Perpetuation of Gender Discrimination in Pakistani Society: Results from a Qualitative Study Conducted in Three Provinces of Pakistan

doi:10.21203/rs.3.rs-1399382/v1

Background

Prejudice based on one’s gender leads to contempt, mistreatment, and marginalization, which can be characterized as gender discrimination. This occurrence appears in every country of the world and in many societies in which women are often on the receiving end. It affects the provision of women’s rights and negatively impacts their physical and emotional livelihoods. Thus, this study aims to qualitatively evaluate the reasons for gender discrimination in a specific country, Pakistan, and how women are affected.

Methods

Participant recruitment was done with purposive sampling. The collection of the data included community leaders/workers and various families using in-depth interviews and focused group discussions. The subsequent data analysis was manually done and electronically through QSR NVivo 10. All data were then complied with and verified by the research team.

Results

The focus of the collected data resulted in three emergent themes. Firstly, gender discrimination seems to be geared more towards women based on how they are perceived by the community. Specifically, women are viewed as sexual objects and dependent beings, who are not identifiable as an individual unless they have a male partner. They are also subject to restrictive responsibilities, inherent to the household, while being deprived of rights, being neglected, and forced to suppress self-expression. Secondly, men are viewed as dominant figures in the lives of women, who often make all the familial decisions and do not share issues with their wives. This puts them in the role to be the financial provider and a source of protection, hence, the desire for male children to be born over female children. Thirdly, many institutions are involved in perpetuating gender discrimination including older generations, media, schools, and healthcare. Participants also gave recommendations to tackle the issue at hand including increasing education and healthcare resources.

Discussion

This study highlights the perpetuation of gender norms as a result of perceptions and cultural norms held by Pakistani society. To promote the wellbeing and rights of women more action is needed. Social movements, drawn out from social institutions, have proven useful for women's empowerment and advocation of societal change.

Conclusion

Due to the largely patriarchal society, Pakistani society continues to encourage gender discrimination through complex gender roles, with high resistance to change. Yet, this can be slowly altered as education can grow for men and women, thus, leading to a public effort with the power to improve the provision of rights for women in Pakistan

Gender Discrimination

Women discrimination

Gender

Pakistan

Gender discrimination is the root cause of injustice, maltreatment, and bring vulnerability within society. It affects the woman that she can’t practice her rights leading to emotional, financial, social, and physical disturbances. This manuscript has used the Mix methodology approach where a systematic review was done to emerge the themes which were triangulated with the primary qualitative data collection from the women. To understand their situation related to discrimination. Two databases; PubMed and Google Scholar with grey literature including reports from organizations were used to extract articles. Three authors independently did la literature review based on inclusion criteria by using the PRISMA guidelines. Six major themes emerged from scoping review and 4 from field research. The emerged themes included "gender discrimination seems to be geared more towards women based on how they are perceived by the community" Women are viewed as sexual objects and dependent beings. The second theme emerged as "men are viewed as dominant figures in the lives of women, who often make all the familial decisions and do not share issues with their wives" and third including as ' institutions are involved in perpetuating gender discrimination including older generations, media, schools, and healthcare".

This study has highlighted the perpetuation of gender norms as a result of perceptions and cultural norms held by Pakistani society. The situation could be improved when the entire society and especially women are educated and are gendered sensitized.

Gender discrimination refers to the prejudicial treatment applied in various settings, which includes gender-based disparities of rights and benefits. Most developed countries around the world consider gender discrimination under the law as illegal and socially unacceptable. ¹ The prevalence of gender inequality significantly differs between cultures and countries, where it is observed as much more evident in certain cultures while considerably less obvious in others. ² The hereditary approach of gender discrimination is found in many societies, where practices of gender discrimination are established through various socially constructed cultural norms. ¹

In Pakistani society, men and women are conceptually isolated into two distinct and extreme ends of a spectrum that entails different rules, responsibilities, and practices for each. ³ Gender roles for women are often assigned at birth based on conventional origins and social principles, ³ largely centered on the concepts of nurturing, accommodating, and reproducing. ² These concepts are rooted deeply into the cultural fabric of the country, and they lead to the deprivation of other rights and freedoms of women. For example, Pakistan’s statistics highlight that 50% of women are deprived of basic education. ⁴ Women in Pakistan also have lower health and nutritional status and their social mobility is firmly restricted. Most women are also limited to staying inside their homes and advised to take on a subordinate role in their families. ⁵ This deprives women of their right to make choices, judgments, and decisions, that directly affect their living conditions and other familial aspects. Instead, a woman’s responsibility is to only assume mundane tasks that do not hold influential power in society. ⁵ This withdrawal of basic rights clasps women in a position that is inferior to the status of men, which leads to the overwhelming apprehension of powerlessness and draws them away from a sense of empowerment. This can be compared to the opposite gender role that is assigned to men in Pakistani society. Men are considered to hold the dominant role both in the household and the real world, thus, this unequal assignment of societal roles leads to discriminatory behavior exhibited by men. ⁶ This subordination of women, upheld by the dominance of men, leads to discriminatory actions against women that may have negative influences on the different stages of a woman’s life.

Many of the case studies use secondary information, which means the researchers had to review previous research findings to gain a broad understanding of the field. ^{1,4,5,6,12,13,15} However, some of these studies could be biased as they were self-reported and the factors causing gender discrimination were not reported by the authors. Also, the reliability of the information is not known as the researchers did not collect this information themselves. A few other limitations were found, such as the generalizability of the study. In some of the studies, only female participants were interviewed, which creates a gender-bias, since male perspectives are unknown. ^5,7,14 In addition, all these studies were focused on the status of women and gender discrimination in Pakistan, therefore, these findings cannot be generalizable to the whole world’s population.

A few studies view the Islamic, historical, or conceptual side, which further gives us an understanding as to why this issue is so significant in Pakistan. ^5,14,15 The 14th study states that the Qur'anic principles are frequently avoided and twisted, especially, regarding the status of women and the ill-practices of Jahiliya that are continuing in Pakistan. ¹⁴ In Islam, equal legal rights and basic equality are given to women, yet Ghag or Forced Marriage is continually being practiced in Pakistan. The patriarchy has caused a total disregard for women in Pakistani society. To solve this, frequent training and awareness programs are needed to be arranged, periodically, to make men and women aware of women’s rights.

