Background Little is known about unintended pregnancies in the Gaza Strip. This study explored causes and consequences of unintended pregnancies among women in the Gaza Strip.

Methods This was a qualitative study, and included 21 women who had experienced unintended pregnancies previously. Data collection took place in three focus groups of 5–12 participants, which were facilitated by one female researcher. Structured questions on reasons for, causes and impact of unintended pregnancies were answered by all participants. Sessions were audiotaped and responses were transcribed and read by all the researchers to extract themes.

Results The mean age of participants was 34.2±6.0 years, parity was 2.7±0.6 and 16 participants (76.2%) had benefitted from secondary level education or above.

Five main themes were identified: (1) economic hardship was the main reason for pregnancies to be unwanted; (2) high pressure was exerted on women for male babies, exposing women to gender-based violence; (3) advanced maternal age was perceived as a social stigma; (4) complete lack of support for women facing unintended pregnancy led to self-management of terminations including attempts of unsafe methods; and (5) changes of methods and incorrect use leading to contraceptive failure was the most frequent cause.

Conclusions Unintended pregnancies in the Gaza Strip are a common cause of distress for women. The most effective way of preventing unintended pregnancies remains access to reliable contraception. However, a service designated to support women facing unintended pregnancies is needed in the Gaza Strip. Local policymakers have to address this when planning healthcare services.