Migration, Motherhood, and Maternal Health: Brazilian Women’s Encounters with the Portuguese Healthcare System

Abstract

This article examines the maternal healthcare experiences of ten Brazilian women during Portugal’s obstetric crisis, focusing on access, use, and quality of care throughout the perinatal and childbirth periods. Using a qualitative approach based on semi-structured interviews, this study explores women’s perceptions of the adequacy and quality of maternal healthcare, contributing to a deeper understanding of their experiences within the Portuguese health system. Thematic analysis revealed persistent barriers to accessing services, linked to limited knowledge of the healthcare system, lack of awareness of legal rights, discrimination, and other structural obstacles. Participants expressed dissatisfaction with the clarity and quality of information provided by healthcare professionals, their communication skills, and the limited access to specialized care. They also described feeling undervalued by healthcare providers and reported an absence of emotional and psychosocial support during pregnancy, childbirth, and the postpartum period. Accounts of disrespectful and abusive practices highlight the vulnerability of migrant women. This study underscores the urgent need to recognize and address migrant women’s needs. Beyond access, policies should promote equity, cultural responsiveness, and intercultural dialogue to ensure respectful, person-centered maternal care.

1. Introduction

Migration presents various challenges and benefits for destination countries, particularly in terms of sociocultural transformations and the promotion of diversity. It often introduces ethnic, cultural, racial, religious, and linguistic identities that contrast with the dominant or hegemonic identities of host societies (de Haas 2023). This diversity calls for adaptation and mutual accommodation, fostering coexistence grounded in respect for emerging identities. However, social tensions may arise when these differences are not adequately recognized or managed. In this context, promoting integration and building social cohesion depends on the implementation of universal values such as equal treatment and non-discrimination (Redin et al. 2020).

Historically characterized as a country of migration, in recent decades, Portugal has become an attractive destination for thousands of immigrants. In 2023, the non-national resident population increased by 33.6% compared to the previous year, with women representing 47% of this contingent (AIMA 2025). This phenomenon highlights the pivotal role of women in migration, popularizing the term feminization of migration, which underscores the importance of gender issues—often overlooked in analyses of international migration (Teodorescu 2024).

Additionally, to gain a more comprehensive understanding of this phenomenon, it is important to consider the main migration routes available to Brazilian citizens moving to Portugal. Even in the face of recent migration policies that have made entry and residence more difficult, these routes continue to include diverse legal pathways, such as residence permits for work, study, or family reunification, as well as specific frameworks like the Statute of Equality of Rights and Duties between Brazil and Portugal, which has historically facilitated administrative and labor integration (Carvalho 2025). Although newer instruments, such as the job-seeking visa, have expanded mobility opportunities, access to them has become more restrictive within the current political and administrative context. The choice among these routes directly shapes migratory experiences and access to social rights, including maternal healthcare, influencing the conditions of integration and how Brazilian women and their Portugal-born children are positioned within the social protection system. This migratory framework, therefore, helps contextualize the dynamics analyzed in the present study.

Immigrant women play a pivotal role not only in strengthening the workforce but also in contributing to demographic renewal. In 2022, Portugal recorded a 4.9% increase in births compared to the previous year, driven largely by births to non-national mothers. That year, live births from non-national mothers accounted for 16.7% of all births, a significant impact given that the non-national population represents just 7.5% of the total number of residents in Portugal, with foreign women comprising only 6.8% of the total female population. These figures underscore the importance of non-national mothers for Portugal’s demographics (Oliveira 2023). In 2023, over one-fifth of babies born in Portugal were to non-national mothers. According to newly released data from the National Statistics Institute (INE 2024), 18,734 of the 85,699 children born in Portugal last year (29.2%) were born to non-national women residing in the country. Notably, between 2015 and 2023, the proportion of live births to mothers of non-national origin rose by 12.8 percentage points, with the most significant annual increase occurring between 2022 and 2023, at 4.7 percentage points (INE 2024).

In this context, the health of pregnant Brazilian immigrant women warrants particular attention, given their dual role as part of the active workforce and as mothers contributing to the formation of future generations. Studies show that these women often belong to socially vulnerable groups, facing gender inequalities and violence exacerbated by social isolation in culturally distinct environments, as well as vulnerabilities inherent to the migration process (Neves et al. 2015; Rusu et al. 2024). This overlapping of vulnerabilities particularly affects Brazilian immigrant women, who contend with issues such as loneliness, cultural adaptation, and unequal access to healthcare services (Annoni 2020).

The migration process is a significant source of stress, trauma, and mental health challenges, especially for pregnant women and new mothers. Women and children are among the most vulnerable populations, frequently experiencing hardships such as fear, social isolation, and loneliness during their migration journey (Andrade et al. 2023). These difficulties are further exacerbated for women from cultures where maternal and childcare responsibilities are traditionally supported by family and community networks—resources that are often absent in destination settings (Ramos 2010).

Health concerns among immigrant populations have become a growing priority within the European Union (EU), particularly in Portugal. On 10 March 2022, the European Parliament adopted Resolution 2021/2003(INI), which underscores the importance of guaranteeing women’s access to sexual and reproductive health rights. This resolution reaffirms the EU’s commitment to championing these rights globally while combating violence, discrimination, and abuse. Such initiatives are vital for addressing the specific needs of migrant populations, promoting equitable access to healthcare, and fostering inclusive social integration, ultimately enhancing well-being and advancing equity.

1.1. Motherhood in Portugal: Challenges Faced by Brazilian Immigrants

The Brazilian community is currently the largest non-national community residing in Portugal. In 2023, Brazilians accounted for 35.3% of all foreign residents with residence permits, the highest percentage recorded since 2012 (AIMA 2025). Brazilian women make up most of this community, reinforcing the phenomenon known as the feminization of migration (Castles and Miller 1998; Oliveira 2023). Several factors contribute to this migratory dynamic, including the historical and cultural ties between Brazil and Portugal, the shared language, a less bureaucratic process of entering the European space, safety, quality of education, and the public health system. Additionally, emotional ties with individuals born or residing in Portugal play a crucial role in facilitating integration and adaptation to the new country (Pinho 2007; Ramos 2015).