The second study of the review also describes the different kinds of students and how different financial status and education of the family change their views on women. The research paper focused on the socioeconomic status of females in three different universities and the results were a bit unusual. The students of one of the three universities did not discriminate against women of any social identity. This may suggest that not all men support discrimination, but those who may have been taught to do so at a young age by their elders, are more likely to do that. Further, the monthly parental income of male and female students in that university was about seven times that of students of the other two universities, and paternal education was almost twice as many. This may suggest that a higher level of education means that people are wearier of gender discrimination. Only 23% of one university’s students reported watching British Broadcasting Cooperation (BBC) and The Cable News Network (CNN), which means that 77% of the students were not aware of world problems, and therefore, stuck to the traditional route of believing that women do not deserve the same rights as men. Women with higher socioeconomic status are not discriminated against and are even favored in some instances by males, however, females with lower socioeconomic status tend to be discriminated against by certain groups of men.

Study Design

This study used mix methodology study design, where systematic review and primary data collection was done

The objective of the Systematic Review

To map the understanding of gender discrimination, inequality, and, violence concerning Reproductive and sexual health in Pakistan.

Literature Search Strategy

A literature search was performed using two databases: PubMed and Google Scholar and grey literature and reports from organizations such as WHO and the Aurat Foundation were also reviewed and selected based on the inclusion criteria. Three authors (TSA, SS, SN) independently performed an extensive literature search and shortlisted articles which were then cross-checked by two of the authors (TSA, and SN) and selected based on the eligibility criteria. The following keywords and phrases were used: IPV, domestic violence, violence against women, domestic abuse, spousal violence, and Pakistan. Quantitative and Boolean operators were used to narrow down the search results. Since this is a review article, approval by the ethics committee was not required. Articles from 2008 to 2018 were assessed and those including women undergoing any form of IPV (physical, psychological, and sexual); a quantitative study design; English as the publication language; and articles in which Pakistan was the study setting were selected. The quality of the selected studies was reviewed using a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, which ensured that all articles were following a structured approach, including an introduction, methodology, results, and a discussion section.

It was also determined that all selected articles were published in peer-reviewed journals and have been used nationally or internationally. Articles were excluded if those were not conducted in Pakistan or studied spousal violence against men or domestic violence involving in-laws or other family members. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) chart was used for study selection. After inserting the keywords and Booleans, a total of 4378 articles were hit including 73 from PubMed, 4300 from Google Scholar, and 5 were retrieved from the grey literature. The articles were checked for duplications, and 2378 articles were removed. The titles and abstracts of 2000 were reviewed and out of which 1500 irrelevant records were excluded. 500 full-text articles were assessed for eligibility and out of those 485 articles were excluded for not meeting the eligibility criteria. The following were the reasons for excluding the articles: lacked focus on women’s health and reproductive health (n=125); did not use research-based methods (n=150); had generalized information about the developed countries (n=120), and quality of the articles was questionable (n= 90). After the exclusion of the articles, 15 were included in the review. The selected articles were approved by one of the authors (TSA), who is an expert in the field of IPV. Data were extracted by 3 authors (TSA, SS, SN) by carefully studying the methodology and results of the selected articles. The methodology was entered into an extraction template in which location was summarized including the study design and sample size in the articles (Table 1). The results covered the title, authors, publication year, objectives of the research, population and setting, research design and data collection method, results, perpetuating factors, and recommendations.and lifetime prevalence of Intimate Partners Violence (IPV) faced by women, which was further categorized into psychological/emotional violence, physical violence, sexual violence, both combined, and violence of any other type.

An explorative descriptive approach was used for this study to gain a thorough understanding of gender-based role association, along with considerations from demographic factors such as socioeconomic status, marital status, education, and gender, along with its profound link to gender-based discrimination. The selected study sites included two districts from Chitral (Upper and Lower Chitral), six districts from Gilgit (Gilgit, Ghizer, Hunza, Nagar, Astore, and Skardu), and two districts from Sindh (Matiari and Qambar Shahdadkot). The data was triangulated by conducting a systematic review of the articles for the last ten years.

Participant Selection

Purposeful sampling was used to recruit participants. Participants included ~~such as~~ groups of married men and women aged between 18 to 49 years, groups of unmarried adolescent boys and girls aged between 14 to 21 years, and groups of healthcare professionals (HCPs), comprising of doctors, nurses, Lady Health Visitors (LHVs), Lady Health Workers (LHWs) and Community Midwives (CMWs). Ethical approval was obtained from the Aga Khan University, Ethics Review Committee.

Data Collection

Data were collected by conducting In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). I was conducted with the healthcare industry administrators, Heads of the Departments (HoDs), and HCPs, of private and government health settings, including gynecologists, LHWs, LHVs, and CMWs. The IDI tool consisted of questions comprising of knowledge, sources of information, and attitudes regarding sexual and reproductive health (SRHR) and discrimination based on gender. These questions were molded in a way that gave an explicit understanding of how each gender is perceived in society and how the physical and social differences in the roles of males and females affect the overall gender dynamics. In addition, individual knowledge regarding gaps and recommendations to bring in gender-based transformation were also explored through the IDIs. The IDIs were conducted in Urdu and local language and were audio-recorded. Each IDIs lasted for 45-60 minutes.

FGDs were conducted using different interview guides (Available as supplement files), which were designed to assess the larger study. The guide also included questions and probes on the perceived roles of men and women in society. The guides consisted of questions focusing on their perceptions of masculinity and femininity, the difference in gender-specific treatment, and their comfort level based on the expectations of society. Also, social, economic, and cultural barriers affecting gender-based discrimination and recommendations to bring changes. All target groups were allowed to provide suggestions to overcome challenges in gender-based discrimination. The FGDs were conducted in Urdu and local language and were audio-recorded. Each IDIs lasted for 60-120 minutes.

Data Analysis

English was the language of choice for the transcriptions of all the audio-recorded data from the FDGs and IDIs. All data were stored on a Microsoft Word document. Emerging analysis and framework analysis were then conducted. The following four steps were used to complete the emerging analysis:

Firstly, transcriptions were read thoroughly by the research team, and codes were identified via manual analysis. Categories, and then themes, were derived based on the codes sorted with contextual similarity. Secondly, another round of manual analysis was conducted by an expert data analyst, by following the above-mentioned steps. Thirdly, analysis was conducted using the data program QSR NVivo 10. The study’s desire for an in-depth understanding of SRH and FP meant the use of queries applied to the data including frequency of words, word cloud, tree-maps, and creation of nodes. Fourthly and finally, the final data was compiled after all three analyses were combined and verified by the research team.

