Healthcare access and utilization among refugee women in Ohio: a qualitative study using a structural vulnerability framework

Refugee women encounter numerous barriers to healthcare access and utilization. Recent changes in immigration enforcement and public policy have raised further concerns about their potential effects on healthcare-seeking behaviors among refugee communities. The aim of this study was to explores factors affecting healthcare access and utilization among refugee women under the current administration and discuss policy recommendations. This is a qualitative study, conducted in Ohio, U.S.A., between May and August 2025. In-depth interviews were conducted with 40 refugee women of reproductive age (18–49) using a validated semi-structured questionnaire. Primary data were collected through reaching out to immigration aid organizations and community networks. 40 of the 45 eligible participants were included in the analytic sample. The interviews were transcribed and imported into ATLAS.ti software for coding and analysis. An iterative coding process was used, and multiple rounds of review were conducted to verify transcription and coding accuracy. The analysis resulted in three overarching themes: (1) systemic and structural barriers to accessing healthcare under the current administration; (2) patients’ knowledge gaps and navigation challenges; and (3) perceived quality and cultural responsiveness of care. The findings highlight significant barriers, including lack of affordable care (67.5%), out-of-pocket expenses even with insurance (62.5%), and not seeking care due to fear of deportation (27.5%). Many participants also reported limited understanding of the U.S. healthcare system, such as differences between types of care (50%) and how insurance works. Language and transportation barriers were common, with 45% citing language-related difficulties and 30% facing transportation issues. In terms of care quality, participants shared mixed experiences. While most (67.5%) felt respected, many reported long wait times for appointments (65%) and experiences of discrimination (30%). Refugee women navigate a healthcare landscape riddled with financial, structural, informational, and interpersonal barriers. Addressing these challenges requires a coordinated, multi-sectoral response that includes systemic policy changes, community-rooted support systems, culturally competent care, and a more inclusive public health narrative.