PURPOSE:
The UK’s National Health Service (NHS) Race and Health Observatory’s (RHO) review of Neonatal Assessment (NHS RHO 2023) represents a landmark in midwifery policy influence. The review critically examined how standard neonatal assessments—e.g. Apgar score and detection of jaundice and cyanosis—fail to account for skin tone diversity, leading to diagnostic delays and inequitable care for babies from ethnic minority backgrounds.

DISCUSSION:
This initiative was grounded in midwifery practice and co-produced with clinicians, educators, and community voices. It drew on national mortality data, the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) reports, and lived experience to inform practical, evidence-based recommendations. Midwives played a central role in shaping and implementing the review’s findings, ensuring that solutions were clinically relevant and culturally competent. Midwifery education is evolving, with inclusive content now embedded in curricula and professional development. Culturally tailored resources, such as parent-facing infographics, have enhanced communication and trust between midwives and families. We aim to inspire further innovation in midwifery education and care delivery—ensuring that all newborns, regardless of ethnicity, receive safe, timely, and equitable assessment from the very start of life. The review exemplifies how midwifery leadership can drive systemic change and has already influenced national policy and practice. The National Institute of Clinical Excellence (NICE) updated its jaundice guidance to reflect skin tone considerations, and 98% of maternity services in England adopted diverse neonatal manikins to improve training.

EVIDENCE WHERE RELEVANT:
NHS and Race and Health Observatory (2023) Review of Neonatal Assessment in Black, Asian and Minority Ethnic Newborns. https://nhsrho.org/wp-content/uploads/2023/08/RHO-Neonatal-Assessment-Report.pdf

KEY MESSAGE:
Visual skin assessments alone are inadequate for diverse neonatal populations. Clinical descriptors must reflect all skin tones to avoid diagnostic bias. Inclusive guidelines, objective tools, and targeted midwifery training are urgently required. This initiative demonstrates the power of midwifery leadership in shaping equitable healthcare policy and practice. Newborn 1