Data Integrity

Strategies to maintain credibility, reliability, transferability, and confirmability were used to keep up the validity of the data. Continuous participant observation, scrupulous field notes, and post-interview reflections were included alongside typical data collection to provide credibility and data truthfulness. Reliability was ensured in using an outside researcher to observe data collection and analysis for some portions of the study. To generalize or transfer findings to other contexts, or transferability, in other words, the research context and its conclusions were thoroughly explained. Lastly, confirmations with audio recordings, vigorous field notes, and study team reflections, allowed the study to maintain confirmability. Key contributions to data integrity also included careful influence from the supervisory team at each point of data collection and analysis.

Ethical Considerations

Aga Khan University, Ethics Review Committee approved this study. Before data collection from the participants written and verbal informed consent were obtained from all participants. All the data present in the hard copy was scanned and saved on the hard drive with password protection. All the hard copies such as note pads used during the FGDs and IDIs and informed consents were kept under lock and key and only the main PI is having the access to it (ERC#: 2020-3606-11489).

Systematic review

The studies selected were scrutinized to form a data extraction template with all the relevant data such as author, publication year, study title, purpose, setting, sample characteristics, design sampling, main results, perpetuating factors, and recommendations wererecorded in Table 1. Results of the articles were analyzed, and themes emerged which included (a) Status of Women in Society (b) Gender Inequality in Health (c) Gender Inequality in Education (d) Gender Inequality in Employment (e) Gender Biased Social Norms and Cultural Practices (f) Micro and Macro Level Recommendations. The keywords used were “gender discrimination” “Pakistan" "women" "men" "adolescent"

Literature Review findings:

Most of the 15 studies included in the review were conducted in Pakistan however the most frequent study design was cross-sectional (n = 7) followed by narrative research based on desk reviews (n=6), one was a case study, and another was cross-country comparison by using secondary data. Four studies were conducted in Province Punjab, two studies were conducted in KPK, and one in both KPK and Punjab. Only one study was conducted in Sindh province the remaining used whole Pakistan in desk review. The maximum sample size in a cross-sectional study was (n=506). Six major themes have emerged from the review which included (a) Status of Women in Society (b) Gender Inequality in Health (c) Gender Inequality in Education (d) Gender Inequality in Employment (e) Gender Biased Social Norms and Cultural Practices (f) Micro and Macro Level Recommendations.

a) Status of Women in Society

The position of women in Pakistani society, is complicated and faces multidimensional inequality. ¹³Women are seen as a sexual object who does not have any power and say in any matter, however, the male is seen as a symbol of power who has all the guardianship of female. Due to male ownership and the patriarchal structure of the society women are submissive to men, treated as property, their rights are ignored and she denied her own identity. Out of 15, seven studies reported that a female can not take an independent decision, someone decides on her behalf mainly father before marriage then-husband and son. ^{1,2,3,4,7,9,13}Out of 15 studies, 3 reported that women are not allowed to participate in elections or have very limited participation in politics, she faces several inequalities in terms of freedom and access to health, education, and employment. ⁵ A study reported that Pakistani women are facing structural inequalities and discrimination that cultivate community structure and the gross power harm the women’s life massively. ¹Woman seen in the stereotyped role even on media whose only responsibility is home and family nothing else. ⁵She has less access and control over financial and physical assets ¹³ and mostly in low economic families went through verbal abuse and physical violence. ⁷

b) Gender Inequality in Health

Gender disparity in health is obvious in Pakistan, a woman is suffering from the neglect of health and nutrition. The different axes of structural violence and social power relations are controlling the women’s health, they don’t have reproductive health rights, appropriate prenatal and postnatal care, and decision-making power for birth spacing and to avail health care as a result maternal mortality and morbidity is high in Pakistan. ¹³Women can not a decision on her health and children’s health; she doesn’t have access to proper and timely health services and health education, consulting doctors seen as taboo. ^13,15Many papers reported son preference and they treat favorable in intrahousehold level, uneven distribution of household food leads to several deficiencies that compromised women health. ^1,2Socio-economic class and poverty emerged as another major barrier to women’s health, therefore, many cannot afford promising health care and others have less access and mobility issues. Gender-based violence is also very common in Pakistan that leads to harmful consequences on the health and wellbeing of women. ⁸

c) Gender Inequality in Education

Low investment in girls’ education was reported in almost all the papers that were under review, the major reason for the low investment is low returns from girls, as the boy perceived potential head of the house and a bread-winner-to-be. ^{9,10,11,12,13,15}A case study reports that people believe that Muslim women should be brought up in a way that they can fulfill the role of good daughter, good wife, and a good mother and school has a “bad influence” to develop these characteristics in women. ¹²Girls become less obedient, become evil and don’t take interest in household chores that is the primary responsibility of her. ¹²Mostly Maulvis who seems strong authority in rural areas misused Islamic teaching and educate parents that through education women become independent so she will not be a good mother, daughter, and wife so these distort the teaching of Islam mostly obstruct girl’s education. Other barriers that play important role in low girl education are related to access and women’s safety, five studies reported that most of the schools are far away, due to long distances and co-education system that perceived as un-Islamic, parents are reluctant to send their daughters for education and they feel unsafe and threatened. ^1,4,12,13,15Poverty is another root cause of gender disparity in education, as parents cannot afford the education of their children and when there is a choice, choice goes to boys due to their perceived productive role in the future, as a result, more dropouts and lower attainment of girls particularly who are residing in rural areas. ^{3,7,8,9,11,13}

d) Gender Inequality in Employment

Economic disparity due to gender inequality and lack of women’s participation is a burning issue in Pakistan. Women are almost 50% of the overall population, this huge number of populations is out of economic growth activities of the country. The low status of women in society, home care responsibilities, gender stereotyping, and social-cultural humiliated practices against women are the main hurdles in women’s growth and employment opportunities. Low education of females, restriction on mobility, lack of required skillsets, sex-segregated occupational choices are also big hurdles in the attainment of economic opportunities, the majority are out of employment however those who are in the economic stream are facing several challenges.³ Once the females are in the market they face discrimination in all layers of the economy, men have the hold on leadership positions, fewer females in decision making, low wages for females, fewer options to opt as professional workplace harassment, and unfavorable work environment that hinders to a long stay on the job. ^1,3,7Moreover, a study reported that in a patriarchal society the very limited number of females are in business and entrepreneurship the main hurdles are capital unavailability, lack of role models, gender discrimination in business, cultural and local customs, and lacking training and education. ⁷

