Homelessness among Women Essay

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Homeless women in the United States were invisible throughout most of the twentieth century. In its early decades, they were a minor, little-noted presence in the hobo camps, skid rows, and missions that sheltered the enormous variety of destitute people who scraped by on the margins of U.S. society. They remained largely unacknowledged in the chronicles of Depression-era homelessness; and as sociologist Peter Rossi (1989) notes, “What few homeless women there were in the 1950s and 1960s must have kept out of sight” (p. 35). But in the 1970s and 1980s, as homelessness overflowed the boundaries of marginal neighborhoods and revealed the diversity of late-twentieth-century poverty, homeless women became a visible fact of urban life. The emblematic figure was the “shopping-bag lady”—an elderly, unkempt, deranged, and isolated woman who carried her possessions in filthy shopping bags rumored to conceal bank books that recorded millions in secret wealth. Most were seen as both repulsive and mysterious, beyond rationality, unknowable. Writings and photographic essays on homeless women in the 1980s began to demystify shopping- bag women, documenting their struggles to meet basic survival needs while exploring the fascination they exerted, particularly in relation to a feminist consciousness of women’s unresolved ambivalence about power and vulnerability.

While popular culture and the feminist gaze were focused on the shopping bag lady, urban bureaucracies were documenting astonishing increases in other kinds of female homelessness.

Younger women with children, disproportionately women of color, appeared in rapidly growing numbers as candidates for shelter, eventually eclipsing older women both in numbers and in the public imagination of homelessness. They were part of a surge in homelessness that reflected the global economic changes reshaping the U.S. industrial structure and labor markets through deindustrialization and the expansion of urban service economies. In many cities, the resulting transformation of local housing markets produced both gentrification and homelessness. In the context of the neoliberal policies that dismantled state-supported safety nets and of ongoing changes in family and household forms, these processes have expanded the proportion of people in poverty, shunting many impoverished men to the margins of the labor force, into shadow work (selling plasma or drugs, scavenging) or incarceration, while “feminizing” household poverty and concentrating its effects in communities of color. Both men and women have been affected, but gender (along with race) has mattered in how they have experienced poverty and in what pathways they took from poverty to homelessness.

Gender And Homelessness

Research since the 1970s has shown that many of the contrasts between homeless women and their male counterparts have remained unchanged. A 1976 study of New York City’s only municipal women’s shelter reported that the fifty-two homeless residents were “poorer, younger, better educated, more often black, and more frequently married” than homeless men (Bahr & Garrett, 1976, p. 135). Women were also more likely to have children and to come from disrupted homes but less likely to have serious substance abuse problems. In subsequent decades, research showed local variations in specific characteristics but largely reaffirmed these contrasts; it also documented higher rates of psychiatric difficulties (hospitalization or symptoms) among homeless women.

Studies in the 1990s found additional differences: Homeless women—particularly those with mental illness—consistently report higher rates of childhood physical or sexual abuse (depending on the definition and the measure used, rates range from 23 percent to 74 percent) than homeless men. Some scholars interpret this finding as evidence of a gender-specific cause of women’s homelessness, though studies reporting similar rates in comparison groups of non-homeless women render the causal role of such experiences uncertain. For women who experience domestic violence as adults, the link to homelessness may be more direct, although its independent effect is unclear.

During the last decades of the twentieth century, homelessness grew faster among women than men, and the number of homeless families increased. In the 1980s and early 1990s, approximately 15 to 25 percent of all homeless adults were women. A national survey carried out in 1996 by sociologist Martha Burt found that the proportion had grown to almost 33 percent, and further increases occurred after 2000. In New York City, the nightly shelter census leaped from 21,000 to 38,000 between 1998 and 2002, as single adults (overwhelmingly men) increased 14 percent to 8,000 and homeless families increased 105 percent to 9,097, with 13,400 (mainly female) adult members. No longer invisible, women have come to outnumber men in New York’s sheltered homeless population. And their increased numbers make their diversity more apparent: Family status, age, and disability delineate subgroups whose contrasting characteristics reflect distinctive experiences of homelessness.

Family Status

Family issues index important differences among homeless women. Burt’s survey shows that the two major subgroups defined by family status—unaccompanied women and those with children—were similar in size but differed in age, race/ethnicity, and duration of homelessness: Women with children were more likely to be women of color, younger, and more recently homeless than unaccompanied women. Numerous local studies report similar contrasts. Findings on mental illness are inconsistent, though most indicate that women with children have fewer and/or less severe psychiatric problems than women who are homeless alone.