For many of these women, the migratory process reflects their desire to build a “better life” in either the host or origin country (Fontes and Pacheco 2022). Female migration is often associated with family reunification, the pursuit of financial and emotional autonomy, or the attempt to escape adverse conditions in their home countries (Topa et al. 2016). Furthermore, non-national women in Portugal are, on average, younger than Portuguese women, contributing not only to demographic rejuvenation but also to the increase in births within the country (Oliveira 2023). In this context, motherhood, as a culturally and socially situated experience, plays a central role in these women’s trajectories, intertwining with their expectations and support networks.

However, motherhood is not a uniform experience; it is deeply influenced by racial, ethnic, social, and gender factors. It is a constantly evolving phenomenon shaped by demographic pressures, feminist debates, and reflections on women’s desires (Scavone 2001). There is no universal approach to motherhood, but rather a variability of feelings, ambitions, and frustrations that reflect different sociocultural contexts (Badinter 1985). For Brazilian immigrant women, experiencing motherhood in a different country presents additional challenges (Giraud and Moro 2004).

Research indicates that giving birth in a migratory context intensifies feelings of isolation and loneliness, reflecting the influence of individualism, a defining value of contemporary society (Lim et al. 2022). Immigrant mothers, whose pregnancies are often deeply rooted in collective processes supported by family and community networks, experience significant disruptions in this shared journey when they migrate. The absence of extended family, cultural traditions, and social backing shifts the family structure towards a nuclear model, leaving mothers to navigate responsibilities previously shared within the extended family (Ramos 2015).

Recent studies, such as Lim et al. (2022), expand on these challenges by identifying specific factors that contribute to the struggles of immigrant mothers. These include family separation, language barriers, past trauma, precarious immigration status, and unfamiliarity with the host country’s cultural norms. The lack of cultural support networks, essential for providing meaning, structure, and emotional guidance during pregnancy and postpartum, further deepens feelings of loneliness and disconnection (Giraud and Moro 2004; Moro 2017).

For many immigrant women, giving birth far from their cultural origins complicates the construction of their maternal role, as they must navigate conflicting expectations and the loss of traditional support systems (Ramos 2010). This lack of support can hinder emotional processing and exacerbate sadness and grief associated with the maternal transition. These findings highlight the urgent need for interventions that foster social connectedness and a sense of belonging. Without such measures, the struggles of immigrant mothers are likely to remain exacerbated by societal structures that emphasize individualism over collective support, failing to address the unique needs of this vulnerable group (Lim et al. 2022; Ramos 2015).

Motherhood is inherently a complex period in the life cycle, where social support plays a vital role in maternal health and well-being. Support networks significantly aid in coping with difficulties during pregnancy, childbirth, postpartum, and the puerperium, benefiting both mother and child (Rapoport and Piccinini 2006). However, many Brazilian immigrant women in Portugal face adverse realities, influenced by gender and socioeconomic inequalities, stereotypes, and migration policies that shape their experiences (Kofman and Raghuram 2015).

These inequalities disproportionately affect women, who often occupy specific roles in the global economy and domestic work, whether paid or unpaid. The immigration process can both challenge and reinforce gender norms, exposing these women to additional discrimination and challenges. For Brazilian women, their experience in Portugal is frequently marked by prejudice and discrimination based on gender, race, ethnicity, and religion, making them targets of social exclusion, public manifestations of racism, and xenophobia (Neves et al. 2016; Padilla et al. 2014).

Racism, deeply embedded in European history and policies, remains a pervasive structural force that significantly impacts the lives of immigrant women. Restrictive immigration policies and unequal treatment further deepen these inequalities (Kilomba 2019). Neves et al. (2016) highlight that Brazilian women in Portugal experience a double form of oppression, as they face both gender discrimination and structural racism, significantly obstructing their integration. This intersectional marginalization limits their access to essential opportunities, particularly in employment, housing, and social participation (Marques and Góis 2012).

While immigration is often driven by the pursuit of a better life and increased safety, it frequently brings new challenges and uncertainties, especially for women who leave behind their support networks. Adapting to a new cultural and social environment can be deeply isolating and require emotional resilience (Padilla et al. 2014). For this reason, it is crucial to recognize the intersection of vulnerabilities that characterize these women’s migratory experiences and to promote public policies that ensure their inclusion and well-being in host contexts.

1.2. Maternal Healthcare, Migration, and Obstetric Violence in Portugal

Maternal healthcare in Portugal is shaped by demographic change, migration dynamics, and persistent structural inequalities. Portugal, as other European countries, faces declining fertility rates, an ageing population, and shrinking cohorts of women of reproductive age (Machado et al. 2006). At the same time, increased life expectancy, driven by advances in medicine and improved living conditions, has resulted in an ageing population structure across Europe. In this context, the contribution of Brazilian immigrant women is particularly significant in tackling demographic ageing. Despite playing a crucial role in Portugal’s demographic growth, this population faces significant challenges in the host country, especially in terms of health and well-being. Cultural barriers, xenophobia, discrimination, precarious working and living conditions, and institutional obstacles restrict their access to high-quality maternal healthcare (WHO 2022). When not addressed through coordinated intersectoral policies, these barriers increase vulnerability and deepen health inequalities.

Access to care in Portugal reflects broader socioeconomic constraints. Following the 2011 financial crisis and the austerity program imposed by the Troika, the National Health Service (NHS) experienced cuts that continue to affect service capacity (Padilla 2013). Although the number of health professionals increased between 2015 and 2021, shortages persist as many migrate to the private sector or abroad (Álvares 2022). These deficits are particularly visible in maternal healthcare, where the lack of obstetric specialists has led to repeated closures of emergency obstetric units, forcing pregnant women to travel long distances and limiting their ability to plan their childbirth experience (Correia 2023; Lusa 2024b).

