Access to Sexual and Reproductive Health Services for Migrant Women in Colombia: A Mixed Methods Approach

Introduction: Migration and forced displacement present critical challenges to sexual and reproductive health (SRH) systems. Colombia hosts over 2.8 million Venezuelan migrants and a high number of internally displaced persons, offering a unique context to evaluate SRH service access and outcomes. Methods: A mixed-methods study was conducted using a parallel convergent design. Quantitative data were collected from 929 women hospitalized for obstetric events in Bogotá and Cali between November 2023 and May 2024. Outcomes and service access were compared across migrant, forcibly displaced, and non-migrant groups. Qualitative data were collected via semi-structured interviews with women, healthcare providers, and stakeholders. The data were analyzed using a combined Tanahashi Coverage Model, Social Determinants of Health, and Complex Systems Theory framework. Results: Quantitative findings revealed no significant differences in antenatal care utilization or testing rates across groups. However, maternal mortality and perinatal mortality were higher among migrant women. Forcibly displaced women had the lowest preeclampsia and severe maternal morbidity rates. Preconception care uptake was critically low in all groups (<18%). Qualitative insights exposed barriers such as legal precarity, insurance fragmentation, stigma, and limited cultural competence, undermining effective service coverage and care quality despite nominal access. Conclusions: While SRH service availability appeared equitable, effectiveness varied by migration status. Structural and systemic barriers compromise outcomes, especially for mobile populations. A complex systems lens reveals how fragmented governance, feedback loops, and sociocultural exclusion drive disparities. Addressing these requires adaptive, culturally responsive policies that account for layered vulnerabilities.