e) Gender Biased Social Norms and Cultural Practices

The gender-discriminatory structure in Pakistani society has deeply rooted in social norms and cultural practices. Gender disparities occur at an intrahousehold level from the beginning of childhood in terms of food distribution, education, and health care rights and later during adolescence as early and forced marriages, denial of inheritance right, mobility restriction, abuse, and violence. ^1,3,4,5,9,11Birth of a boy child was celebrated, the girl seen as a burden, in a traditional stereotype gender role, household chores are a duty of female and that she cannot demand or expect any reward for it, on the other hand, male work has socio-economic value. ^3,5,15Likewise, the female has restricted power in decision making, as a cultural and social norm most of the decisions are done by male figures in a family or a leader of the tribe or community who is always a male, this patriarchal system is sustained and practiced under the name of Islamic teaching. ^5,12,13 The prevalence of gender-based violence is also high, in the form of verbal abuse, physical abuse, sexual assault, rape, forced sex, etc., and consider a private matter which is not the concern of any court. ⁷Another form of domestic violence is “honor killing” or the brutal murder of a female, Karo Kari,Siya Kari, Kala Kali, and Tora-Tora are different forms of honor killing all over Pakistan that is justified as killing in the name of honors or Ghairat. Similarly, women are seen as a commodity and faced other forms of gender-based violence that are bride price, Satta Satta, vani, marriage with Quran, swara, and kari that are prevailing in Pakistani culture. ^1,4,8,14,15Gender inequalities are also practiced by restricting women's political participation as a social norm. ¹³

f) Micro and Macro Level Recommendations

Positive change in gender disparity can only be achieved if women would have equal status and participation in all aspects of life that include, health, nutrition, education, employment, and politics. ^{1,3,4,8,11,15}It is crucial on a macro level as a society to eliminate discriminatory attitudes against women and pay attention to women empowerment at the policy level to legislation and then implementation to accountability. ^1,3For, this constitution of Pakistan should give equal rights to all citizens, and women should be educated about their rights. ^{1,4,5,9,13,14,15}To better the status of women the utmost intervention is an investment in girl education, until and unless women will not be educated, they cannot fight for their rights, gender parity only is achieved if educated women can participate in the decision making process of law and policymaking institutions that should be open, transparent, and accountable. ^{4,6,8,9,11,14}Access to health care services is a woman’s right, proper education, nutrition, antenatal and post-natal care services, skilled birth attendants, and access and awareness about contraceptives to avoid early childbearing is important to improve the women’s health and to reduce maternal mortality.

Similarly, women should be given equal opportunities to take part in national development, and economic activities of the country to reduce poverty, this is possible through fair employment opportunities, support in women’s own business both financially and morally, equitable policies at the workplace, and uniform wages and salaries. Besides these female employees must be informed about their rights and privileges at the workplace and employment. ^1,3,7,11Policy actions should be taken to increase the level of women’s participation in economic growth and entrepreneurship opportunities, there should be active actions to identify the bottlenecks of gender parity and unlock the growth potential of social institutions. ⁶Another barrier for women empowerment is threatened and unsafe environment to thrive, there should be policies and legislation to protect women from harm, violence, and honor killing that ensure the health, safety, and wellbeing of her. ^4,12

Education institutes and mass media are two powerful sources that can bring change in society. Govt must start a mass media awareness campaign on gender discrimination at home, education, and employment to break the discriminatory norms of patriarchal society and to reduce the monopoly of males in the marketplace. Parent’s education on gender-equitable practices is also important to bring the change at the microlevel, gender-equitable child-rearing practices at home including boys mentoring because they think discrimination against females is a very normal practice and part of a culture. ²

There is a scarcity of data on women’s participation and gender parity in health, education, and employment. There is a dire need to identify which type of institution has a greater effect on gender parity and type of intervention will be needed to reduce the gap and to see its link with growth analysis of the country. ⁶

Results of the Qualitative study design, primary data collection highlighted three major themes, as shown in Figure 2.

Perception of women in society:

Perceptions expressed by the community were collected with regards to how women are perceived within society.

a) Woman as a sexual object:

Female participants highlighted that they were seen as “sexual objects” and “a means of physical attraction” which prevented them from comfortably leaving their homes, as family members also encouraged them not to do so. One female participant explained this further as, “we are asked to stay inside the house because men and boys would look at our body and may have bad intentions about us” (Adolescent girl, FGD in Astore). Male participants echoed this narrative as they agreed that women are judged by their physical appearance, such as the shape of their bodies. A male participant stated, “woman is a symbol of beauty and she's seen by the society as the symbol of sex for a man" (Male HCP, IDI in Gilgit).

b) Women as dependent beings:

One of the major study findings suggests the idea that women must be “helped” at all times, as they are naturally dependent upon other persons to protect them. One participant stated, “If a woman is alone, she is afraid of the man's actions” (adolescent girl, FGD in Lower Chitral). Some female participants, however, agreed with this statement to some extent because they felt that the male figure’s role is something women can utilize as a way to fit into society. Oftentimes, judgment may pass for women without an accompanying male. Participants put it as a wife not being able to survive without a husband and daughter not being able to survive without a father. One participant mentioned, “We are only allowed to go out when we have our father or brothers to accompany us” (Adolescent girl, FGD in Astore). `

Other participants agreed with the sentiment differently. Since it is implied that men become easily attracted to women, having a male figure with the woman will protect her from naturally prying eyes. However, if she cannot be accompanied by a male, she must protect herself by suppressing her natural state, a rather paradoxical situation. A male participant reported, “Women should cover themselves and stay inside the house” (married man, FGD in Nagar). One female participant verbalized, “We have breasts, and therefore, we are asked to dress properly". Another stated, “girls are supposed to dress properly and avoid eye contact with boys while walking on the road” (adolescent girls, FGD in Astore).

c) Women’s autonomy

Female participants, especially young adolescent girls, shared how restrictions governing their actions affected their livelihoods. Participants expressed how easy it is for males to gain permission and leave the house, while females often have a series of red tape in front of them. A young girl stated, “There are a lot of constraints when we see women in our culture. They must take care of everything at home, yet they must get everybody's permission to go five minutes away. Whereas a boy can go out of town and that too, without anyone’s permission. Looking at this, I wish I were a boy. I'd go wherever I want, and I could do whatever I want” (adolescent girl, FGD in Lower Chitral).

d) Males as an identity for females:

Women are often identified through a prominent male figure in their life and are not considered to have individual personalities and identities. A female participant mentioned that a “woman is someone having a low status in society. People know her through their husband or father name” (married women, FGD in Lower Chitral).

e) Child’s upbringing responsibility:

