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Background: Despite existing research on sexual and reproductive health and rights (SRHR), a gap remains in understanding of specific needs and experiences of female sex workers (FSW), who often face complex social, economic, and relational challenges that hinder healthcare access and sexual and reproductive agency, particularly regarding contraceptive/FP services.

Aim: The aim of the study is to explore perspectives of female sex workers on factors influencing the utilization of contraceptive/family planning services.

Methodology: Three databases were systematically searched. Articles were included if they were qualitative/mixed methods, addressed factors influencing utilization of contraceptive/FP services, used interviews/focus groups/ethnographic methods from FSWs’ perspectives, were peer reviewed, in English, and published between 2020-2025. 17 articles were selected and appraised through the JBI checklist for Qualitative Research. Data was analyzed through inductive thematic analysis.

Results: Three themes denoting key factors and dynamics that influenced utilization of contraceptive/FP services among FSWs were identified: (1) Barriersto Contraceptive Use: Structural, Social, and Interpersonal, (2) Complex Decision Making and Risk Navigation, and (3) Facilitators and Pathways to Empowerment.

Conclusion: The results highlight that access to contraceptive/FP services for FSW is hindered not only by evident, systemic barriers, but also by less visible factors (e.g., risk navigation, definitional challenges, or competing priorities).Therefore, addressing the contraceptive needs of this population requires eradicating systematic inequalities, while enhancing FSWs’ voices and dignity.