“Do not leave me behind and do not put me in your box”: family-planning access and care needs among women with migration histories in Berlin, Germany—a mixed-methods study

Abstract Introduction Family planning is a fundamental human right and contributes to several Sustainable Development Goals. Women who have migrated from low- and middle-income countries may encounter barriers to family planning and reproductive healthcare. This study examined access to family planning information and services and related care needs among first-generation women with migration histories in Berlin, Germany. Methods We conducted a qualitatively driven, emergent sequential mixed-methods study with 29 first-generation women who had migrated from low- and middle-income countries to Berlin and accessed maternal or reproductive healthcare services within the preceding two years. Semi-structured interviews were conducted between 17 July and 12 November 2024, analyzed thematically, and mapped to the Education, Training, and Research (ETR) Health Equity Framework. Selected codes were organized in a participant-by-code matrix for descriptive cross-case comparison. Findings were integrated through cross-case comparison and conceptual-model development. Findings Four care-need domains were identified: communication and information; continuity and affordability; respect and shared responsibility; and cultural and life-course responsiveness. Access was shaped through four pathways: Systems of Power, Psychological Pathways, Individual Pathways, and Relationships and Networks. Structural, linguistic, financial, psychological, and relational conditions constrained access, while individual agency, peer and community networks, and navigation support could facilitate it. Barriers and facilitators co-existed. Conclusion Equitable family planning access requires more than formal service availability. Health systems should provide affordable, understandable, continuous, respectful, responsive care that supports informed choice and reproductive autonomy while reducing structural, linguistic, financial, and administrative barriers. Agency and community support should complement, not substitute for, health-system responsibility.