Bravery of giving birth in the homeland: pregnant women’s and new mothers’ decisions on staying in Ukraine during the war

BACKGROUND: The full-scale Russian invasion of Ukraine has profoundly disrupted maternal care systems, exposing pregnant women and new mothers to extreme contextual adversity. While many relocated abroad, others remained to give birth in a war zone. The psychosocial and health-related factors shaping these decisions remain poorly understood. The purpose of the study is to identify the psychological, contextual, and dispositional factors associated with women's wartime decisions to remain in Ukraine or relocate abroad. METHODS: Cross-sectional data were collected online between December 2022 and October 2023 from 730 Ukrainian women who were pregnant or postpartum during the full-scale invasion. Decision tree modelling, supported by random forest analysis, was used to explore predictors of relocation. Regression models and equivalence testing examined group differences in personality traits. Missing data were addressed using multiple imputation. RESULTS: Perceived disruption of daily life and geographic proximity to hostilities were the strongest predictors of relocation decisions. These contextual factors consistently outperformed dispositional traits, including Big Five personality dimensions. Personality traits did not distinguish women who relocated abroad from those who remained in Ukraine overall. However, higher Extraversion appeared as a secondary factor in the decision-tree models, suggesting that it may be associated with remaining in Ukraine under specific contextual conditions. Women who gave birth abroad exhibited higher rates of postnatal depression than those who remained. CONCLUSIONS: Relocation decisions among pregnant women and new mothers during war are driven primarily by acute contextual adversity rather than individual personality traits. These findings align with evidence from non-war migration contexts and highlight the need for trauma-informed, context-sensitive approaches in perinatal care and policy during armed conflict. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05654987, 2022-12-16.