Socio-ecological Analysis of Access To Sexual and Reproductive Health Services among Migrant and Refugee Women in high-income Countries: A Systematic Review

Previous efforts to synthesise sexual and reproductive health (SRH) literature have primarily focused on singular services, specific migrant groups, or mostly individual-level influencers. In this systematic review we assessed access to comprehensive SRH services, including multilevel barriers and facilitators, among migrant and refugee women in high-income English-speaking countries. We searched seven databases for peer-reviewed studies involving quantitative and mixed methods, published between 2010 and 2024. We extracted data following PRISMA-Equity guidelines and assessed the risk of bias using the ‘quality appraisal for diverse studies’ tool. We used a socio-ecological framework to organise results into multilevel barriers and facilitators. Twenty-nine studies met inclusion criteria across four countries. Fifteen studies focused on cervical screening, 7 on maternity care, 5 on contraception, 4 on HIV and other sexually transmissible infections, and 2 on intimate partner violence. Summary findings from these studies indicate that migrant and refugee women utilise SRH services less often than native-born women. Barriers to SRH services included knowledge and risk perception gaps at the individual level; implicit bias, discrimination, and language barriers at the interpersonal level; lack of culturally sensitive practices and environments at the organizational level; and lack of health insurance coverage and anti-immigration and racist discourse at societal and policy levels. Migrant and refugee women face significant inequities in accessing SRH services in high-income countries. Eliminating these disparities will require culturally sensitive solutions that encompass multiple levels of influence, especially moving beyond an individual focus to consider interventions at interpersonal, institutional, societal, and policy-level.