INTRODUCTION:
While Bangladesh has achieved remarkable milestones in maternal health, tea garden workers remain trapped behind "invisible borders" of historical isolation and labor exploitation. This study synthesizes evidence from Bangladesh, India, and Sri Lanka to quantify the reproductive health equity gap and examine how the plantation labor system functions as a structural determinant of health exclusion.

METHODS:
A systematic secondary analysis and meta-synthesis were conducted using data from the 2022 BDHS, national health reports from Assam (India), and peer-reviewed studies (2019–2024). We employed a comparative "Equity-Gap" model to measure the distance between tea-worker indicators and national averages, focusing on Antenatal Care (ANC), Institutional Delivery, and Adolescent fertility.

RESULTS:
The "Equity-Gap" is profound: while Bangladesh’s national facility delivery rate has reached 65%, tea garden utilization remains stagnant at 12.3%—a 52.7 percentage point disparity. This pattern is mirrored in Indian tea estates (<25% delivery rate), suggesting a regional labor-linked crisis. Qualitative synthesis reveals that "Work-Health Conflicts"specifically inflexible shifts, fear of wage loss, and the lack of onsite maternity benefits are more significant barriers than distance or cost. Furthermore, adolescent workers face a "triple burden" of early marriage, menstrual poverty, and restricted mobility, with 88% reporting a lack of reproductive autonomy.

CONCLUSIONS:
Reproductive health disparities in tea gardens are not merely "service gaps" but "rights gaps" embedded in the plantation economy. To achieve "Health Without Borders," public health interventions must move beyond clinical outreach to include labor-rights advocacy, mandatory onsite maternity protections, and adolescent-specific empowerment programs.