narrative methods.

Findings from this study suggest that these women felt forced to choose between participation in the paid labor force and safe participation in the care and maintenance of family life. Careers financially supported these women and their families and provided personal fulfillment. This added to feelings of loss and isolation. A major feature pushing Black women to leave the workforce included experiences with racial discrimination regarding work schedules, limited safeguards against COVID-19 exposure, and the lack of flexibility to work from home. Though many women wanted to prioritize the needs of Black patients in these health care settings, they felt they needed to prioritize the needs of their families. Finally, participants reported their multiple family, community, and work roles become increasingly complicated during the pandemic with fewer of the supports they used to cope prior to the pandemic. Placing themselves last, in combination with the loss of common spaces and supports, meant participants needed to find strength in new places and comfort in new ways.

In conclusion, this dissertation suggests oral histories are appropriate ways to collect diverse stories from Black women’s experiences. Black women navigated multiple roles and often competing priorities before the pandemic, which presented challenges that increased as community supports shut down and workplace policies reacted to global change. A pervasive narrative in all interviews was the need for quality and reliable care for children and for elderly family members. This research suggests the need for the development and implementation of policies that include job protections and allowing for paid time off during a crisis such as a pandemic. In direct practice, use of culturally specific methods and theoretical frameworks that recognize and name the intersections of multiple roles, pressures across systems levels, and competing priorities and values will support women facing impossible choices.