Palestinian women have one of the highest fertility rates in the world, averaging 4.38 births per woman. However, Palestinian fertility patterns are distinct from those of other developing nations, in that high fertility rates coexist alongside high levels of education and low levels of infant mortality – both of which have been established elsewhere as predictors of low total fertility rates. This study explores the dimensions and context of the contradictions between fertility predictors and rates, isolating main factors that shape Palestinian reproductive behaviour. Furthermore, while this study addresses factors that influence the high fertility in the Palestinian Territories, it also addresses factors that contribute to the steady decline of this trend. In-depth interviews were conducted with Palestinian women in urban refugee communities and key informant interviews with experts on Palestinian reproductive health. The findings indicate that five factors shape women's reproductive behaviour: (1) the fear of losing one's children in the ongoing conflict; (2) socio-economic factors including poverty and density of space; (3) the marital relationship; (4) religious values; and (5) generational differences. These results highlight the influence of socio-political conditions on reproductive behaviour and the significance of women's agency in manoeuvring their fertility outcomes.