Culturally, it is expected of the female members in the family, often mothers, to rear children and take care of their upbringing. Male members, mainly fathers, are expected to provide financially and tend to the male children more than the female children. Female children are expected to learn from their mothers. These designations are deemed important because society would blame the designated parent for a child’s missteps, hence, tarnishing reputations. Yet, it seems like the mother takes a greater portion of the blame for male and female children, considering her role to raise the family within the household. A married woman explained that "If a girl does something, the mother is blamed for that. Even in our house, my mother-in-law talks to my mother if I argue or refuse for anything. This is the culture in my maiden home as well" (Married Woman, FGD in Nagar).

f) Unrecognized contribution of women:

Many female participants verbalized their concern for the disregard they receive from their families despite contributing significantly. Women who take on major roles in maintaining the household and family unit are not recognized for their efforts. By doing the cleaning, cooking, and other duties, they keep the family healthy and help keep costs low. One participant mentioned, “if women don’t clean the house, it is extremely dirty. If women do not rear children, no one else would do it. We do so much for the family” (married woman, FGD in Hunza).

g) Restriction for self-expression:

Both men and women struggle with self-expression as certain expectations for both genders hold people back from expressing their true selves. Men, for example, as indicated by participants, are expected to remain firm in challenging situations and not show emotion. Even in hobbies, participants shared that, parks and recreational activities are geared towards young boys and men, while girls and women are given more quiet and indoor activities. A female participant verbalized that, “boys have a separate area where they play cricket and football daily but for girls like us, only indoor activities are arranged” (adolescent girl, FGD in Gilgit). In places where males and females freely mix or live closely in one area, people also often find themselves taking extra precautions in their actions, as to not be seen as disgraceful by the community. One female participant reported, “two communities are residing in our area. Events for females, such as sports day, are very rarely arranged. Even then we cannot fully enjoy because if we'll shout to cheer up other players, we would be scolded as our community is very cautious for portraying a soft image of females of our community” (adolescent girl, FGD in Gilgit). Another participant stated that, “after prayers, we cannot spend time with friends as people would point that girl and say that she always stays late after prayers to gossip when she is supposed to go home” (adolescent girl, FGD in Gilgit).

h) Deprivation of women’s rights

A woman's liberty has always struggled to be accepted as power struggles within communities often favor males, thus, women are given lower status. Participants highlighted that, in general, men are seen as superior to women. One participant stated, “men are the masters of women…” (FGD married women Gilgit). On the other side of the coin, even though men suppress female liberty, women often do not know what their rights would be, leaving them vulnerable to deprivation. A female participant explained that “women do not dominate society that's why people take away their rights from them" (married woman, FGD in Lower Chitral). Female participants also shared that they see men as having stronger and more dominant personalities, making them better suited to decide on the provision of rights, medical care, making an income, gaining life opportunities, and reproduction. One female participant verbalized, "If there's one egg on the table and two children to be fed, it is considered that males should get it as it is believed that males need more nutrition than us" (HCP, IDI in Upper Chitral). Another reported that “There is a lack of equal accessibility of health care facilities and lack of employment equality for women” (HCP, IDI in Upper Chitral).

Figure2: In here

Theme 2: Perception of men in society:

a) Male Dominance:

Inferiority and superiority and common concepts are seen in Pakistan's largely patriarchal society. This allows men to be seen as the dominant decision-maker in the family and as the sole breadwinner. Women, however, are caught in a culture of subordination to men with little power over family and individual affairs. A female participant said, “if we look at our society, men are dominant. They can do anything while a woman cannot, as she is afraid of the man's reactions [gussa] and aggression” (adolescent girl, FGD Lower Chitral). While another reported, "In our society, husband makes his wife feel his superiority over her and would make her realize that it is him, who has all the authority and power” (married woman, FGD at Lower Chitral).

b) Inclination towards the male child:

There is often an extreme desire for the birth of sons over daughters, which adds to the culture of gender discrimination in Pakistan. Male children are important to the family as they often serve their parents financially, when they are able, even once they are married and up until the parents reach old age. This is one of the main reasons that parents are more inclined towards the birth of a male child rather than a female child. Hence, why education is also more prioritized for male children. For women, female participants expressed that their desire for a male child is to appease the husband’s family and reduce the pressure on her to fit in. According to a female participant, “when my son was born, I was satisfied as now nobody would pressurize me. I noticed a huge difference in the behavior of my in-laws after I gave birth to my son. I felt I have an existence in their family” (married woman, FGD in Astore). Participants highlighted, that, women who have brothers are often more protected as brothers create a sense of intimidation, a considerable benefit for women. According to a young participant, "brothers give us the confidence to move within the society because people think before saying anything about us" (adolescent girl, FGD in Astore).

c) Lack of communication of husband with wife:

Married couples often lack communication skills as they rarely discuss important matters with each other. Men often choose not to share issues with their wives as they believe that they are not rational enough to understand the situation. A male participant stated, “Women are so sensitive to share anything. They can only reproduce and cook food inside the home” (married man, FGD in Skardu).

d) Men are protectors

Many female participants verbalized their consideration of men as protection, as they take on the heavier burdens of finances and public security. They feel confident in a man’s ability to contribute to their livelihoods in those ways. One participant mentioned, “We go out when we have our father or brothers to accompany us” (Adolescent girl, FGD in Astore). Another highlighted, “men are our protectors. We can only survive in the society because of them” (Married woman, FGD in Astore).

Theme 3: Factors reinforcing gender discrimination.

a) Influence of generation gap:

With a tight-knit family situation and collective mindset that Pakistanis value, differences of opinion exist within family systems, and between different generations, which can affect how one views gender. Participants highlighted the role of the older paternal matriarch who often favors their sons and male family members. Daughter in-laws, as expressed by married women, often struggle to find their voice in this situation. One participant mentioned, “we don’t take decisions on when to have the child or what method needs to be used for family planning. Our mothers-in-law decide and we have to obey” (married woman, FGD in Astore). The family system that often includes three generations living closely, allows traditional norms to carry forward, as opposed to a typical nuclear family that may fizzle out these ideas. This includes considering attire, conduct, and relationships. One participant mentioned, “I live with my mother-in-law. I have to cover my head whenever I had to leave the house. My sister-in-law lives separately with her husband, and she does not have to follow these rules” (married woman, FGD in Nagar).

b) Media influence on gender discrimination:

