Globally, more than half of all pregnancies are unintended or unplanned, with approximately two-fifths resulting in abortion. In Iran, abortion is carried out under circumstances where intentional termination of pregnancy is not legally sanctioned. This article focuses on how women make decisions to either continue or terminate a pregnancy, and seeks to identify the stages and key actors involved in this process. A qualitative research approach was employed using grounded theory methodology, incorporating participant observation and in-depth interviews as primary data collection tools. The sample included 46 married women in Tehran, selected through purposive sampling techniques. Findings reveal that the decision-making process surrounding pregnancy continuation or termination unfolds in three key stages: cognitive awareness, decision-making, and action or withdrawal. In the cognitive stage, women gather information on abortion from a variety of sources. During the decision-making phase, a network of actions and collective decisions influences the individual’s uncertainty about pregnancy, ultimately steering them toward continuation or termination. In legally permitted cases, the entire abortion process is conducted under medical supervision in hygienic hospital settings. However, in instances of self-induced abortions lacking legal or institutional support, the procedure is carried out through illegal channels under unsafe conditions. Overall, the establishment of formal structures to provide accurate information on the consequences of abortion, stricter regulation of promotional content related to pregnancy counseling, adequate family support, and the development of specialized decision-making counseling centers are critically important in mitigating the psychological and physical risks associated with abortion.