A closer look at family status reveals additional complexities. Unaccompanied homeless women include nonmothers and mothers of adult children, but most are mothers of minor children living elsewhere. And many homeless women accompanied by children also have at least one child living with others. Moreover, family status fluctuates: In a study of 10,474 women in New York City shelters, 689 women (28 percent) who were in “singles” shelters had also stayed in family shelters; and 618 women (7.7 percent) who stayed in family shelters had also stayed in singles shelters.

Women’s familial and intimate relationships— with parents, partners or spouses, and children— both shape and are shaped by their homeless experiences. Some family events—leaving an abusive partner, divorce, the death of a spouse or coresiding parent, or a custody loss that disqualifies a mother for welfare benefits or housing subsidies—lead directly to housing loss and homelessness. When women live with parents or other relatives, pregnancy and childbirth may also precipitate homelessness if the expanding family overstrains relationships and household capacity.

Homelessness affects women’s intimate and family relationships as well. Among poor mothers, the stresses of homelessness may increase the risk of involuntary separation from children by negatively affecting parenting practices—for example, when shelter rules (about mealtime, discipline, bedtime, and so on) contravene family practices and undermine parental authority or when surveillance by shelter staff reveals parenting problems that remain unexposed in housed families. Homelessness also leads some mothers to “voluntarily” place children with relatives or others to protect them from the shelter environment. And for some mothers, both homelessness and family separations may be the result of personal mental health or substance abuse problems. Homelessness influences family processes in other ways, too. Shelters are often distant from the kin and friends in a mother’s network of child care and support. Nonmothers also report that homelessness estranges them from family and friends, either because shame prevents them from revealing their homelessness to relatives and others or because homelessness places demands on relationships already strained by unmet needs. Thus, while overburdened relationships may push a woman toward homelessness, once she arrives there, homelessness further weakens the fibers of relationship and support.

Age

Age is related to a woman’s family status, but it also has other implications for how women experience homelessness. In the 1996 Urban Institute survey, 15 percent of unaccompanied homeless women were fifty-five or older. Some older women approximate the “shopping bag lady” stereotype: isolated, reluctant to accept contact or help except on her own terms, ensconced in an alternative reality structured by mental illness. And research has found high rates of psychiatric problems in this group: In a New York study of older homeless women, 42 percent showed evidence of psychotic symptoms and 27 percent reported past psychiatric hospitalizations; a study in Virginia found that 48 percent of homeless women over fifty had received mental health or substance abuse services, and 40 percent were receiving Supplementary Security Income (SSI) or Social Security Disability (SSD) benefits. However, older women with indicators of psychiatric disorders are a minority; the group as a whole is more generally characterized by extreme poverty, a variety of physical problems, and isolation from family and friends. For some older homeless women, critical life events precipitated homelessness (for example, being the last caretaker as parents or other relatives died or losing a live-in job); for others, the cumulative effect of smaller events (such as illness, rent increases, family conflicts, job loss, or divorce) led to homelessness. Women in their fifties and early sixties are particularly vulnerable since unless they are severely disabled, they do not qualify for the social security benefits that can protect women only slightly older than they are from homelessness.

Older homeless women have often confounded service delivery efforts except at the lowest level of demand—drop-in or shelter services that impose few rules and ask few questions. A New York study found that fewer than half in a sample of 201 older homeless women became housed after two years; those who did had higher baseline levels of social support, community services, and entitlements benefits than those remaining homeless. They were also less likely to be psychotic and had shorter histories of homelessness. The study notes the “apparent lack of suitable housing options for older homeless women as evidenced by the high percentage of women who received no housing offers, and by the large number that rejected offers that were made” (Cohen et al., 1997, p. 73). Descriptive accounts indicate that in the absence of viable alternatives, some women remain in shelters until the infirmities of age lead them to nursing homes or hospice care.

Very young homeless women constitute another age-defined group with distinctive characteristics and needs. One study of New York City families on public assistance found homeless women far more likely than others to be pregnant (35 percent versus 6 percent) or to have given birth in the last year (26 percent versus 11 percent); another New York study found young homeless mothers with infants at particularly high risk for recurrent homelessness. Frequently these women have been residing in family situations that are unable to accommodate additional members, and having young children adds to the financial and social strains that make it difficult for them to establish a stable residence on their own.

Pregnant homeless women are also at risk for pregnancy complications, poor birth outcomes, and having children with medical and developmental problems. In addition to prenatal care, they may need parenting supports (since homelessness often cuts women off from support networks that are particularly important for new mothers), mental health services (for those who have experienced trauma and victimization), substance abuse programs that do not require separating mothers from children, and some continuity of services after they become rehoused to foster linkages to resources and support.

Disabilities

Despite public perceptions that homelessness is caused by psychiatric disorders, most homeless women do not have major mental illnesses, although they do have higher rates of many symptoms and disorders than homeless men, other poor women, or women in the general population.

