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Climate change is intensifying flood risk globally, with social and socio-economic vulnerabilities shaping their impacts, leading to differential outcomes and risk reduction needs and priorities, exacerbating existing inequalities and undermining resilience gains. Ecosystem-based disaster risk reduction (eco-DRR) presents a nature-based pathway to reduce risk holistically, addressing hazard, exposure, and vulnerability dimensions. However, evidence remains uneven regarding how and under what conditions eco-DRR reduces underlying vulnerability beyond physical hazard risk reduction.This presentation reports findings from a qualitative, multi-country study examining how eco-DRR interventions interact with drivers of vulnerability to flood hazards across Sierra Leone, Haiti, Colombia, Honduras, India, Nepal, and Tajikistan. Data were generated through focus group discussions with implementing teams and key informant interviews with eco-DRR specialists. We conducted thematic analysis guided by the Pressure and Release (PAR) model and Bohle’s “double structure” of vulnerability to assess (i) vulnerability drivers; (ii) the mechanisms through which eco-DRR addresses (or fails to address) these drivers in practice; and (iii) enabling conditions and constraints for sustained, equitable resilience outcomes.Findings suggest that eco-DRR can contribute to reductions in social and socio-economic vulnerability through multiple pathways, including livelihood diversification and income stability, strengthening of social cohesion and collective action, enhanced risk awareness and local capacities, and increased community stewardship of ecosystems. Crucially, outcomes are uneven and contingent upon local power dynamics and differential access to resources (such as land, labour, time, and finance) based on structural inequalities. Governance-related barriers such as insecure tenure, limited institutional capacity, and weak service delivery can constrain longer-term vulnerability reduction when eco-DRR is implemented as a standalone intervention. We argue that eco-DRR more meaningfully, comprehensively, and sustainably reduces risk when designed and implemented with an understanding of the contextual drivers and impacts of social and socio-economic vulnerabilities as well as of the physical hazard, and is complemented by measures targeting these structural drivers of vulnerability.