Characteristics perpetuated through media also play a vital role in the association of stereotypes to males and females. Advertisements, for example, pictorials represent young girls and boys. However, advertisements for activities such as washing powders show young boys playing happily. But advertisements for cooking oils and spices usually show young girls helping their mothers in the kitchen, with men often enjoying something else or are nowhere to be seen. These 15 seconds are impactful in perpetuating gender conduct solely for societal acceptance. One participant verbalized, “every household has a radio, on which different advertisements are going on. People get messages through media” (married man, FGD in Sindh).

c) Gender Discrimination in Healthcare:

Results showed the need for increased attention towards SRH issues, especially for males. Participants felt disregarded in terms of their health because they did not have services catered to them. Oftentimes, only female HCPs are present in facilities and many male participants felt discomfort while sharing SRH related concerns with them. One participant stated, “Males usually do not visit the clinics as they feel uncomfortable sharing their SRH concerns with LHVs. Therefore, they send their wives and we counsel them” (HCP, IDI in Gilgit). Hence, any SRH information given to males is often second hand where they may not get all the information they need. Since they are getting some information, they do not feel the need to go in person which can cause treatment delays if they have a concerning SRH issue. Another female participant reported, "Males don't visit our clinics because they feel shy in discussing SRH issues with females due to cultural concerns. Sometimes, when their wives tell us about those issues, we realize that the case has worsened and ask them to visit the hospital in the main city" (HCP, IDI in Gilgit).

d) Gender Discrimination in Schools:

Adolescent boys shared their concerns about schools not meeting their needs in terms of sharing information on SRH. They explained that girls often attend SRH sessions on sexuality, breast cancer, and menstruation, where boys do not have the same access to SRH awareness sessions. A young boy stated, "We also go through changes during puberty, but no one teaches us about it at school" (Adolescent boy, FGD in Ghizer). Therefore, they look to outside sources such as friends and the internet to answer their questions, which can often result in misinformation. One participant mentioned, “I only discuss issues related to SRH with my friends. But I mostly search on the internet” (Adolescent boy, FGD in Lower Chitral). The authenticity of each source can be questioned, thus, indicating the need for adolescent safe spaces for both adolescent boys and girls to speak about their SRH questions and concerns. Another participant explained, “separate spaces are suitable for both girls and boys because both can freely express themselves” (Adolescent boy, FGD in Ghizer).

Theme 4: Gaps & recommendations from the eye of participants/community/society:

Several challenges pertain to the issues outlined in this study of gender discrimination. A lack of female autonomy and empowerment were recognized as critical reasons for the disregard of women in society and discrimination against them. They do not have the means to participate in society, nor are they allowed to speak against traditions. Therefore, attention must be centralized around these concepts to increase female autonomy and decision-making roles, while allowing them to negotiate their capacity in a role with other people. One of the major contributors to this is male dominance, which must be brought down to build up women. The male role is often overbearing, yet they remain absent from their women’s life. Women life is on their female relatives, further exacerbating the effects of opposing social roles held by men and women. To reduce this, communication is key between spouses and family, and community members surrounding issues that impact the communal livelihood.

Gender discrimination affects both the micro and macro levels of Pakistani society, kept in tow by established institutions. Therefore, public systems such as media outlets, healthcare practices, and schooling systems, must exhibit a change in the way they conduct affairs. Thus, they must include gender equity and equality that eliminates gender discrimination. Perpetuating stereotypes, such as allowing boys to be active outdoors and forcing girls indoors on television advertisements and in schools, only feed a culture of gender discrimination. Depicting these narratives makes it harder for individuals to change their situations and change the perspectives of society. In terms of SRH, HCPs play an important role in acquiring knowledge and training to best treat male and female patients. Both males and females become neglected in different SRH areas about a lack of resources, staff, and attention. Schools and communities also play an important role in sharing SRH knowledge with young people. Once they are knowledgeable, you educate generations to come and generations before that may be unaware of the challenges that individuals face such as puberty, pregnancy, and motherhood. Thus, authentic information sharing can be taught through certified curriculums in schools, furthering the education of communities and using knowledge acquisition to close the gap between male and female educational levels.

Our study revealed that women are not allowed to step out of the house because they are seen as sexual objects. This identity of a woman only being assessed by the way she looks has tremendous implications on the way she is perceived, as these notions instill fear in the woman and fundamentally limit their autonomy in various aspects of life. Many women face difficulty leaving the households alone and they require protection from men and men. ²Men are, therefore, labeled as protectors while women are regarded as dependent beings who need a man's identity and his aid in every role that is conducted outside of the home.

The role of men inside the house was identified as authoritative, while women seek approval of the male figure because she is seen as incapable of making sound decisions on her own. A woman’s primary responsibility is only associated with being the caretaker of the family, most often as the role of a mother. However, even these contributions go unnoticed as the attitude “who else would do it” is adopted by the culture. These gender power differentials are so strong in households, that many women do not know their rights. Women comply with the societal and cultural values that force them to become lesser beings in society. Girls in society grow up to eventually adopt the well-learned role of women, awaiting their destiny to be discriminated against and enduring unequal distributions of human rights. ⁷

Despite the discrimination against women that our study outlines, other studies indicate a positive change of gender norms that labels women as more educated and sincerer in society. ²Through the gradual modification of gender roles, there is an increase in educational levels of women associated with enhanced access to information, increased autonomy, and the spread of more liberal ideas amongst women. ²Although this change in perception is gradual, perhaps the slow increase in education level amongst women can serve to enlighten women to act against the patriarchal ideals that are upheld in Pakistani society.

Men labeled with a dominant role in society also perpetuate gender discrimination and strengthen the patriarchal norms set in stone throughout generations. Acts of discrimination manifest due to the deep-rooted prejudices against women as well as stereotypes that are perpetuated across generations to become the norm of Pakistani society. ¹Prejudice is further bolstered by cultural and religious values, that deem to subordinate women in society. The discrepancy in power structures within the family system often leads to a lack of communication between married couples as men do not share their responsibilities with their wives, often considering women to be incapable of understanding. ⁶

Furthermore, a very common phenomenon observed in Pakistani society is the intense desire for a male child, while the birth of a female child is mourned. Girls are seen as a liability, while the birth of a male child is celebrated as it is believed that he will be the breadwinner for the family. ⁶This inclination for a male child extends to the point where female feticide can be observed and innumerable female fetuses are aborted. ⁸However, studies also suggest that the preference for a son is only significantly increased in low socioeconomic areas. In the areas where the impoverished conditions are lifted, such discrepancies disappear. ⁸ This claim of the study opposes our qualitative understanding of the inclination towards a son. However, this does not discredit the perception that only men are seen as economic and social security providers of the household. Therefore, the tag of manhood in society, through which hierarchal familial structures are produced, attributes great power to the gender label of a man. This increases the disparity of roles between men and women leading to the reinforcement of gender discrimination.

