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Marina Pugaczowa is head of the Mariupol Women’s Association, which has helped evacuate and shelter more than 700 people from Mariupol.Anna Liminowicz/The Globe and Mail

Every Monday, Wednesday and Friday evening, Dr. Mira Marchenko sits by her phone in Krakow and spends four hours fielding questions from Ukrainian women about one topic: birth control.

The women are all refugees from the war in Ukraine and they’re almost always uneasy when they call, sometimes speaking in hushed tones or giving one-word answers. They’re not sure who they can trust or where they can turn if they need emergency contraception or an abortion, both readily available in Ukraine but almost completely illegal in Poland.

“They are very afraid to ask those questions because they don’t know who is answering and what will be next,” said Dr. Marchenko, an obstetrician-gynecologist who is also a refugee from Kyiv, where she had a thriving practice before the war. “They are frightened of everything.”

While Poland has generously opened its doors to more than one million Ukrainians since Russia invaded on Feb. 24, the country’s strict laws on birth control have become an issue for many refugees, the vast majority of whom are women.

One of the biggest concerns is caring for Ukrainian women who have been victims of sexual assault during the fighting. Human Rights Watch and forensic doctors working for Ukrainian prosecutors have documented dozens of cases of sexual violence committed by Russian soldiers. Some aid groups fear the number could be in the hundreds and that it will keep climbing as the conflict continues. It’s not clear how many of those women have made their way to Poland but this country can be a difficult place for any pregnant woman in distress.

Poland has some of the strictest anti-abortion laws in Europe. New restrictions came into force last year that banned terminations except in cases of sexual assault, incest or if the woman’s life is at risk. But even under those exemptions, access to abortion can be difficult.

Doctors often force women to attend repeated consultations, which take them beyond the 12-week deadline for an abortion. And victims of a sexual assault must have a certificate from a prosecutor to prove that the assault occurred, something Ukrainian refugees can’t possibly obtain.

Abortion pills – two medications that terminate early pregnancies – are only available with a prescription in Poland and anyone who gives out the pills without a doctor’s consent can face jail time for aiding an abortion.

The tight rules have meant that for years thousands of Polish women have gone abroad to seek help, including to Ukraine, where terminations are legal if performed in the first 12 weeks of pregnancy. Abortions between 12 and 28 weeks require approval of a medical panel and only for significant medical, social and personal reasons. And abortion pills are available in Ukraine without a prescription.

“From [the] second week of war, we started to organize our help and assistance to adapt our activities to the needs of Ukrainian refugees, women and girls,” said Krystyna Kacpura, president of Poland’s Federation for Women and Family Planning, or Federa. Ms. Kacpura said the organization has helped more than 100 refugees obtain emergency contraception through a network of sympathetic doctors, hospitals and organizations across Europe that source the pills legally and then mail them to refugees in Poland.

Federa also set up the hotline that Dr. Marchenko operates and it has volunteers throughout Poland who distribute information in Ukrainian to refugees.

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Kateryna Shukh, right, leads a group of Ukrainian refugees from Mariupol in an art therapy session. The mothers and children were putting together posters that reflected what they wanted for their lives in five years.Anna Liminowicz/The Globe and Mail

Dr. Marchenko said she receives about 10 calls every shift and at least three involve questions about abortion. She recalled one of her patients in Kyiv who discovered abnormalities in her fetus just two days before the war started. “She wanted to terminate this pregnancy because of medical reasons but she had no time,” Dr. Marchenko said. “And when she got to Poland she was in terrible condition because she could not solve this question. She had to go to [the] Czech Republic.”

She added that while she had some idea about Poland’s abortion law before fleeing Ukraine with her 10-year-old son and mother, nothing prepared her for the reality of living in the country. She’s even had trouble accessing standard birth control pills, which also require a prescription in Poland. She had to get a doctor in Ukraine to write her a prescription and then find a pharmacy in Krakow that would accept it. “These were just simple birth control pills, not emergency contraception, just pills that I take usually in Ukraine,” she said.

Anti-abortion groups and Catholic Church officials in Poland have been just as vocal in voicing their concern about any effort to weaken the law or provide special treatment for Ukrainian women seeking abortions.

The Life and Family Foundation has been encouraging its supporters to print a pamphlet outlining Poland’s abortion restrictions and give it to refugees as they cross the border. The pamphlet notes that any doctor who performs an abortion is “subject to imprisonment for up to eight years.” It also warns refugees that anyone who assists with an abortion can face jail time. And it adds: “If the procedure is complicated and you seek medical attention, law enforcement must initiate an investigation into how an abortion was attempted.”

One flyer from the group also says: “The biggest threat to peace is abortion. If a woman is allowed to kill her child what’s stopping me or you from killing each other?”

Kateryna Shukh, a psychologist who counsels refugees from Mariupol, said most women don’t want to discuss the sexual violence they’ve experienced. “All these women, they need time. We just do it very step by step, we don’t hurry,” she said from a shelter in Warsaw, which is run by a charity called HumanDoc.

In a recent session, Ms. Shukh encouraged a group of nine women to make posters with pictures showing what they hoped their lives would look like in five years. “It’s a way to get them thinking about moving forward,” she explained.

Ms. Shukh is better placed than most therapists to connect with the refugees. She also had to flee Mariupol, where she spent years working with the Mariupol Women’s Association. That organization was founded by her mother, Marina Pugaczowa, and it started in 2015 by supporting women caught up in the war in eastern Ukraine.

Now, Ms. Shukh and Ms. Pugaczowa are both refugees in Warsaw. With the help of a team of volunteers, they’ve continued some of their work in Mariupol by organizing evacuations out of the city and providing counselling to refugees once they get to Poland.

“I never thought I would be a refugee too,” said Ms. Shukh. “I’m a woman and a person too, and I have a lot of feelings about it and sometimes I’m crying.”

Ms. Pugaczowa said she knows of four cases involving women who were gang raped by Russian soldiers. “Our women are still in a really bad psychological condition,” she said.

She knows all too well that the Mariupol refugees have little chance of returning home and her goal now is to help them start over in Poland. “With our Polish friends, we want to show that refugees cannot only be victims of the war but refugees can be people who can be independent and a potential for the country where they live,” she said. “They can have independence and start a new life in the country.”

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