INTRODUCTION
Women living in border regions face significant vulnerabilities related to their sexual and reproductive health, compounded by social, historical, and geographic inequalities. In response to these challenges, the Brazilian government launched the National Policy for Comprehensive Women’s Health Care (PNAISM) in 2004 to advance sexual and reproductive rights, strengthen actions against domestic and sexual violence, and consolidate previous achievements in women’s health programs (1,2).
This policy stood out as innovative because it expanded beyond reproductive health to include marginalized groups within public health policies, such as Black women, quilombola communities, rural workers, lesbian women, and incarcerated women (2).
In 2011, the National Policy for Comprehensive Health Care for Populations of the Countryside and Forest (PNSIPCF) was implemented. This policy plays a crucial role in border regions, where many riverside, Indigenous, and quilombola communities reside. It aims to ensure proper care for pregnant and postpartum women who often encounter geographical, cultural, and institutional barriers to health services. The PNSIPCF reinforces the need for differentiated strategies for prenatal, childbirth, and postnatal care, promoting respectful and comprehensive health attention aligned with the principles of equity and universality of Brazil’s Unified Health System (SUS) (3).
Although these public policies target women living in border zones, the provision of sexual and reproductive health services remains inefficient. Access to contraception, cervical cancer screening, sexually transmitted infection (STI) prevention, and care for victims of sexual and gender-based violence is still limited. As a result, women in these areas are more vulnerable to unintended pregnancies, preventable diseases, and unaddressed health risks (4,5).
A 2022 study demonstrated that countries like Australia, Israel, and the United States also face barriers in border regions, such as differences in language, limited patient–provider communication, educational inequalities, and individual factors that restrict access to healthcare (6). Consequently, women continue to encounter legislative, geographic, sociocultural, and temporal obstacles that severely restrict access to essential medical assistance (7,8).
Additional challenges include the shortage of healthcare professionals in border regions, insufficient financial resources, insecurity in border territories, and inadequate patient identification systems, all of which contribute to unfavorable conditions for accessing health services (6). Prenatal care in northern Brazilian border regions shows inadequate performance scores, largely due to service disorganization, weaknesses in appointment scheduling systems, and limited health promotion and disease prevention initiatives, which hinder the planning and execution of effective health actions (9).
Given this scenario, women’s health in Brazilian border regions requires special attention, particularly in light of the geographic, social, and economic challenges that define these areas. This context aligns with the Sustainable Development Goals (SDGs), especially SDG 3 – Good Health and Well-Being, which aims to ensure healthy lives and promote well-being at all ages. Within this framework, target 3.1 seeks to reduce global maternal mortality rates, a goal that is particularly challenging in border areas with restricted access to healthcare. Additionally, SDG 5 – Gender Equality emphasizes the importance of guaranteeing women’s sexual and reproductive rights.
Thus, this study aims to conduct a scoping review to map existing scientific evidence regarding the barriers faced by women living in border regions in accessing healthcare services, with particular emphasis on sexual and reproductive health.
METHODS
Study Design
This scoping review will follow the recommendations of the Joanna Briggs Institute (JBI) and the methodological stages proposed by Arksey and O’Malley (10). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist will guide the reporting process to ensure that all essential items are addressed (11,12). The protocol has been registered on the Open Science Framework (OSF) (13).
Research Question
Following the PCC mnemonic, Population, Concept, and Context, Population: women; Concept: access to healthcare and barriers; Context: border regions, the research question will be: what evidence does the literature provide regarding access and the barriers women face in obtaining healthcare services in border regions?
Eligibility Criteria
Population
We will include studies involving women, particularly pregnant and postpartum women, across all age groups and without restriction regarding ethnicity, socioeconomic status, or educational level. We will exclude studies involving women with psychological disorders or those who died during the study period.
Concept
We will include studies addressing the Alyne Attention Network and women’s access to healthcare services, especially those concerning sexual and reproductive health planning. Studies must clearly describe how women accessed these services. We will exclude studies that do not allow identification of access pathways.
Context
We will include research conducted in terrestrial border regions worldwide, including Brazilian border regions (North, South, West, Northwest, Southwest) and international borders. We will exclude studies that discuss access barriers without specifying that the population lives in a border zone.