Lastly, our study revealed the theme of social factors, such as living in a joint family system, reinforcing the unequal societal values set by previous generations for women in society, ⁶maintaining gender-discriminatory notions in Pakistani society. These values are further asserted by the media through advertisements that often assign household chores to a woman while equating men to having economic and professional roles in society. Such stereotypes brought about by different media outlets insist on the adaptation of each gender into their separate and opposite roles in society, instead of having cohesive societal roles that work together with one another. Previous studies suggest an interesting note on the role of social institutions raised was the idea that women have a role in social institutions to continue the cycle of gender discrimination. They labeled this idea as "what I got – I give back" and stated that women who gain influential power with age, reinstate, and perpetuate gender norms that go against women (6). This phenomenon was not evaluated by our study and perhaps future studies can address these concerns.

Challenges

The execution of the study faced several challenges, as some participants could not reach the venue due to extreme weather conditions, and the team found it difficult to reach out to them due to poor connectivity. Also, the lockdowns following the pandemic made it very difficult to gather 10-12 people at one place for the FGDs. Interviews could not be done virtually as the information was very sensitive.

Strengths of the study

The use of group interviews allowed rapport development with communities and created a meaningful and intimate setting for data collection. With multiple people present, sharing similar views, many were inclined to give purposeful answers and recommendations regarding gender roles in communities. Based on previous literature searches, this study, to the best of our knowledge, has not been published in Pakistan at the community level. No other study also explores the views of Pakistanis on their healthcare, sexual health, and genders with the inclusion of multiple community groups and across multiple districts.

Limitations

Topics given were of a sensitive nature which may have held back participants from answering fully and truthfully. Thus, considerable time was taken to develop some sense of conformity and trust for participant comfort. Yet, it is possible that some study subjects still may not have had that reassurance to answer to the best of their ability. Also, challenges out of our control, during the study, that may have limited its conclusions. This included the COVID-19 pandemic and extreme weather conditions in some areas which limited participant follow-up for a select few subjects. To minimize this, efforts to reach participants virtually were made, especially, where in-person follow-ups were not possible.

Gender roles in Pakistani society are extremely complex and are passed down from generation to generation with minimal change regarding how women are viewed. This study reveals some of the factors as to why women in Pakistan face gender discrimination. This notion is partly established due to the preservation of cultural and societal values that place the woman in the household with a more nurturing role/identity in society. Through the reinforcement of these roles by different family members, as well as by the dominant men in society, women face adverse challenges to seek empowerment that will help them defy such repressive roles assigned to them. There is also a lack of acknowledgment and safeguarding of these social norms by public institutions such as in healthcare facilities and schooling systems. Administrative reorganization in these healthcare facilities and proper education in schools for boys and girls will help serve to decrease the gaps between the societal roles of men and women that allow for gender discrimination to take place.

Aga Khan Foundation of Health AKF

British Broadcasting Cooperation BBC

The Cable News Network CNN

Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA

Reporting of Observational studies in Epidemiology STROBE

Intimate Partners Violence IPV

healthcare professionals HCPs

Lady Health Visitors LHVs

Lady Health Workers LHWs

Community Midwives CMWs

In-Depth Interviews IDIs

Focus Group Discussions FGDs

Heads of the Departments HoDs

Sexual and Reproductive health SRHR

United Nations Population Fund UNFPA

We declare that this is original research and all the authors have contributed to the proposal writing, funding management, data collection, analysis, and manuscript development.

Declaration of Conflict of Interest: Authors declare that they have no conflict of interest.

Consent for publication: All the authors consented to publications and we ensure that there is no personnel data in this manuscript.
Availability of data and materials: On request, the data will be available by hiding the IDs
Ethics approval and consent to participate: The written informed consent was from all the participants and the parent or guardian for the participants under 16 years old.
Competing interests: None
Funding: Global Affairs Canada (GAC)Project No: P006434; Arrangement #: 7414620
Role of the funder: This is to declare that there was no role of the funding agency for the planning and implementation of this study.

Ethics Approval and Consent to Participate: The Ethics approval was received from Aga Khan University Ethics Committee. The ERC number is 2020-3606-11489. Zulfiqar Bhutta: SIHAAT MAND KHAANDAAN – HEALTHY FAMILIES FOR PAKISTAN THROUGH ACCELERATING SEXUAL AND REPRODUCTIVE HEALTH (SRH)

Acknowledgment: The authors wish to thank the Research specialist, Coordinator, research associates for data collection, and the study participants for their time and valuable data. We would also like to appreciate and thank Mr. Adil Ali Saeed for helping us with the literature for the systematic review of the paper, and Ms. Amirah Nazir and Daman Dhunna for the overall cleaning of the document. We are thankful to UNFPA and AKF for providing advisory and monitoring support.
Authors' contributions: All authors have read and approved the manuscript

TSA contributed to proposal development, tool development, ERC approval, data supervision, Data validation, Systematic review, Data analysis, manuscript development, and overall supervision.
SS assisted in proposal development, data collection supervision, Data validation, Systematic review, Data analysis, and reviewed manuscript.
SN, contributed in -Literature Review, Analysis of literature review and its write up of findings.
ZM reviewed tools, assisted in ERC approval, filed preparation for data collection, assisted in Data validation and enhancing the approval processing, Review the Data analysis, and reviewed the final manuscript.
SS, contributed to proposal development, assisted in ERC approval, overall supervision, filed preparation for data collection and training the data collectors, assisted in Data validation and enhancing the approval processing, reviewed the final manuscript.
FM contributed to the tool development, facilitated field data collection, and contributed to the validation and analysis processes. Reviewed the final manuscript before submission.
YK contributed to the tool development, facilitated field data collection, and contributed to the validation and analysis processes. Reviewed the final manuscript before submission
SM, contributed to proposal development, field preparation for data collection, Validation, and reviewed the final manuscript.
ZB, contributed to proposal development, brought the funding, assisted in ERC approval, overall supervision, data validation, and enhancing the approval processing, reviewed the final manuscript. He provided overall mentorship

Iqbal H, Afzal S, Inayat M. Gender Discrimination: Implications for Pakistan Security. IOSR Journal of Humanities and Social Science 2012; 1(4), 16-25.

Delavande A, Zafar B. Gender discrimination and social identity: experimental evidence from urban Pakistan. FRB of New York Staff Report 2013; (593).

Alam A. Impact of gender discrimination on gender development and poverty alleviation. Sarhad J. Agric 2011; 27(2), 330-331.

