This community-based participatory research study explores the influence of structural racism on sexual and reproductive health (SRH) inequities among immigrant, including refugee, youth. We conducted interviews with emerging youth and youth service providers living in two communities in Massachusetts. Our results detail three major themes illustrating how structural racism influences SRH inequities among immigrant youth: (1) lack of culture-centered SRH supports for recently immigrated youth; (2) immigration enforcement and fear impacting access to adolescent SRH (ASRH) education and services; and (3) perceived ineligibility related to tenuous legal status as a barrier to accessing ASRH services. Conclusions: Findings illustrate the importance of rooting sexuality education curricula in a culture centered framework that recognizes local cultural understandings, acknowledges structural constraints faced by young people, and prioritizes youth agency and voice when engaging in this work. Raising awareness of SRH resources available to immigrant youth may expand access for this underserved population.