Background and objective <p>Pregnant women in certain socio-cultural contexts face not only interpersonal abuse but also systemic and symbolic forms of violence embedded in societal structures. In Iran, particularly in under-resourced regions like Ilam, such violence remains understudied. This research aimed to explore how structural, symbolic, and familial dynamics shape the lived experiences of violence among pregnant women.</p> Methods <p>This qualitative study employed a conventional content analysis approach based on Graneheim and Lundman's method. In-depth, semi-structured interviews were conducted with 26 postpartum women and 6 key informants, including spouses, in-laws, and professionals, in Ilam, Iran. MAXQDA 18 software was used to analyze the data.</p> Results <p>Two central categories emerged: Gender inequality within social structures, and Absence of supportive structures from family and spouse. These encompassed seven subcategories, including weak legal protections, economic neglect, symbolic and psychological violence, and lack of support in domestic roles.</p> Conclusion <p>Violence against pregnant women in Ilam is a multifaceted phenomenon rooted in patriarchal norms, structural inequality, and institutional neglect. Addressing this requires systemic reform, culturally sensitive interventions, and enhanced support networks for women. The insights provided can inform public policy, healthcare practice, and advocacy aimed at promoting maternal dignity and well-being.</p>