Social and Structural Forces Shaping Reproductive Decision‐Making in Hispanic Women with Systemic Lupus Erythematosus: A Qualitative Study

OBJECTIVE: Systemic lupus erythematosus (SLE) disproportionately affects women of reproductive age, making pregnancy timing and contraception use central to care. Although clinical counseling is vital to reproductive planning, less is known about the sociocultural and structural influences shaping reproductive decision-making among Hispanic women with SLE in the United States. This study explored patient perspectives on multi-level factors influencing reproductive health decision-making. METHODS: We conducted semi-structured interviews with 30 Hispanic women with SLE recruited from a safety-net rheumatology clinic and a community lupus support organization. Participants were aged 18-45 years, sexually active or considering pregnancy within three years, and fluent in English or Spanish. Interviews were conducted virtually, transcribed, and analyzed using a grounded theory-informed approach, with the Socioecological Model retrospectively applied to guide analysis. RESULTS: Four major themes aligned with the Socioecological Framework. Reproductive decision-making was shaped by structural stability, including financial security, career readiness, and confidence managing SLE during pregnancy. Culture and religion were present but variably integrated into reproductive health considerations, while partners and family members influenced how risks and decisions were discussed and supported. Participants also relied on informal information networks, including peer experiences and online resources, to interpret reproductive risks and contraception options. CONCLUSION: Reproductive planning among Hispanic women with SLE is influenced by structural, relational, and informational factors extending beyond the clinical encounter. These findings highlight the need for supportive interventions or resources beyond the clinical encounter, including supportive networks, trusted information, and peer-informed support tailored to young women living with SLE.