Navigating barriers and building solutions: a mixed-methods study on sexual and reproductive healthcare for migrant women in Milan

Abstract Aim: To develop strategies to lower barriers to sexual and reproductive health (SRH) care for migrant women (MW) in Milan, Lombardy, Italy. Background: SRH is a fundamental human right, yet MW experience poorer SRH outcomes than non-MW due to cultural, linguistic, legal, and financial barriers. Despite Italy’s universal healthcare system ( Servizio Sanitario Nazionale , SSN), disparities persist. Methods: Quantitative SRH data from the health information system of a non-governmental organization (NGO) clinic in Milan was used to describe the demographic, socioeconomic, and administrative profile of MW with SRH needs, and to examine factors associated with SRH-related consultations. Qualitative data were collected through semi-structured interviews with 29 stakeholders, including MW, healthcare workers, NGO representatives, and policymakers. Thematic analysis was guided by a socio-ecological framework across individual, organizational, societal, and policy levels. Findings: SRH needs were the most frequent presentations among MW accessing the clinic. Most MWs came from Romania, Morocco, and Peru. Nearly half of those eligible for SSN registration were not enrolled, primarily due to lack of awareness. Economic vulnerability was strongly linked to SRH needs, while language proficiency alone showed no significant effect. Interviews underscored the importance of culturally sensitive care and mental health support. They also emphasized the inconsistent enforcement of regulations across government facilities and legislative gaps that leave certain groups, particularly undocumented EU nationals, without essential services. Community networks and stronger coordination across providers - including formal collaboration between NGOs and the SSN - were identified as promising levers to improve SRH access and equity in Milan and similar settings.