Barriers to Inclusive Sexual and Reproductive Health Care for LGBTQ+ Populations: A Narrative Review With Emphasis on Midwifery and Obstetric Services in Greece

Despite recent legal and policy advancements, LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, and additional identities) populations continue to face significant barriers to equitable sexual and reproductive health care. In Greece, legislative reforms have expanded rights for same-sex couples and gender-diverse individuals; however, these changes are not consistently reflected in everyday healthcare practices. Midwives and obstetric staff play a critical role in shaping access to inclusive and affirming sexual and reproductive health services. This narrative review examines the structural, cultural, and professional factors influencing sexual and reproductive healthcare experiences among LGBTQ+ communities in Greece and, where relevant, in broader European and international contexts. A narrative literature review was conducted using PubMed and Google Scholar, focusing on peer-reviewed studies and relevant policy or legal sources published in English and Greek between January 2014 and March 2025. Search terms addressed LGBTQ+ populations, sexual and reproductive healthcare, midwifery, obstetric practice, healthcare access, provider education, discrimination, stigma, and inclusive care. Findings were organised thematically. Five interrelated barriers were identified: discrimination, stigma, and heteronormativity within healthcare encounters; insufficient education and training of midwives and obstetric staff regarding LGBTQ+ health needs; economic constraints and insurance-related exclusions; gaps between legal protections and implementation in clinical settings; and geographic disparities limiting access to inclusive services. These factors frequently intersect and reinforce inequalities in care provision. Improving sexual and reproductive health outcomes for LGBTQ+ populations requires coordinated action beyond legal reform, including LGBTQ+-inclusive curricula, continuing professional development, respectful collection of sexual orientation and gender identity data, institutional accountability mechanisms, and equitable access to fertility, gender-affirming, preventive, and perinatal care services.