Recent political developments have further complicated access for migrant populations. In December 2024, right-wing extremist parties approved Bill No. 364/XVI/1ª, restricting access to NHS services for non-resident foreign citizens under the justification of combating so-called “health tourism”. Data from the General Inspectorate of Health Activities (IGAS 2024) show that over 140,000 non-resident foreigners received emergency care between 2021 and 2024 without insurance or international agreements. Yet, these cases do not stem from the Basic Health Law (Law 95/2019) or the NHS Statute (Decree-Law 52/2022), both of which safeguard healthcare access for non-nationals. Instead, they reflect the severe dysfunction of Agência para a Integração, Migrações e Asilo (AIMA), which, by late 2024, had over 400,000 pending cases, leaving migrant families without access to essential services such as health and education (Rattner 2024).

These systemic failures directly impact pregnant migrant women, who face discrimination, delayed antenatal care, and accusations of “birth tourism”. The precariousness of the system, which is free for pregnant women, regardless of migration status, has been aggravated by successive closures of obstetric units and the implementation of NHS 24 triage lines for pregnant women—measures that compromise clinical safety and violate legal guarantees of free movement and access within the NHS (Order No. 7495/2006; CRP Art. 64).

Maternal and infant health indicators further highlight these concerns. After a pandemic-related decline, infant mortality has risen since 2022, reaching its highest level between 2019 and 2024 (Lusa 2024a). Contributing factors include unequal access to care, poorly supervised pregnancies, and the arrival of women already pregnant and unable to navigate bureaucratic barriers. In 2023, a fifth of all births in Portugal were to non-national women, underscoring the urgent need for targeted policies to guarantee equitable maternal healthcare (Direção-Geral da Saúde 2015; Alarcão et al. 2022; Rusu et al. 2024).

Informal social networks have taken on a central role in supporting migrant mothers. Research shows that emotional and familial support from friends and relatives can be more significant for Brazilian immigrant women’s maternal role consolidation than formal healthcare services (Almeida and Caldas 2013; Topa 2016). These findings demonstrate the importance of culturally sensitive, inclusive, and community-centred approaches to maternal care (Topa 2016). On 19 December 2024, Parliament approved a measure revoking the entitlement of irregular foreign citizens and non-residents to free healthcare under the NHS. Despite opposition from left-wing parties and the Liberal Initiative (IL), the proposal was passed with the support of right-wing parties (Begonha 2024). Although the NHS provides access to healthcare, including emergency services, specialist consultations, and maternal care, the lack of an NHS user number may require these women to pay in full for services (Alarcão and Pintassilgo 2025). These pose added risks for pregnant irregular migrants, potentially worsening health outcomes and pregnancy monitoring. Given this reality, which impacts all women in Portugal, a structural transformation of the NHS is essential. Beyond salary increases, measures should include better recognition of professionals’ work and improved working conditions. Additionally, intersectoral policies must be strengthened to reduce access barriers, ensure the inclusion of vulnerable populations, and promote equality, particularly in maternal healthcare.

Within this complex landscape, obstetric violence (OV) emerges as a critical structural issue. OV is a form of gender-based violence manifested through practices that undermine women’s autonomy, dignity, and bodily integrity during pregnancy, childbirth, and the postpartum period (Sesia 2020). In Portugal, high rates of unnecessary obstetric interventions reveal persistent violations of women’s reproductive rights, particularly affecting Brazilian and racialized women (Barata 2022a, 2022b; Rusu et al. 2024, 2025).

Common forms of OV include verbal and physical abuse, non-consensual procedures, unnecessary medical interventions, humiliation, and neglect (APDMGP 2020; Mendes et al. 2022). A landmark study by Teixeira et al. (2013) showed that Brazilian women experienced higher rates of interventions and caesarean sections in northern Portuguese hospitals compared to other groups, suggesting structural biases within the system. Despite WHO recommendations discouraging routine practices such as episiotomies and the Kristeller manoeuvre (WHO 2018), Portugal maintains one of the highest intervention rates in Europe: 73% of vaginal births involve episiotomy—far above countries such as Denmark (3.7%) (Oliveira and Gomes 2018). Portugal also ranks third in Europe for OV (Lazzerini et al. 2022).

Recent evidence from Rusu et al. (2024) found that racialized Brazilian women in Portugal often face problematic maternal healthcare, marked by OV in various forms, including physical, verbal, institutional, moral, sexual, and psychological abuse within the NHS. Among the experiences reported were: (1) verbal and physical abuse: disrespectful comments, shouting, and procedures performed without consent; (2) excessive medical interventions: unnecessary procedures and a lack of information about the care provided; (3) emotional and psychological impacts: feelings of disrespect, fear, anguish, frustration, and loneliness during and after childbirth; (4) long-term consequences: problems in sexual and mental health, difficulties in bonding with newborns, and strain in intimate relationships. These dynamics reveal how maternal healthcare in Portugal continues to reproduce structural, racial, and migratory inequalities, underscoring the urgent need for comprehensive, rights-based, and culturally informed reforms. OV reflects not only individual practices but also structural problems within the healthcare system and professional training. Despite advances in the scientific literature and recommendations for humanized childbirth, such as those from the WHO, there remains a gap between theory and practice in Portugal. This scenario underscores the need for: (1) professional training: continuous education for healthcare professionals to foster respectful, evidence-based practices; (2) monitoring obstetric practices: implementation of systems to control and evaluate the quality of obstetric care; (3) education and information for women: ensuring that pregnant women are aware of their rights and best practices in childbirth; (4) policy reform: promoting a culture of humanization in healthcare services, prioritizing women’s well-being and dignity. These steps are crucial to ensuring a more equitable and respectful healthcare system that values women’s sexual and reproductive rights and promotes positive, safe childbirth experiences

1.3. Present Study

Considering this context, the present study raises the following research questions: What are the migration trajectories of Brazilian women residing in Portugal? How do these factors influence their maternal health experiences, including pregnancy, childbirth, and the postpartum period? What are the personal/social impacts and potential experiences of violence and discrimination?

