“They looked at our vaginas but didn’t tell us why”: a participatory study on sexual and reproductive health needs of refugee women on Lesbos, Greece

Abstract Background Refugee women face poorer sexual and reproductive health (SRH) outcomes than host populations. Their SRH needs remain inadequately understood. Particularly, participatory research integrating women’s own perspectives is lacking. Therefore, the objective of this study was to examine the self-identified SRH needs of refugee women of reproductive age residing in Europe’s largest refugee camp. Methods This participatory qualitative study (August-October 2023) combined six focus group discussions with 27 peer-to-peer interviews. Refugee women ( n = 67, of whom seven recruited for both methods) from nine nationalities in Mavrovouni camp, Lesbos, Greece participated. Nine refugee co-researchers contributed to question development, recruitment, data collection, and collective analysis. A socioecological and intersectional lens guided subsequent thematic analysis. Results Women articulated SRH needs transcending clinical care. Beyond timely, equitable, and respectful healthcare, they emphasised autonomy, mental wellbeing, health literacy, and information. SRH was found to be inseparable from material living conditions (accommodation, sanitation, nutrition), relational and religious support, physical and institutional safety, legal clarity, and broader demands for justice. Safety was defined as physical protection, legal stability, food security, and information access. Justice encompassed fair asylum procedures, non-discriminatory camp treatment, equitable healthcare access, protection from gender-based violence and pushbacks, and reproductive justice -- conceptualised as reproductive autonomy, dignified pregnancy conditions, safety for newborns, and birthright citizenship. Needs were shaped by intersecting identities, particularly legal status, (single) motherhood, and gender. Conclusion Findings reflect a holistic understanding of SRH, shaped by precarious camp conditions, border violence, and securitized migration governance. Improving SRH therefore requires addressing structural constraints on self-determination, information, food security, safety, legal stability, and dignified healthcare through interdisciplinary and justice-oriented approaches. This study contributes to reproductive and gender justice debates by demonstrating how justice is lived, rather than externally defined.