The contractions came early and often. So did the headaches. For Austin nonprofit worker Eva Roberts, each of her four pregnancies developed with unerring, and unsettling, similarity.
All of her children were born preterm, and none was heavier than 4 pounds, 15 ounces. Roberts’ second child, son Delbert, arrived 14 weeks early. At 1 pound, 13 ounces, the infant spent four precarious months in the neonatal intensive care unit. Today, Delbert is 25 and healthy.
“It was stressful,” recalled Roberts, who works for AIDS Services of Austin, which supports those affected by HIV and AIDS. “I started my prenatal care early and I was eating right. I took all of the right precautions and felt that everything should have gone well.”
For Parker Dominguez, it’s a familiar refrain. A clinical associate professor of social work at the University of Southern California, Parker Dominguez has worked for nearly two decades to crack a public health riddle that long has vexed researchers. Why do African-American women, including Roberts, face twice the risk of experiencing pregnancies that result in early delivery, low birth weight or even infant death? National Vital Statistics show that black infants are twice as likely to die in the first year of life as white infants.
“Given all of the advances we’ve had in public health and neonatal medicine, we’re still seeing this disparity,” said Parker Dominguez, who was a member of the U.S. Secretary of Health and Human Services’ Advisory Committee on Infant Mortality from 2011 to 2013. “The mystery part of it intrigues me and keeps me engaged.”Among researchers, a consensus is developing that “psychosocial stresses,” such as racism, play a unique role in African-American pregnancies. While everything from socioeconomics and education to preexisting conditions and access to health care are thought to influence birth outcomes, they don’t provide a satisfactory explanation for disparities that have existed since data was first collected more than a century ago, Parker Dominguez said. Across the African-American stratum, birth outcome disparities have held stubbornly and uncannily constant.
Neither do genetics explain the problem. African immigrant women have “much better” birth outcomes than American-born black women, said Parker Dominguez, an African-American mother of three whose own children were born preterm. She first started studying the problem while attending graduate school at the University of California at Berkeley. There she read “Bad Outcomes in Black Babies: Race or Racism?,” the landmark 1991 study by pediatricians Richard Davis and James Collins.
The idea that racism impacts birth outcomes isn’t without its critics, and “there are always going to be naysayers,” Parker Dominguez said. “I welcome it as an opportunity to educate people around the complexity of the issue.
“Racism is always a loaded term,” she added. “We don’t like to think about it, and we don’t like to be reminded of our sordid history and that it still exists. Even in an academic setting, it still challenges our thinking. It still is to an extent controversial, but I think people are more open to thinking about the social determinants of health.”
Parker Dominguez’s 2007 paper, “Racial Differences in Birth Outcomes: The Role of General, Pregnancy, and Racism Stress,” is hailed as a seminal contribution toward understanding and ultimately conquering the problem.
In that study, unlike in past research that asked pregnant African-American women whether they had ever felt they had been a target of overt racism, Parker Dominguez posed more specific questions to elicit experiences that were perceived to be racist. She queried women about exposure to racism during childhood and adulthood, and she asked
about direct experiences and “vicarious racism” — such as witnessing or hearing about a family member being mistreated because of skin color. Both dynamics have been associated with birth outcomes.
“That perception piece is incredibly important,” she said. “You might second-guess yourself, as in ‘Did that really happen? Am I crazy?’ You can start to make excuses for other people’s behavior, or just let things slide, resigning yourself to the fact that racism is just a part of everyday life — like being overlooked while waiting in line or being followed in a store.”
Parker Dominguez said the findings were robust and “stood up, even when we took into account all of these other things,” such as the stress of job loss or a death in the family, anxiety about the pregnancy, or medical risk and socioeconomic factors.
“It indicated to us that we were picking up a unique stressor that seemed to have a unique effect. Racism is a chronic stressor based on an immutable personal characteristic, so the threat is always potentially there. Maintaining a hyper-vigilance against it can be costly. The body’s stress response never fully disengages. Over time, that can lead to wear and tear on your physiological system, which places you at a higher risk for health problems,” Parker Dominguez said.
“African-American women, for example, are more likely to develop hypertensive disorders while pregnant, which puts them at higher risk for premature delivery.”
Parker Dominguez’s interest in social justice traces back to her days at Rice when, as a member of Will Rice College, “I discovered that I was intrigued by the nature of social relationships, social power and social institutions. I could dedicate my life to helping to make the world a better place.”
She ended up triple majoring in philosophy, sociology and policy studies, and she took part in campus outreach efforts. Parker Dominguez helped develop the “College 101” program to bring inner-city high school students to campus for an overnight taste of college life. With the Rice Student Volunteer Program, she also volunteered at Houston’s Star of Hope Mission homeless shelter, the Houston Area Women’s Center and Family Services of Greater Houston, where she co-led support groups for teenagers in at-risk families.
Tyan Parker Dominguez and Eva Roberts work with African-American women in Austin to promote healthy pregnancies and births.
These weren’t Parker Dominguez’s only life-forming moments at Rice; she also met her future husband, Manuel Dominguez Jr. ’91. Manuel taught at-risk youth in Los Angeles’ schools before the couple’s recent move to Austin, where Parker Dominguez now teaches exclusively online via the USC School of Social Work’s Virtual Academic Center.
It’s her research on African-American birth outcomes that has allotted Parker Dominguez’s life its singular purpose. Her work isn’t just revolutionary, it’s bold, said Atlanta activist and educator Fleda Mask Jackson, founder of Save 100 Babies. The organization was created in 2008 to find solutions to assure better birth outcomes among African-American women.
“Clearly, when you move from a discussion of whether it’s about health care, poverty or neglect of oneself, to link it to societal issues or racism and sexism — that’s courageous,” Jackson said. “The research isn’t to negate individual responsibility, but it moves it into another domain. The disparity is still there, but Tyan brings passion and expertise that can bring this challenge more to the forefront.”
Parker Dominguez since has worked to find solutions, particularly through churches. African-Americans have long been wary of the medical community, she said, jaded in part by the U.S. government’s Tuskegee syphilis experiment, in which doctors refused to treat infected patients during a clinical study that lasted from 1932 to 1972.
Churches, meanwhile, are considered a trusted and vital part of the African-American community. Parker Dominguez used a $25,000 grant from the March of Dimes to work with the Pasadena, Calif., Church of God to highlight birth disparities. She did that by promoting a health fair and helping to develop an eight-week support group in which women were encouraged to talk about stressful experiences, coping skills, and ways to foster their own emotional, physical and spiritual health.
She now is consulting with the City of Austin Health and Human Services Department to develop and evaluate a community health worker intervention program, in which trained workers can work with pregnant and nonpregnant African-American women alike. The goal is to educate and connect them to resources to promote healthy pregnancies.
Roberts, for her part, has joined Undoing Racism Austin, an attempt to stamp out discrimination by raising awareness. “I’m extremely optimistic,” she said. “You want to teach your child at a young age that racism exists, but that they can overcome it and go far in life.”