Healthcare Professionals' Perspectives on Barriers to Reproductive Care Access in One Urban City: A Qualitative Study

Inequities exist in reproductive care access for biological women of childbearing age from minoritized, racialized, and lower socioeconomic communities in the United States. While patient-reported barriers are well documented, less is known about healthcare providers' perceptions of these challenges in urban, under-resourced contexts. Providers' frontline insights are essential for understanding operational, institutional, and community-level obstacles and for designing more effective, contextually relevant interventions. This qualitative study explores providers' perspectives on the barriers clients face when accessing reproductive care in Washington, DC. We conducted in-depth interviews with 14 reproductive healthcare providers. The analysis yielded four themes: (1) limited health literacy: lack of or limited health and resources knowledge, (2) distrust and mistrust: skepticism toward health-related information and hesitancy to seek reproductive care, (3) challenges navigating care: challenges centered on engagement with available healthcare services, and (4) upstream structural barriers: policy-driven challenges that affect clinic operations and financial stability. Collectively, these findings underscore persistent barriers to reproductive care, even in contexts with broad insurance coverage, highlighting the disconnect between coverage and meaningful access. Despite high insurance coverage in DC, low-income, publicly-insured patients continue to encounter significant obstacles to reproductive care. Addressing these challenges requires policies that ensure healthcare systems provide accessible, patient-centered, and equitable care, as well as interventions that meaningfully integrate provider perspectives to enhance relevance, feasibility, promote provider engagement and buy-in, and support the long-term scalability and sustainability of efforts aimed at improving equitable access. PATIENT OR PUBLIC CONTRIBUTION: This study provides insight from reproductive healthcare providers serving patients in Wards 1, 4, 5, and 7 of the District of Columbia, Washington. All aspects of this qualitative study were informed by a community-advisory board (CAB) made up of members from these respective wards.