Accordingly, this study aims to understand the maternal health trajectories of Brazilian women living in Portugal. Specifically, it seeks to explore their migration process in terms of adaptation and integration; characterize their experiences within healthcare services; understand their experiences during pregnancy, childbirth, and the postpartum period in the national healthcare service; identify the impacts felt on personal, family, professional, and social levels; and describe potential experiences of violence and discrimination during antenatal care, childbirth, and postpartum.

2. Materials and Methods

This exploratory and descriptive study used a qualitative approach, chosen for its focus on the individual and on understanding the meanings and experiences of the participants (Yin 2016). The qualitative methodological approach plays a crucial role in advancing this case study research. This study seeks to deeply examine a particular unit to uncover insights that would be difficult to achieve using alternative methods (Yin 2016). The research sought to explore the migratory trajectories, maternal health experiences and challenges faced by Brazilian women living in Portugal who became mothers after 2020.

The following inclusion criteria were defined: (a) age 18 or over; (b) residence in Portugal; (c) Brazilian nationality; (d) motherhood after 2020 in the country; (e) availability to participate in the study.

Ten Brazilian immigrant women took part, aged between 32 and 42 (M = 37.4; SD = 3.46), living in different regions of Portugal. The participants had different levels of education: 6 had a university degree, 3 had postgraduate qualifications, and 1 had secondary education. Regarding marital status, 8 were married and 2 were single. Concerning occupation, 5 were at home looking after their children, 2 were unemployed, 2 were employed, and 1 was a worker/student. All of them were legally resident in the country, with an average of 4.2 years of residence in Portugal (cf.

Table 1. Sociodemographic characteristics of participants.

Participants	Age	Marital Status	Academic Qualifications	Employment Situation	Region of the Country	Number of Kids	Time Living in Portugal (Years)
P1	33	married	graduated	unemployed	South	2	4
P2	35	married	pos-graduated	employed	North	2	2
P3	32	single	graduated	unemployed	South	1	5
P4	41	married	graduated	unemployed	South	2	6
P5	36	married	graduated	employed	Centre	1	5
P6	41	married	high school	employed	Centre	2	5
P7	38	married	graduated	employed	Centre	2	3
P8	36	married	graduated	unemployed	South	2	2
P9	42	single	pos-graduated	unemployed	Centre	1	4
P10	39	married	pos-graduated	unemployed	West	2	4

).

A literature review was carried out to support the study, and the project was submitted to and approved by the Ethics Council of the University of Maia. The study was publicized via social networks and groups of Brazilian immigrants. In addition, the snowball sampling technique, considered to be the most effective, was used, with initial participants referring to other women who met the inclusion criteria.

All the participants were given detailed information about the objectives and purpose of the study, as well as guarantees of confidentiality, anonymity, and the freedom to withdraw at any time. Informed consent was obtained before the interviews to ensure compliance with ethical and deontological standards. As the interview process had the potential to prompt disclosures from participants, crisis intervention and referral to specialized services were ensured. The interviews were conducted by a psychologist with specific training in health and clinical issues to provide appropriate support.

Data was collected between January and April 2023 using semi-structured interviews conducted remotely, lasting an average of 45 min. The interviews were recorded with the participants’ authorization and later transcribed for analysis. The interview script included 27 questions divided into four main topics: (1) Socio-demographic data; (2) Migration process (Could you describe your immigration story?; What were the biggest challenges you faced when you arrived in Portugal? And what facilitators did you find?); (3) Maternal health experiences (How was it to get pregnant abroad?; During childbirth, did you feel treated with respect and dignity?; Was it a humanized birth?; Did you experience any discriminatory situations or obstetric violence in healthcare services?); (4) Recommendations (Please indicate what individual, social, institutional, and/or governmental measures you believe should be implemented to help resolve these difficulties?).

After transcribing the interviews in full, the thematic analysis proposed by Braun and Clarke (2006) was used to identify patterns and thematic categories in the data. This process was made, in an initial phase, by each member of the research team, individually, and then the categorization was compared to refining themes. A final consensus was obtained, resulting in a Thematic Analysis map.

The process was conducted collaboratively by the two lead researchers and followed Braun and Clarke’s six phases: familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. During the first phase, transcripts were read and reread, with preliminary notes made to immerse in participants’ narratives. Initial codes captured both semantic content and conceptual features and were organized in a central analytic matrix to identify patterns and contrasts. Related codes were then collated into potential themes and subthemes, which were iteratively reviewed to ensure coherence and accurate representation of the dataset, resulting in a thematic map. Themes were further refined through analytic interrogation, clarifying boundaries, internal coherence, and relevance to the overall narrative. The final report integrated themes into a coherent narrative with illustrative extracts, situating findings within broader theoretical frameworks. Theme development was guided by intersubjective consensus and a hybrid deductive–inductive approach: deductive coding was informed by frameworks such as intersectionality and obstetric racism, while inductive coding allowed emergent patterns to surface, producing a nuanced and contextually grounded understanding of Brazilian migrant women’s reproductive experiences in Portugal.

This flexible method allowed recurring meanings to be grouped, providing an in-depth understanding of the participants’ experiences. Thematic analysis (TA) is widely recognized for its effectiveness in qualitative studies and is adaptable to the complexity of the social and psychological phenomena studied (Braun and Clarke 2020). This process made it possible to construct a comprehensive narrative about the experiences of Brazilian women in the context of migration and maternal health in Portugal.

3. Results and Discussion

Resulting from Braun and Clarke’s (2006) TA technique, the results presented in this study stem from the Thematic Analysis map (see Figure 1) through the analysis and interpretation of the interviews conducted. Excerpts from the narratives illustrate the perceptions of the interviewed Brazilian immigrant women regarding their experiences with maternal care in Portugal. The subheadings used correspond to the themes that emerged from the thematic analysis, as they reflect the most recurrent and significant patterns identified across the participants’ accounts.

