Tamara Zaiva, a 35-year-old veterinarian, fled Ukraine when Russia launched a full-scale invasion in February 2022.
She traveled with her five-year-old son and settled in Poland, where her husband worked.
However, 18 months later, at 22 weeks of pregnancy, Zaiva returned to Odessa despite the risks to give birth in her homeland.
“Because her new life depended on it,” Zaiva said, hugging her newborn daughter, who moved for a moment before dozing off again on her shoulder.
Due to a misunderstanding caused by a language barrier, she thought her daughter had Down syndrome and feared she would not be able to afford expensive tests.
“I really wanted to go home and see the doctor,” she said.
Her baby was born five months ago in a hospital in southwestern Ukraine, weighing 3.3 kg at 40 weeks.
Zaiva said she decided to return to the war-torn country from the Polish port city of Gdynia because she had no help navigating a health care system that seemed foreign to her.
Her son recently started school in Ukraine. Nevertheless, Zaiva keeps the children’s passports on hand in case they need to flee again.
Anna, 30, a teacher from Kiev, also returned from Poland to give birth.
She fled the war at the beginning of her pregnancy “because I realized that it was not safe in Ukraine.”
However, she said waiting times for patients in Poland were long and said the level of care was insufficient.
“It was very difficult,” she said.
The deadline is scheduled for January.
“If the (security) situation changes, I will think about going abroad with my newborn.”
According to local non-governmental organizations and research by the New York-based Center for Reproductive Rights (CRR), the two women are among hundreds of people who returned to war-torn Ukraine while pregnant, citing shortcomings in maternity care in receiving countries.
“Because of the barriers women face in these countries, it is often easier for them to return to Ukraine,” Leah Hoctor, CRR’s European leader, told Al Jazeera.
Some reasons are specific to refugees, such as language barriers and information gaps, while others are structural, including lack of resources or funding.
“Many interlocutors pointed out that the standard of care is much lower (than in Ukraine),” Hoctor said.
In all four countries covered by the CRR study – Hungary, Romania, Slovakia and Poland – non-governmental organizations have stepped up to help women.
“It’s really easy to get lost in this system, refugees are expected to know their way around without orientation,” said Anna Ivanyi from the Emma women’s association in Hungary.
Emma volunteers accompany women to meetings, sometimes to protect Ukrainian women against the “hostility” of institutions.
Even though health care for refugees is state-funded, some doctors demand payment or refuse to treat Ukrainians, said Carmen Radu, spokeswoman for the Romanian Independent Association of Midwives.
She estimated that since the beginning of the war in Russia, hundreds of Ukrainian women have left Romania to return.
According to Małgorzata Kolaczek, vice-president of the Ku Dialogowi Foundation, a Polish non-governmental organization working with Roma refugees from Ukraine, hundreds of pregnant women also left Poland.
Throughout Europe, members of Roma communities are subject to intense persecution. When the war began in Russia, Roma refugees from Ukraine told of episodes of discrimination during dangerous journeys to safety.
“I don’t think Poland wants to encourage them to stay here, to be honest,” Kolaczek said.
“Compared to some (these) countries, we have a well-developed system of gynecologists and family doctors,” said Galina Maistruk, a gynecologist who heads Women Health and Family Planning (WHFP), the Ukrainian partner of the International Planned Parenthood Foundation.
“Even during the war, this system did not break down,” she said.
The Kyiv-based organization provided medical equipment to maternity clinics across the country, including three hospitals in Mariupol, a city currently occupied by Russia.
In March 2022, Russia bombed a maternity ward in Mariupol, killing at least three people.
Doctors of the Kiev Maternity Hospital No. 1 are busy preparing for winter.
Last year, doctors and nurses stayed in the hospital for 40 days, melting snow for water during power outages, said Oleksandra Lysenko, deputy director of the hospital.
“Still, everything was clean,” she said.
Currently, the hospital has its own water supplies, two generators and a fully equipped bomb shelter.
But there is no cure for anxiety.
Lysenko, wearing a lab coat decorated with blue and pink birds, joked that she cures her insomnia with a sip of beer every night.
“Ukrainians are in great mental shock,” said Maistruk from WHFP. “And doctors say there are a lot of complications.”
According to several studies, miscarriages and pregnancy complications increase during conflict.
“We have seen an increase in the number of premature births and complicated pregnancies,” said Lyudmila Ivanova, a gynecologist from central Ukraine.
About 40 percent of her patients left at the beginning of the war, but many still consult with her by telephone. She once attended a birth in a Dutch hospital via Zoom.
According to her, all women experience gynecological problems due to war stress.