Types of Sources of Evidence
Searches will be carried out during the second semester of 2025 in the following databases: CINAHL, MEDLINE/PubMed, Web of Science, EMBASE, LILACS, CAPES Periodicals Portal, and Cochrane Library. Grey literature will be explored through Google Scholar and academic thesis and dissertation repositories.
Search Strategy
The search strategy will combine controlled descriptors from DeCS and MeSH with Boolean operators (AND/OR). Terms will be used in both Portuguese and English according to the requirements of each database. We will include synonyms and terminological variations to maximize the retrieval of relevant studies. For the DeCS terms in Portuguese, we will use the following controlled vocabulary: ("Mulheres" OR "Gestantes" OR "Puerpério" OR "Saúde da Mulher" OR "Saúde Materna" OR "Saúde Reprodutiva" OR "Planejamento Familiar") AND ("Acesso aos Serviços de Saúde" OR "Atenção Primária à Saúde" OR "Serviços de Saúde" OR "Serviços de Saúde Materna" OR "Equidade em Saúde" OR "Determinantes Sociais da Saúde") AND ("Regiões de Fronteira" OR "Zona de Fronteira" OR "Fronteiras Internacionais" OR "Tríplice Fronteira" OR "Região de Fronteira Brasil-Paraguai-Argentina") AND ("Populações Vulneráveis" OR "Desigualdades em Saúde" OR "Acesso aos Cuidados de Saúde"). In English, we will actively apply the following MeSH terms: ("Women"[MeSH Terms] OR "Pregnant Women"[MeSH Terms] OR "Postpartum Period"[MeSH Terms] OR "Maternal Health"[MeSH Terms] OR "Women's Health"[MeSH Terms] OR "Reproductive Health"[MeSH Terms] OR "Family Planning Services"[MeSH Terms]) AND ("Health Services Accessibility"[MeSH Terms] OR "Primary Health Care"[MeSH Terms] OR "Health Services"[MeSH Terms] OR "Maternal Health Services"[MeSH Terms] OR "Health Equity"[MeSH Terms] OR "Social Determinants of Health"[MeSH Terms]) AND ("Border Regions"[MeSH Terms] OR "International Borders"[MeSH Terms] OR "Cross-Border Region" OR "Triple Frontier" OR "Border Areas" OR "Frontier Zones") AND ("Vulnerable Populations"[MeSH Terms] OR "Health Disparities"[MeSH Terms] OR "Access to Health Care").
Study Selection
All retrieved studies will be imported into Rayyan® for screening (14) in order to carry out the screening, selection and exclusion of studies. Thus, the steps will be conducted independently by two reviewers, and, in cases of divergence, a third reviewer will be consulted to reach consensus, before proceeding with the full reading and inclusion of the studies in the review. The titles and abstracts of the studies will be read and analyzed, then the full reading of the selected studies will proceed.
Data Extraction
Data will be extracted into a spreadsheet created in Microsoft Excel 365/2025, following JBI guidelines. Extracted variables will include title, authors/year, study design, sample, population, objectives, and key findings.
Data Analysis and Presentation
Once the studies are obtained, the data will be synthesized using the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ) version 0.7, alpha 2(15), and subsequently, the findings of the studies will be synthesized descriptively, following the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool (16). For the analysis of the levels of evidence of the articles, Oxford Centre Evidence-Based Medicine will be considered (17).
Ethical Considerations
As this is a scoping review protocol based solely on published data and does not involve human participants or primary data collection, ethical approval is not required according to Brazilian Resolution 510/2016.