3.1. Migration and Maternal Care Assistance

When addressing the cycle of pregnancy, childbirth, and the postpartum period in a foreign context, it is essential to recognize the profound influence of the migratory journey on this process. This journey encompasses not only the physical and geographical movement across borders but also the navigation of diverse cultural and sociocultural landscapes. Therefore, migration is intrinsically linked to the development of maternal care assistance. By interacting with diverse realities and global contexts, the migratory process reflects the complex and interconnected relationships that shape the modern world. This section explores the motives and reasons why participants decided to migrate to Portugal. Furthermore, it highlights their experiences, the challenges and facilitators they encountered, as well as episodes of violence and/or discrimination they faced.

3.1.1. Crossing Borders: New Perspectives, Reception, Adaptation and Barriers

One of the main reasons people leave their home countries is the pursuit of better living conditions, particularly when it comes to providing for their children. Depending on the country of origin, safety emerges as a central concern. In this study, seven out of ten participants identified safety and the pursuit of a better quality of life for themselves and/or their children as key reasons for migrating.

“It was really about changing our lifestyle, providing experiences for my daughter, for the baby who was about to be born, a safer life, because the area where we lived in Brazil was really unsafe.”

(P1)

“(…) we came seeking new opportunities and a better future for our children (…)”

(P8)

Regarding children, immigrants often face the absence of support networks due to being far from family and friends. In this study, however, some positive aspects emerged, as three participants mentioned migrating to improve their living conditions with the support of pre-existing social networks in Portugal, which facilitated their integration and decision-making processes.

“(…) a friend of mine in Ireland, who was here (…) guided me, gave me some tips. I did a lot of research, and I also had a friend who wanted to come here too. She lived near me but not in the same place, and we came together.”

(P1)

“My aunt said, ‘Come here,’ because in Brazil, even though we had qualifications… it was really hard to find work (…) I came alone, but I have family here.”

(P3)

In addition to the additional challenges faced by Brazilian immigrant women in motherhood in a foreign country (Giraud and Moro 2004), these findings underscore the importance of a support network during a phase when women are particularly sensitive and vulnerable. In a migration context, these issues often intensify, impacting the physical, psychological, and social well-being of migrant mothers. The welcoming process is crucial to ensure that they do not feel isolated and unsupported—one of the most common sentiments in the feminization of migration (Fontes and Pacheco 2022; Padilla 2008).

Moreover, these women migrate to seek new opportunities, specifically better living conditions for themselves and their families, with an emphasis on safety (Pinho 2007; Ramos 2015). These motivations align with existing literature, which suggests that women increasingly take an active role in seeking better living conditions, moving beyond merely accompanying partners or participating in family reunification. This trend reflects greater autonomy and female empowerment (Pinho 2007; Topa 2016).

When it comes to challenges, the main obstacles reported by all participants were linguistic and communication barriers.

“(…) our accent was hard to understand, and it was difficult for us to understand them, even though it was the same language. The first month, maybe the second, was a bit tough. The culture itself is very different (…)”

(P2)

“The biggest challenge, which was actually a big surprise, was thinking that because we speak Portuguese, everything would be fine. So, I think the biggest difficulty was the language. You have a very fast linguistic pace. When I first went out in Porto, it felt like everyone was speaking English (…)”

(P6)

For these women, the Portuguese language can become a significant barrier, hampering their ability to express themselves adequately and be understood in the new country, as well as to understand various procedures (Morais et al. 2021; Padilla 2013). Furthermore, nine out of ten participants reported difficulties related to their administrative status in Portugal. Not being in a regularized situation creates stress across all areas of life, including housing, work, and healthcare.

“The issue of legalisation (…) the time it takes, from filing the declaration of interest to actually obtaining a residence permit, is very lengthy. I waited from September 2018 to February 2020 without a residence permit.”

(P1)

“The main difficulty, I think, was the documentation. It takes a long time; we spend years waiting for a document. (…) we are often exploited.”

(P3)

These challenges, which seem to intensify in the realm of maternal health, arise due to constraints stemming from a lack of information and/or communication and linguistic barriers. Consequently, the social vulnerability to which they are subjected, coupled with professional instability, difficulties in legalization, and exclusion, makes these women targets of discrimination and victimization (Redin et al. 2020; Topa 2016).

3.1.2. Reality of Maternal Healthcare Assistance Provided in Portugal to Brazilian Immigrant Women: Challenges, Discrimination, and Violence

Maternal health raises questions about the care a mother provides to the developing fetus during pregnancy. Maternal health plays a crucial role in ensuring the healthy development of the baby. This association highlights the importance of care, protection, and a favorable environment for the healthy growth and well-being of both the mother and the baby.

Participants reported their experiences in health services: from the barriers encountered in accessing healthcare, to the main difficulties during pregnancy and postpartum, instances of obstetric violence, discrimination, and devaluation by healthcare professionals.

During gestational follow-ups, participants reported opting for health centers in their residential areas and/or the reference hospital as their main choice for health services. However, three out of ten participants highlighted difficulties in initially accessing these services for pregnancy monitoring due to a lack of information, communication barriers, and insensitivity from administrative staff.

“I had to insist in many ways to get my first obstetrics appointment. (…) I went to the parish council president to see if he could do something because I had already sent numerous emails to the health centre, I had gone there several times and still couldn’t get my first obstetrics appointment”

(P2)

“I arrived here at 22 weeks and only got my first appointment at 33 weeks. (…) I had cancer when I was 20, and they said they couldn’t prioritise me, even though I was pregnant. I only had one appointment.”

(P8)

“When I discovered I was pregnant, I didn’t have a residence permit yet (…) they referred me to the health centre here in the city, but they didn’t see me”

(P9)

They were told that the service was full and that being pregnant did not mean anything. They were also not referred to another health center or hospital. Although all the interviewees received follow-up care through the NHS during pregnancy, this monitoring began late due to a lack of response from the services.

This kind of constraint constitutes a form of obstetric and/or institutional violence, classified by Bowser and Hill (2010) as “neglect and refusal of care.” According to the World Health Organization (WHO), such practices amount to a violation of women’s fundamental human rights. As per WHO (2018), “all women have the right to the highest attainable standard of health, including the right to dignified and respectful care throughout pregnancy and childbirth, as well as the right to be free from violence and discrimination.”.