Actual rates of mental health problems among homeless women vary widely, depending on the indicators and measures used, the subgroups considered, and the type of illness or distress studied. Psychiatric hospitalization, symptoms of distress, and a diagnosis of mental disorders are all commonly used as indicators of psychiatric problems. In a comprehensive review in 1996 of the relevant research, psychologist Marjorie Robertson and epidemiologist Marilyn Winkleby report that homeless women consistently score higher on symptoms of distress and depressed mood than women in the general population. They caution, however, that these scales may measure reactions to traumatic events and difficult environments as well as ongoing psychiatric conditions, and that these scales do not necessarily reflect major mental disorders. In studies of psychiatric hospitalization for homeless women, rates ranged from 8 percent to35 percent, compared to 3 percent among women in the general population. Diagnoses of several specific psychiatric disorders (schizophrenia, major depression, bipolar disorders, alcohol disorders, and drug disorders) are also higher among homeless women than among women in the general population or among other poor women.

There are subgroup differences as well, with unaccompanied women experiencing more problems: They have higher hospitalization rates (10 to 27 percent) than women with children (2 to 14 percent) and higher rates of schizophrenia and bipolar disorder. Rates of major depression are high in all subgroups.

The psychiatric profile of homeless women has not been static. In the 1990s, studies began to report elevated rates of disorders not previously identified among homeless women. When the profile of post-traumatic stress disorder (PTSD)—a diagnosis developed after the Vietnam War to encompass symptoms once described as wartime psychosis or shell shock—was applied to victims of sexual and physical abuse, PTSD acquired a female face. Not surprisingly, among homeless women, who often have histories of victimization, rates of PTSD are high: In studies in St. Louis, Missouri, and Worcester, Massachusetts, over one-third were diagnosed with PTSD. Women’s growing use of illegal drugs during the 1990s also contributed to the changing diagnostic profile of homeless women. While the prevalence of drug and alcohol abuse remains lower among women than among men in both homeless and non-homeless samples, substance abuse is a prominent issue for many homeless women, both accompanied and unaccompanied by children.

Less attention has been given to homeless women’s physical health problems. Homeless adults experience acute illnesses, chronic physical conditions, and various communicable diseases much more frequently than the general population. Many acute problems (including respiratory infections, trauma, and skin ailments) emerge directly from the conditions of homelessness, and several chronic problems (like hypertension and diabetes) are exacerbated by these conditions and by limited access to health care. Communicable diseases like TB and HIV are also more prevalent among the homeless than the general population. In several studies, women with AIDS were disproportionately represented among the homeless: A study of HIV infection among homeless drug users found rates of 32 percent among Hispanic women and 38 percent among African-American women living on the streets; and in a New York study of sheltered homeless adults, AIDS contributed to a death rate among homeless women in the twenty-five- to forty-four- year-old age group that was fifteen times higher than that of other New York women. Despite high rates of sexually transmitted diseases (STDs), pelvic inflammatory disease (PID), and abnormal Pap smears, few homeless women receive regular gynecological care; pregnant homeless women are at particular risk for complications and poor birth outcomes, yet they are far less likely to receive prenatal care than poor housed women. And among homeless women and men, the rates of traumatic injury (such as broken limbs and burns) are up to thirty times higher than in the general population. Why do homeless women experience so many physical and mental health problems? Homelessness itself is often responsible for psychological distress and demoralization, as well as for various specific health conditions—skin ailments, peripheral vascular diseases, infections, and so on. Other problems, such as severe psychiatric disorders and chronic health conditions, can interfere with a woman’s ability to maintain income and housing, making her more vulnerable than her healthier peers to acute episodes and exacerbations, as well as to the disruption of livelihood, family ties, and housing stability that often precedes homelessness.

Strategies And Problems Of Survival

The literature includes only a few accounts of women’s experiences and survival strategies on the streets and in shelters. Women on the streets face theft of their possessions and a variety of assaults on their person and dignity, reflecting both an absence of basic facilities for women—toilets, showers, safe sleeping spaces, places to store possessions—and the vulnerability of these women to harassment and violence. Even in the context of food lines, shelters, or drop-in centers, women may be victimized by down-and-out men, security staff, and others who frequent these institutions. In the broader world they also face harassment by police, store security personnel, business proprietors, and other gatekeepers who protect regular users of public space from close encounters with homelessness. In rare extreme instances, they are at risk from thrill-seeking predators who believe the lack of a protected domicile makes them fair game for robbery and sexual assault. The 1996 Burt survey found that solitary homeless women are particularly vulnerable, experiencing robbery, theft of possessions, assault, and sexual attacks at notably higher rates than women with children.

