Objectives: This study examined the accessibility and utilization of sexual and reproductive health (SRH) services among ethnic minority populations in Vietnam’s mountainous regions, with a focus on their perceptions and challenges. Methods: A mixed-methods design was employed, combining a structured survey of 630 adults with semi-structured interviews and focus group discussions to capture both utilization patterns and contextual experiences. Results: Most participants were of Thai ethnicity (77%). Commune health stations and district hospitals were the most frequently used facilities, primarily for genital tract diseases, pregnancy, and contraceptive services. Over 80% reported satisfaction with services; however, major barriers included long waiting times, limited transportation, and geographical isolation. Respondents expressed a preference for district-level and private facilities due to perceived higher quality, while residents in remote areas often relied on village midwives for maternal care. Additional challenges included the absence of school health staff and the financial burden on teachers providing basic medical support. Conclusion: Findings highlight both service availability and persistent inequities. Addressing logistical, cultural, and systemic barriers through culturally sensitive policies and programs is essential to improving SRH equity for ethnic minority communities in Vietnam.