These findings align with evidence from numerous studies (Rusu et al. 2024; Padilla 2013) pointing to the inequalities and inequities faced by Brazilian immigrant women in accessing healthcare contexts. Although the right to access health centers and NHS is guaranteed to all migrants, regardless of legal status, nationality, or economic level, as established by the Ministry of Health’s Dispatch No. 25 360/2001, the testimonies reveal that this access is not always straightforward.

These barriers create situations of heightened anxiety for pregnant women, potentially resulting in less frequent and delayed prenatal consultations for this population (Machado et al. 2006), posing risks to the health of women and/or their children.

At the psychological support level, even when participants shared their need for psychological assistance during and/or after pregnancy with doctors, some reported feeling dismissed and unsupported.

“During pregnancy, I didn’t have any psychological issues, but in the postpartum period, I did. (…) I told the family doctor at the time because I really felt I wasn’t okay (…) I wouldn’t leave the house, I didn’t want to go out at all. (…) My baby didn’t sleep well, and I wasn’t sleeping well either, and that started leading me to a depressive process (…) I was extremely pessimistic, and I told this to the family doctor. She prescribed me antidepressants, which I took, but nothing else, no psychological support, which I thought I needed. (…)”

(P2)

“I sought help because I had depression during pregnancy. It was a process where I was newly arrived in the country, newly in a relationship, and I never thought I could get pregnant. At the time, I only managed one consultation with a psychiatrist, who prescribed me medication.”

(P9)

As this period is characterized by heightened emotional vulnerability (Coutinho et al. 2014), the difficulty in accessing psychological support, coupled with an overly bureaucratic healthcare system and limited access to necessary care (Morais et al. 2021; Rusu et al. 2024), generates increased distress, isolation, and anxiety.

Women experiencing such violence are often in vulnerable situations, which exacerbates the severity of their experiences (Topa 2016). This is a clear violation of human, sexual, and reproductive rights, compromising the body, dignity, and autonomy of women during critical moments of their reproductive lives (Alarcão et al. 2022).

Regarding the discrimination experienced by participants, the testimonies reveal that seven out of ten women reported experiencing at least one episode of racism and/or xenophobia during maternal care within the SNS.

“You Brazilians are all crazy; you like to exaggerate the pain. We ask you to rate it from 0 to 10, and you already want to say it’s 100.”

(P4)

“It’s very heavy; we suffer for being women, for being Black, and for being Brazilian. Oh, she’s Brazilian, she’s a prostitute.”

(P5)

“(…) at the health centre, they told my daughter to go back to Brazil, ‘Oh, go back to Brazil.’”

(P10)

These accounts highlight the discrimination and stereotypes present in the NHS during maternal care for Brazilian immigrant women (Barata 2022a, 2022b; Rusu et al. 2024). The violent acts of racism and xenophobia these women face must be examined through the lens of gender, nationality, and race, revealing those inequalities among groups—whether related to gender, nationality, or race—cannot be explained by a single isolated factor, thus underscoring the importance of intersectionality (Rusu et al. 2024). For Kilomba (2019), the difference relies on the view that there is “Us” and the “Other,” and that this relationship is hierarchical, revealing asymmetries.

In addition to explicit forms of violence, there is a subtler yet equally harmful dimension: the widespread stigma associating Brazilian women with specific stereotypes (Morais et al. 2021; Padilla et al. 2014). Even when they manage to access health services, they often face stereotypes and are treated unequally, a situation exacerbated by their often vulnerable and fragile circumstances (Marques and Góis 2012). This stereotyped image directly affects these women’s daily lives in various social contexts, including healthcare, where its impacts also manifest (Topa et al. 2016).

Alongside this, episodes of obstetric violence are also present, with seven out of ten participants reporting that the experience of childbirth brought the worst memories, revealing forms of violence by the medical/nursing teams.

“I think at the beginning, a doctor who attended to me to insert that catheter was not very humane. She just came in, and we are super sensitive there, and some people have a rough touch. I was screaming in pain, and even so, she didn’t stop.”

(P3)

“I felt that I wasn’t being heard.”

(P6)

“I had pain during sexual intercourse for almost a year and a half because of the stitches they made internally.”

(P8)

The OV mentioned by participants highlights the physical, psychological, and sexual violence these women suffered, reinforcing studies that reveal this routine practice in Portugal with this population, where bodies are subjected to unnecessary, painful, and traumatic interventions, causing harm (Barata 2022a; Rusu et al. 2024).

This form of violence also aligns with acts that characterize it as institutional violence (Mendes et al. 2022; Rusu et al. 2024). Furthermore, the insensitivity felt by healthcare professionals (Topa et al. 2013) reveals behaviors and practices that negatively affect immigrant women’s experiences in health services.

One of the major challenges associated with migratory phenomena is ensuring the universal and equitable provision of healthcare, guaranteeing accessibility and quality services regardless of gender, race, ethnicity, or country of origin—reinforcing health as a universal right (Oliveira 2023). Health and guaranteed access to healthcare are recognized as fundamental pillars for the social inclusion of immigrants, constituting one of the main pathways to participatory citizenship and civil rights (Padilla et al. 2014). In this context, the idea of accessible, public, and free healthcare strengthens the expectation of quality in maternal care assistance.

3.1.3. The Absence of Support Networks and Significant Challenges for This Population

These women face a range of significant challenges, with the lack of an adequate support network being particularly pronounced. This absence is regarded as a fundamental pillar in their lives, with three participants reporting increased feelings of insecurity, vulnerability, and fear as a result.

“It’s a more solitary experience. Everyone lives their own lives; you can’t expect people to say, ‘Oh, I’ll look after your child to help you out.’ No, here it’s just you, your child, and your partner. And if your partner works, then it’s just you and your child.”

(P3)

“What I really missed was the support of my mother and grandmother and how they cared for me and helped with the birth of my first child”

(P10)

For migrant mothers, who traditionally receive support from women in their family and community during pregnancy, migration disrupts this process of sharing and creating meaning (Moro 2017; Ramos 2015). This lack of support can significantly impact the motherhood experience (Moro 2017; Rapoport and Piccinini 2006). Participants’ accounts also highlight negative experiences related to precarious working conditions during pregnancy.

