Although modern contraceptive use in Peru has increased, many women still face unwanted or unplanned pregnancies and abortions remain high despite the illegality of elective pregnancy termination. To improve understanding of how men and women make reproductive decisions, we conducted this study in Lima. Fifty-two 18–37 year old low- and middle-income women and men participated in in-depth interviews and focus groups. Reproductive planning constitutes a worry among participants. The paradigm of contraception, pregnancy, childbearing and pregnancy termination is complex and contained within a context of contradictory pressures toward women: while women feel the need to be autonomous in all realms of their lives, they also need to meet the traditional roles associated with sexuality and childbearing and rearing. The woman, her partner and family members take part in reproductive decisions. However, participants expressed difficulties preventing unwanted pregnancies and social stigma if they resorted to abortion or, interestingly, if they continued a pregnancy when involved in a socially undesirable personal situation. Abortion-related stigma generated fear and guilt in addition to safety concerns given the unsafe, clandestine contexts in which pregnancy termination takes place. Despite these concerns, interviewees often opted for abortion for personal reasons, which were primarily economic.