A 2014-2020 analysis of US births (with gestational ages ranging from 22 weeks 0 days to 25 weeks 6 days) showed that while the rate of active treatment has increased over time, neonates born to non-Hispanic black, Hispanic, and asian individuals were less likely to receive active treatment compared with neonates born to non-Hispanic white individuals.4 These findings highlight that while disparities in neonatal outcomes are partly a consequence of differential quality and access to high-quality care, there may also be provider and institution-related factors that shape the counselling and treatment of patients from minoritised populations. Loss-sensitive care for patients using AAPT must address structural inequities When considering efforts to address morbidity and mortality among preterm neonates, it is important to acknowledge structural racism as an upstream contributor to racial disparities in preterm birth.2 Structural racism perpetuates socioeconomic and educational disadvantages that expose black women to chronic stressors, including hazardous living and working conditions.6 These exposures limit black families’ access to health-promoting and life-saving resources, heightening the risks of extreme prematurity for black parents and their children.2 The advent of AAPT will not alleviate the pressures of structural racism and other forms of systemic oppression present in our healthcare systems or create opportunities for black women and neonates to receive state-of-the-art care. ...it is vital to consider how AAPT and other neonatal interventions might obscure structural racism and what might be done to avoid reinforcing ongoing health injustices.6 As we echo Romanis and Adkins in calling for loss-sensitive care pathways for families who use AAPT, we emphasise that such care paradigms must account for structural racism and the lived realities of black women. ...clinicians, researchers, ethicists and policy-makers must prioritise the needs and preferences of marginalised patients with limited agency, visibility and voice–especially pregnant persons who are most likely to experience preterm birth and its complications.6 Justice demands that loss-sensitive AAPT care recognise and address racial disparities in preterm birth or risk reinforcing long-standing health injustices.