“I faced some difficulties because sometimes I had to lift an elderly person weighing nearly 100 kg. There was no one to say, ‘Look, don’t lift that.’ I had to do it. They treated me as if I wasn’t pregnant (…)”

(P3)

“(…) as soon as they found out I was pregnant, they fired me. I thought it was awful. I don’t think this sort of thing happens in Brazil. They claimed it was a temporary contract, so they could terminate it. But I didn’t even bother to complain because the pregnancy had already been so difficult”

(P7)

These accounts confirm the prevalence of precarious labor conditions, often characterized by inadequate work environments, exploitation, and a lack of legal and social protection (Kofman and Raghuram 2015; Ramos 2015), exposing these women to greater occupational risks and stress (Topa et al. 2013).

In such cases, effective reception practices must be based on best practices, offering standards that foster successful care and encouraging reflection on the physical, psychological, and social aspects affecting these women’s lives (Topa 2016). The data from this study reveal feelings of loneliness and lack of support, highlighting the vulnerability inherent in being an immigrant, compounded by the absence of support networks, family, and labor structures geared towards the migrant population. An appropriate reception process is thus essential to mitigate these feelings, particularly loneliness, which emerges as one of the most significant emotions in the feminization of migration (Fontes and Pacheco 2022; Padilla 2008).

3.1.4. Strategies for Improving the Quality of Maternal Care

It is important to emphasize the provision of guidance and directions to help individuals deal with an uncertain future, enabling them to be more prepared and empowered to face the challenges that may arise. In this context, creating changes such as new laws and comprehensive policies regarding migrant maternal health becomes crucial. Measures at the individual, institutional, and governmental levels must be adopted to ensure the well-being of immigrant women during pregnancy, childbirth, and the postpartum period.

Individual Measures

Individual measures refer to actions that each person can take in their daily lives to contribute to a more just and inclusive society. Almost all participants in this study suggested education on pregnancy, childbirth, and the postpartum period as a primary measure.

“Do your own research on everything, (…) like what a humanized birth would be, the stages of pregnancy, then the postpartum, (…) and have those questions ready to ask health teams. I think that’s a good recommendation. (…) also research hospitals and find out which one you want to give birth at.”

(P2)

“Seek information about the rights you have. Look for hospitals that respect your wishes, there are good hospitals in Portugal, though few. Most people don’t know, but you can choose where to give birth.”

(P5)

“I recommend getting health insurance so you can be followed, and if possible, get more than one opinion. Even if you don’t have money for the birth, at least be followed”

(P9)

This involves educating oneself on social issues, fighting prejudice and discrimination, practicing empathy, and taking care of others (Padilla 2013; Padilla et al. 2014; Neves et al. 2016; Topa et al. 2013). Promoting education and awareness about maternal healthcare is fundamental. It is essential to offer recommendations, guidance, and support for immigrant women regarding prenatal care, humanized childbirth assistance, respectful and safe birth options, and to raise awareness about obstetric violence and reporting options (Ramos 2015; Rusu et al. 2024).

Institutional Measures

Institutional measures refer to actions that organizations, businesses, and institutions can adapt to promote equity and inclusion within their spaces. Participants highlighted culturally sensitive training for healthcare professionals as a key recommendation.

“I think Portugal has experienced, and continues to experience, a large wave of immigration, and I think healthcare professionals need to take this into account (…) there’s a lack of respect towards immigrants, so if there was specific training in this area for health teams, it might be a very positive step (…).”

(P2)

“Regarding psychological care, for example, (…). I think maybe this area could improve. Connecting psychological work with pregnant women, or even with those who have children or are trying to, would be important.”

(P3)

“I only managed to get my IUD inserted 11 months later. I went 11 months without having relations with my husband because I was afraid of getting pregnant. (…) I believe it’s a lack of organization.”

(P10)

As studies suggest, it is important to create culturally sensitive and inclusive approaches in maternal healthcare services, ensuring that the specific needs of migrant women are met, such as the availability of interpreters, culturally competent healthcare professionals, and targeted support programs for immigrant women (Annoni 2020; Castañeda et al. 2015). This includes implementing policies of diversity and equality and creating safe and welcoming spaces for all (Council of Europe 2017; WHO 2018). Healthcare professionals should be trained with cultural and linguistic competencies, respecting the needs and preferences of immigrant women, providing clear and understandable information, and promoting sensitive and empathetic communication (Oliveira and Gomes 2018).

Governmental Measures

Governmental measures are actions taken by governments and public authorities to ensure equal rights and opportunities for all citizens. Some participants suggested improving access to public healthcare services as a key recommendation.

“I think, first, they should make it easier for pregnant women to register at health centers because I think that’s the biggest difficulty they face.”

(P1)

“People arrive at the health center but don’t have a family doctor, or don’t have documents. Pregnant women shouldn’t be in a situation where they are told ‘You don’t have the right because you don’t have documents or a family doctor.’ If you’re pregnant, you have the right. Make it more practical, because it’s too bureaucratic.”

(P6)

For this, it is essential to implement public policies that guarantee access to basic services, create laws and regulations protecting the rights of minorities, and establish support and assistance programs for vulnerable groups (Morais et al. 2021). This involves the implementation of specific maternal health programs for immigrants, removing legal and administrative barriers that may limit access to services, and allocating sufficient resources to ensure quality care (Morais et al. 2021; Rusu et al. 2024).

However, with the crisis in the Portuguese NHS and the recent approval of Bill No. 364/XVI/1ª by the Portuguese parliament, driven by right-wing extremist parties, there is a significant setback in the migrant population’s access to healthcare. Under the pretext of combating the supposed “health tourism,” this measure disregards evidence showing that the NHS crisis is not linked to the demand from non-resident citizens but rather to poor management and structural deficiencies in the system. Data from IGAS (2024) demonstrate that, despite the increase in healthcare services, this does not justify the narrative of overburdening caused by migrants. On the contrary, the access barriers created by AIMA highlight a problem of administrative mismanagement.