Shelters proliferated in the 1980s and 1990s. Early accounts of homelessness in New York and other large cities reported that public shelters for unaccompanied women were less massive and dangerous than some of the gigantic and unruly institutions sheltering homeless men, but regimentation, demeaning encounters with staff, and pervasive harassment deterred many women from using them.

In some locales, nonprofit agencies developed twenty-four-hour drop-in centers offering showers, meals, and protection from the elements, or small, privately run shelters specifically catering to homeless women. These alternatives were often spartan but left a woman’s dignity intact. Most women— whether homeless alone or with children—have preferred indoor accommodations, despite the lack of privacy and inadequate facilities, to the dangerous autonomy of the streets.

Ethnographic accounts document additional difficulties of survival even in relatively protected shelter settings. The usual shelter context is one in which everything from laundry vouchers to an extra meal portion has to be negotiated with staff who are fearful of encouraging “dependency,” where a woman is surrounded by the troubles, illness, and sometimes anger of others who are also trying to cope with homelessness, and where shelter rules—about when to sleep, get up, or shower, who can eat what and where, what one may possess and where it may be kept—produce feelings of powerlessness, resignation, and anger. At the same time, some women develop friendships and supportive relationships with other shelter guests or receive genuinely helpful services and support from the staff.

Service Needs And Service Utilization

In the mid-1970s, sociologist Theodore Caplow introduced his colleagues’ study of homeless and disaffiliated women by noting that “for a sizeable minority, disaffiliation culminated a long series of wrong choices and personal failures, drunkenness and desertion, shoplifting and marital violence, abused children and neglected obligations. For this group, strongly represented in the Women’s Shelter sample, there is little that anybody can do. . . .” Caplow depicted disaffiliated but still housed women as less blameworthy victims of age and infirmity who “could lead happier, and more useful lives if they had higher incomes, better housing, and a safer environment” (Bahr & Garrett, 1976, pp. xvi, xvii).

While efforts to distinguish the deserving from undeserving poor continue to inform policy debates, research on services has shifted focus from “wrong choices and personal failures” to the distinctive concerns of homeless women, including physical health problems, separated children, and the trauma of victimization. Noting that women often experience the settings where help is offered as stigmatizing, disempowering, or frightening, observers have suggested that the often reported “service resistance” of homeless women might better describe the settings than the women, who respond favorably to low-demand approaches that allow them to accept help on their own terms in settings that offer them a sense of security and community.

The growth of family homelessness has altered the service landscape. Public attitudes are more generous toward children, who cannot be blamed for their plight. Not surprisingly, homeless women with children are not only more likely to receive income supports and Medicaid insurance than men or solitary women; they also tend to be directed to service-intensive transitional shelters that provide case management, mental health and substance abuse services, parenting education, and job search or job training services. While families often benefit from these intensive services, the role of these services in fostering exits from homelessness is less clear-cut. Critics suggest that requiring homeless women to “graduate” from transitional shelter programs in order to be eligible for housing referrals and subsidies may unduly prolong homelessness, and that homelessness could be more effectively addressed if similar services were offered to stressed, but still-housed, families as an alternative to entering the homeless services system or in conjunction with housing subsidies that facilitate an immediate move to permanent housing. In fact, the most rigorously designed studies have demonstrated that subsidized permanent housing is the most effective response to family homelessness.

Research shows that rental subsidies, supportive services, and the availability of diverse housing options are also keys to residential stability for unaccompanied homeless adults, including those with severe psychiatric disorders. While women have been included in this research, the few studies that have specifically focused on women’s success in exiting from homelessness have emphasized that limited housing options, often mismatched to preferences, undermine their housing stability.

Issues For The Future

Twenty-five years of recent experience with homelessness makes it clear that for the largest portion of the population that becomes homeless, affordable housing and income supports can avert homelessness and restore residential stability. Many of the additional transitional services that have been developed—case management, parenting supports, child care, treatment programs, and health care—can improve the quality of life for women and their families but may be most effectively provided in the context of permanent housing rather than as “housing readiness” services. For women with particular vulnerabilities (young pregnant women, mothers with severe mental illnesses, and older homeless women with psychotic disorders), supportive safe spaces or transitional programs may be useful interim steps out of homelessness. But if the goal is to establish residential stability, the sooner permanent housing is obtained, the more effective the other services will be.

Thus much of what homeless women need is the same as what poor communities more generally need: housing, income, jobs, quality schools, child care, and health care services. Without these basics, it will remain difficult to tease out the causes of homelessness from its consequences and to tailor special assistance around the needs and problems remaining once all are afforded the basic human requisites for life, health, and dignity.

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