Effect of Spanish language proficiency on acculturative stress and access to sexual and reproductive health and rights services among sub-Saharan African women immigrants in Spain.

Despite growing African immigration to Spain, research that examines how language barriers affect acculturative stress and access to sexual and reproductive health and rights (SRHR) services by sub-Saharan women is scarce. This study addresses this gap in knowledge by investigating the relationships between proficiency in Spanish language, acculturative stress and access to SRHR services among 384 African immigrant women in Spain using a cross-sectional, quantitative design. Data were collected via online snowball sampling, employing validated measures of Spanish proficiency (CEFR), acculturative stress (RASI), and SRHR access (WHO/UNFPA). Structural equation modeling (SEM) revealed that higher Spanish proficiency reduced acculturative stress (β = 0.50, *p* < 0.01) and directly improved SRHR access (β = 0.56, *p* < 0.01), with stress mediating this relationship (indirect effect: β = 0.24, *p* < 0.05). Findings highlight language proficiency as a dual pathway for mitigating stress and enhancing healthcare access. The findings of this study are important for immigration and re-settlement policies to promote cultural integration, access to social services, as well as culturally sensitive care, especially for minority women in order to address systemic disparities.