These restrictions have a disproportionate impact on pregnant immigrant women, who face barriers, discrimination, stereotypes, and violence (Rusu et al. 2024). This situation neglects the precarious conditions in which they live, worsened by the lack of resources in obstetric services (Alarcão and Pintassilgo 2025). The shortage of professionals and the closure of emergency units violate fundamental rights, such as universal and free access to healthcare guaranteed by the Portuguese Constitution (CRP, Article 64) and current legislation (Order No. 7495/2006) (Lusa 2024a; Fragata and Almeida 2024).

Moreover, the system’s inability to adequately serve these women reflects structural inequalities and reinforces intersectional discrimination. According to the European Parliament (2022), the quality of maternal healthcare is an indicator of a country’s development. Combating discriminatory norms is essential to ensure that all women, regardless of their origin or migration status, have access to quality healthcare (Lim et al. 2022). Therefore, according to Mendes et al. (2022), it is urgent to implement inclusive policies that guarantee equitable access to the NHS, combat discriminatory stereotypes, and uphold women’s sexual and reproductive rights.

4. Conclusions

The migration of Brazilian women to Portugal is primarily driven by the search for better living conditions, security, stability, and access to quality healthcare for themselves and their families. In this context, these women’s experiences highlight challenges related to motherhood, cultural adaptation, and barriers to accessing fundamental rights. Although Portugal offers opportunities, it also presents structural and social obstacles that limit these women’s full integration, particularly regarding maternal health and reproductive rights.

By moving away from their familial and cultural support networks, these women face significant challenges associated with motherhood. The lack of emotional and social support can be exacerbated by linguistic and cultural barriers, hindering communication with healthcare professionals and, consequently, increasing the risks of medical neglect and avoidable complications. The differences between caregiving practices in Brazil and Portugal also create difficulties in adapting to new healthcare systems and protocols. Therefore, recognizing these cultural and social specificities is essential to providing more inclusive and humanized care.

Another relevant aspect is these women’s socioeconomic vulnerability, often heightened by gender, racial, and social discrimination. Many immigrant women face precarious working conditions or unemployment, directly impacting their access to healthcare services and perpetuating inequalities. The crisis within Portugal’s NHS further worsens this situation, restricting access to essential care due to staff shortages, the closure of medical facilities, and an overburdened system.

In this scenario, inclusive public policies sensitive to the needs of migrant women are indispensable. It is essential that the government assumes responsibility for ensuring equitable access to quality healthcare services, education, and dignified employment. Moreover, investing in the training of healthcare professionals is crucial, focusing on developing interpersonal skills and raising awareness about obstetric violence and the importance of woman-centered care. A humanized approach, based on scientific evidence and tailored to cultural specificities, can reduce the barriers migrant women face and foster more positive experiences during pregnancy, childbirth, and the postpartum period.

The establishment of support networks for these immigrant mothers also stands out as a critical strategy. Safe and inclusive spaces where they can share experiences, exchange information, and seek mutual support can mitigate the impacts of isolation and the challenges faced in the host country. These networks also have the potential to strengthen their sense of community and promote social integration.

Furthermore, it is essential to foster intercultural dialogue and value diversity as a valuable resource. The inclusion of Brazilian women in Portuguese society not only contributes to social justice but also enriches the country culturally and supports demographic rejuvenation. Recognizing the contributions of these women, both socially and economically, is a crucial step towards building a more equitable and inclusive society.

In the realm of maternal health, it is necessary to address the multiple forms of discrimination these women face and consider the cultural influences shaping their experiences and perceptions of motherhood. The exchange of knowledge and best practices between Brazil and Portugal could bring significant improvements to healthcare services, enabling better adaptation to the needs of migrant women. Collaboration between women, healthcare professionals, institutions, and governments is vital to creating an environment that prioritizes the safety, well-being, and human rights of all mothers.

Finally, reflecting on these women’s experiences of motherhood highlights the importance of giving them a voice and space to share their stories. Their narratives reveal resilience, coping strategies, and the pursuit of solutions in a challenging context. Ensuring respectful, evidence-based care for all women is not only a matter of justice but also an ethical responsibility for healthcare professionals and systems. Building public policies and practices that promote equality and inclusion is essential for overcoming barriers and providing migrant women with safer, more dignified, and respectful maternal experiences.

5. Limitations and Future Research

Several limitations to this study should be considered. Although useful for gathering detailed perspectives, the qualitative approach and reliance on semi-structured interviews limit the relevance of the findings to the broader population of Brazilian immigrant women in Portugal. The limited sample size might not accurately reflect the range of maternal healthcare experiences in various geographic locations, socioeconomic backgrounds, or medical environments. Moreover, due to its exploratory and qualitative nature, this study cannot establish general conclusions or demonstrate causal correlations and relying on self-reported data raises the possibility of recall bias.

These drawbacks emphasize the necessity of mixed-methods studies and larger, more varied samples to obtain a more thorough grasp of immigrant women’s experiences with maternal healthcare in Portugal.

Based on the findings of this research, additional studies could be carried out using various methodologies: (1) a broader investigation would be beneficial, facilitating a deeper comprehension of the connections among class, nationality, and various forms of discrimination; (2) studies to determine the prevalence and categories of OV within the Portuguese healthcare service; (3) longitudinal analyses to understand how immigrant women’s healthcare experiences evolve over time, from pregnancy to postpartum; (4) comparative studies examining the maternal healthcare experiences among distinct migrant groups in Portugal and abroad; (5) research on the institutional responses to complaints related to OV and discrimination, particularly within the context of the Portuguese NHS; (6) analyses of the impact and significance of social and support networks in mitigating the challenges encountered by migrant women; (7) examination of the level of awareness and perceptions healthcare professionals have regarding OV and discrimination; (8) development and assessment of training programs aimed at enhancing cultural competence and eliminating discriminatory practices in healthcare settings.