The ethical imperative to pursue neonatal health equity and justice

There are significant racial and ethnic inequities in neonatal care. These inequities are the result of the multiple levels of racism: structural, institutional, interpersonal, and internalized racism. Recently, there has been significantly increased attention to measuring and addressing inequities for minoritized infants and their families. One way to support these strategies is to clarify the bioethical justification for allocating clinical, research and educational resources to address inequity. In this narrative review, we describe two bioethical frameworks-the four pillars and the ethics of care-as a foundation to justify equity-focused research, investigation, and interventions. We focus on these two frameworks with specific attention to their application to micro- and macro-level racism. Finally, we conclude with a case example to illustrate how to employ bioethical frameworks in neonatal health equity efforts. Through this narrative review, we demonstrate that pursing neonatal health equity is, in fact, a bioethical imperative.