Making decisions about whether to keep or terminate a pregnancy is an emotionally laden process for any woman. The purpose of this study was to explore gender-based power relationships and cultural influences on reproductive decision making during pregnancy among 4 HIV-concordant couples in Taiwan. Feminist ethnography was used to explore how reproductive decisions were made during pregnancy. The study findings showed that the process of a couple's decision making about their desired outcome of pregnancy can be categorized as occurring in 3 stages: shaping the meaning of the pregnancy, encountering medical systems, and structuring decisions. These Taiwanese couples interpreted the meaning of their pregnancy as a “kindly” reminder from God, to make them aware of the HIV status, and having a child as a way for them to demonstrate filial piety. A couple's perception of substantial support from senior family members and from health care providers was crucial to the decision to continue the pregnancy to term. The Confucian value of filial piety drove the couples' reproductive decisions during pregnancy.