Background <p>Financial barriers to healthcare access is a major public health issue in Sierra Leone. This study aims to examine the trends and inequalities of perceived financial barriers to healthcare access among reproductive-age women in Sierra Leone.</p> Method <p>This study employed repeated cross-sectional design to analysed data from the Sierra Leone demographic health surveys of 2008, 2013, and 2019. Inequalities were measured using the World Health Organization’s Health Equity Assessment Toolkit, calculating metrics including difference, ratio, population-attributable risk, and population-attributable fraction. These metrics were assessed across factors such as economic status, education, residence (urban/rural), marital status, employment, number of children, and province. No formal statistical trend analysis was performed.</p> Result <p>The proportion of reproductive-age women facing financial barriers to healthcare access dropped from 80% in 2008 to 66.9% in 2019. However, persistent inequalities remained, with the highest barriers reported among reproductive-age women in the poorest quintile, those with no education, and those in rural areas. Reproductive-age women in Northwest province reported the highest significant disparities in financial barriers to healthcare access in 2019.</p> Conclusion <p>While perceived financial barriers to healthcare access among reproductive-age women in Sierra Leone have decreased overtime, the persistent inequalities demand targeted interventions, such as microfinance programs, to support these disadvantaged women.</p>