REFERENCES
1. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Política nacional de atenção integral à saúde da mulher: princípios e diretrizes. Brasília-DF: Ministério da Saúde; 2004. 82 p. (C. Projetos, Programas e Relatórios). Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nac_atencao_mulher.pdf
2. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Política Nacional de Atenção Integral à Saúde da Mulher: Princípios e Diretrizes. 1. ed., 2. reimpr. Brasília-DF: Ministério da Saúde; 2011. 82 p. (Série C. Projetos, Programas e Relatórios). Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_mulher_principios_diretrizes.pdf
3. Ministério da Saúde (BR). Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa. Política Nacional de Saúde Integral das Populações do Campo e da Floresta. 1. ed., 1. reimp. Brasília-DF: Ministério da Saúde; 2013. 48 p. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_saude_populacoes_campo.pdf
4. Davison N, Stanzel K, Hammarberg K. The Impact of Social Determinants of Health on Australian Women's Capacity to Access and Understand Health Information: A Secondary Analysis of the 2022 National Women's Health Survey. Healthcare (Basel). 2024 Jan 15;12(2):207. Doi: https://doi.org/10.3390/healthcare12020207
5. Mendes M, Simões PA, Simões JA, Santiago LM, Prazeres F, Maricoto T. The link between happiness and health: a review of concepts, pathways and strategies for enhancing well-being. Fam Med Prim Care Rev 2023; 25(3): 288–96. Doi: https://doi.org/10.5114/fmpcr.2023.130090
6. Oginni SO, Opoku MP, Nketsia W. Crisis at the intersection of four countries: healthcare access for displaced persons in the Lake Chad Basin region. Ethn Health. 2022 Oct;27(7):1698-717. Doi: https://doi.org/10.1080/13557858.2021.1947471
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8. Guhlincozzi RA. "The political economy of healthcare access and Chicagoland health-oriented non-profit organizations," Environment and Planning C. 2024;42(4):658-75. Doi: https://doi.org/10.1177/23996544231211243
9. Mendes LMC, Sudré GA, Oliveira JV, Barbosa NG, Monteiro JC, Gomes-Sponholz FA. Social Representations of Puerperal Women about the Search for Prenatal Care on the French-Brazilian Border. New Trends in Qualitative Research. 2021;8:130–37. Doi: https://doi.org/10.36367/ntqr.8.2021.130-137
10. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. Doi: http://doi.org/10.1080/1364557032000119616
11. Joanna Briggs Institute. JBI manual for evidence synthesis. Adelaide: JBI; 2020. Doi: http://doi.org/10.46658/JBIMES-20-01
12. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. Australia: JBI; 2020. chap. 11. Doi: http://doi.org/10.46658/JBIMES-20-12
13. Dos Santos GG, Nascimento MVF, Ribeiro EES, Rocha GST, de Farias AS, de Oliveira C, et al. Saúde de mulheres em zonas fronteiriças: um protocolo de revisão de escopo. OSF; 3 May 2025. Doi: https://doi.org/10.17605/OSF.IO/ZJ4XP
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15. Amaral-Rosa MP. Considerations on the use of IRAMUTEQ software for qualitative data analysis. Rev esc enferm USP [Internet]. 2019;53:e03468. Doi: https://doi.org/10.1590/S1980-220X2019ce0103468
16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRIS-MA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71). Doi: https://doi.org/10.1136/bmj.n71
17. Phillips B, Ball C, Sackett D. Oxford Centre for Evidence-Based Medicine – Levels of Evidence (March 2009). Oxford: Centre for Evidence-Based Medicine; 2009.
Funding and Acknowledgments:
Nothing to declare
Authorship Criteria (Authors' Contributions):
1. Substantially contributed to the conception and/or planning of the study: dos Santos GG, de Farias AS, Rocha GST, de Oliveira C;
2. contributed to the acquisition, analysis, and/or interpretation of the data: dos Santos GG, Nascimento MVF, Ribeiro EES, do Nascimento ES, Pirozi LRR, Coelho HER, Viana ILRS, do Nascimento JM;
3. contributed to the drafting and/or critical review and final approval of the published version: dos Santos GG, de Farias AS, Rocha GST, de Oliveira C, Nascimento MVF, Ribeiro EES, do Nascimento ES, Pirozi LRR, Coelho HER, Viana ILRS, Beserra Junior CR
Declaration of Conflict of Interest:
Nothing to declare
Scientific Editor: Ítalo Arão Pereira Ribeiro. Orcid: https://orcid.org/0000-0003-0778-1447
Rev Enferm Atual In Derme 2025;99(4): e025138
Atribuição CCBY