Overall, the few existing studies on the reproductive health of women with severe mental illness (SMI) suggest a potential unmet need for family planning education, counseling, and contraceptive services. Family planning has been given little attention in mental health contexts, and yet it is a foundation of women’s preventive healthcare required to optimize the health, wellbeing, functionality, and reproductive autonomy of those with SMI. We qualitatively interviewed 17 English-speaking women aged 18-55 diagnosed SMI receiving treatment at an outpatient community mental health clinic. We conducted in-depth interviews with semi-structured guides to elicit information on reproductive experiences including contraception, prenatal, postpartum and abortion care with the goal of comprehensively describing the family planning experiences and needs of women with SMI and to identify the multi-level barriers to contraceptive use that contribute to unintended pregnancy risk among this group. Our findings suggest the significant role of SMI in driving reproductive decisions and behaviors within this population, influenced further by complex and interrelated social and environmental factors. Findings raise important questions regarding pregnancy intentions, decision making, and partner dynamics, all of which need further investigation.