How do immigrant women access the public healthcare services in the Basque Country (Spain)?

Background: Immigrant women face diverse barriers in order to access the public healthcare services in Spain. Furthermore, in 2012, a legislative change made the access conditions more difficult to fulfil for immigrants. Besides the public healthcare system, “free clinics” exist, which provide health attention to immigrant men and women who are not eligible for accessing it. Objective: To explore the perception of healthcare professionals working in free clinics in regards to the barriers and facilitators that immigrant women face to access the public healthcare general services and sexual and reproductive health services in the Basque Country (Spain). Methods: Qualitative study based on 11 individual interviews with healthcare professionals working in four different free clinics. A qualitative content analysis was done identifying meaning units, codes and categories. Results: Four categories emerged from the analysis that represent how the personal characteristics of the immigrant women (Tell me who you are and I will let you know how you will access); the attitude of the staff at the healthcare system (“Once they have been attended, everything is fine. The problem is with the administrative staff”); the organization of the healthcare system (The healthcare system is bureaucratic and passive), and health policies (“If you do not fulfil the requirements, you are just out. The law is the law”) influence the access of immigrant women to the public healthcare services. Conclusions: The results of this study show that there are a great number of barriers and few facilitators for the access of immigrant women to the public healthcare general services and sexual and reproductive health services in the Basque Country. The barriers based on the personal characteristics of the immigrant women, which vary based on their origin, were the most largely recognized, whereas the legal barriers were considered the most restrictive ones and difficult to overcome. Key messages: Immigrant women face personal, institutional and legal barriers to access public health services. Legal requirements are considered the main barriers to access public health services.