Background <p>Women of refugee background in high-income countries experience disproportionately poorer maternity care experiences and maternal health outcomes compared to non-refugee women. Their maternity care needs remain under-recognised and under-researched.</p> Aim <p>This qualitative systematic review aimed to synthesise evidence on (1) what women of refugee background need from maternity care in high-income countries, and (2) the barriers and enablers experienced by health, social, and community-based maternity care professionals providing maternity care to this population.</p> Methods <p>Following the JBI methodology for systematic reviews, five databases were searched for peer-reviewed qualitative studies published in English between 2013 and 2025. Eligible studies were screened, data were extracted and appraised critically for methodological quality. Findings were synthesised using meta-aggregation and the overall confidence in synthesised findings were assessed using the JBI ConQual approach. The EQUIP framework was applied to the findings to ensure health equity considerations were captured.</p> Findings <p>Fifty-six studies met the inclusion criteria. Three synthesised findings were generated: (1) Structural and systemic factors shape the provision of and access to equity-oriented maternity care; (2) Key components to equity-oriented maternity care are: trauma-informed care, culturally responsive care, woman and family-centred care, and continuity of care and carer; and (3) women’s settlement experiences influence their transition to new healthcare systems.</p> Conclusion <p>Addressing the persistent health inequities faced by women of refugee background in high-income countries requires systemic reform, sustainable workforce investments and specialised training for care providers. Further research on the co-design of equity-oriented care interventions is also needed to ensure maternity services are responsive to the needs of this population.</p>