Bukhari MAHS, Gaho MGM, Soomro MKH. Gender inequality: problems & its solutions in Pakistan. The Government-Annual Research Journal of Political Science 2019; 7(7).

Ejaz SS, Ara AA. Gender Discrimination and the Role of Women in Pakistan. Journal of Social Sciences and Humanities 2011; 50(1), 95-105.

Ferrant G, Kolev A. Does gender discrimination in social institutions matter for long-term growth?: Cross-country evidence. EconPapers 2016; https://econpapers.repec.org/scripts/redir.pf?u=https%3A%2F%2Fdoi.org%2F10.1787%2F5jm2hz8dgls6-en;h=repec:oec:devaaa:330-en

Mahmood B, Sohail MM, Khalid S, Babak I. Gender-specific barriers to female entrepreneurs in Pakistan: A study in urban areas of Pakistan. Journal of Education, Society and Behavioural Science 2012; 339-352.

Tarar MG, Pulla, V. Patriarchy, gender violence and poverty amongst Pakistani women: A social work inquiry. International Journal of Social Work and Human Services Practice 2014; 2(2), 56-63.

Kazimi AB, Shaikh MA, John S. Mothers Role and Perception in Developing Gender Discrimination. Global Political Review 2019; 4(2), 20-28.

Atif K, Ullah MZ, Afsheen A, Naqvi SAH, Raja ZA, Niazi SA. Son preference in Pakistan; a myth or reality. Pakistan journal of medical sciences2016; 32(4), 994.

Rabia M, Tanveer F, Gillani M, Naeem H, Akbar S. Gender inequality: a case study in Pakistan. Open Journal of Social Sciences 2019; 7(03), 369

Shah S, Shah U. Girl education in rural Pakistan. Revista Internacional de Sociología de la Educación 2012; 1(2), 180-207.

Hamid A, Ahmed AM. An analysis of multi-dimensional gender inequality in Pakistan. Asian Journal of Business Management 2011; 3(3), 166-177.

Bhattacharya S. Status of women in Pakistan. Journal of the Research Society of Pakistan 2014; 51(1).

Butt BI, Asad AZ. Social policy and women status in Pakistan: A situation analysis. Orient Research Journal of Social Sciences 2016; 1(1), 47-62.

Table 1: Showing the results of the summary of the selected articles

S #

First Author, Year & Title

Objectives

Population & Setting

Research Design & Data Collection

Main Results

Perpetuating factors

Recommendations

1

Iqbal (2012)

Gender Discrimination: Implications for Pakistan Security[i]

To describe the gender discrimination in Pakistan
To describe gender discrimination in education and employment
To discuss gender and human security

Pakistan

Desk review, narrative research

Gender balance can be improved by enhancing non-traditional security

Gender discrimination against females can be reduce by providing them equal chances at the workplace and in society.

Social Cultural

-Patriarchal society

-Honor killing

-low social, economic, and political status in society

-DV is personal matter

Education:

-Cultural boundaries

-Co-education

-poor physical environment and lack of fundamental services in education sector

-limited opportunities for rural girl for education

Employment:

-low literacy rate

-Marriage

-Childbearing

-unfavorable work environment

-discrimination in male and female pay scale

-Low promotion

-Fewer female in decision making and leading position.

Eliminate discriminatory attitude of the society towards the women.

The constitution of Pakistan guarantees equal rights to all citizens and make sure the forceful implementation.

Govt must start mass media awareness campaign on gender discrimination in employment.

Female employees must be informed about their rights and privileges.

NGOs should come forward to support the victimized female employees to get justice.

-Govt should compilation annual reports of Human resource in Govt. and private sector.

More investment on female education

2

Delavande (2013)

Gender Discrimination and Social Identity: Experimental Evidence from Urban Pakistan[ii]

To find out the discrimination against females regarding gender and social class

N=2836

male and female students

from Islamabad, Rawalpindi and Lahore

Experimental design

-Survey questionnaire

Nature and intensity of gender discrimination is not same in all educated class

Higher socioeconomic status females are not discriminated and are even favored in some instances by males

Women of lower socioeconomic status are discriminated against by certain groups of men

-Low socioeconomic status

-Discrimination because of Social Identities (Class, ethnicity, race)

-Push for policies favoring economic development, such as education policy, will lead to an improvement in women's rights and status.

-Male education can play an important role in discrimination as educated males tend to discriminate less

-Gender equitable child rearing practices at home including education to boys.

3

Alam (2011)

Impact of Gender Discrimination On Gender Development and Poverty Alleviation[iii]

To know the main reasons and areas of gender discrimination and its impact on development and poverty alleviation

N=50

25 Male and 25 female selected from purposive sampling from Peshawar

Cross-sectional study

Survey questionnaire and Interview

Gender disparity exists in targeted geographies.

women have no or low share in income / earnings of the family

Women are more vulnerable to poverty, women share more burden of productive and household work.

Women are not given equal opportunities in jobs

Gender inequality hinder poverty alleviation.

Lack of women participation in development and women have no political and propriety rights.

Lack of skill enhancement opportunities for women would affect poverty alleviation and gender development.

No equal status of women in family as she didn’t contribute to family earning.

Female were not allowed to work outside home.

Decision makers are male in household.

No equal opportunity in higher education for females

Old traditional role of male and female hindering the women development

Sex segregated occupational choices; females are only in teaching.

Females are economically dependent on man

Exclusion from development and it affects poverty alleviation.

Equal educational opportunities and quality education should be provided to women for different jobs.

women should be given equal rights and power of decision-making.

Equal opportunities of Participation

to bring equality in resources distribution

Household and productive burden should be share equally that may help in poverty alleviation.

Skills training facilities should be available for females

Equal opportunity in family affairs.

Need of policy formation focused on women empowerment for poverty alleviation and gender development.

4

Bukhari (2019)

Gender Inequality: Problems & Its Solutions In Pakistan[iv]

To highlights the practices of gender discrimination,

identifies the problems and its solutions in Pakistan

Pakistan

Desk Review, narrative research

Female discrimination is present due to socio-cultural norms in Pakistan.

Gender discrimination mostly influence by tribal, feudal and

religious social formations.

Financial problems are a major concern for educating the women

Girls face harassment and criticism from society while traveling

- Rural females are suffering more in terms of getting education.

-Government seats mostly occupied by males.

Male dominancy

Lack of participation in discission making

Social cultural norms and inhuman cultural practices

Co-education and boarding facilities are hindrances in girl education.

Provide equal status and opportunities to women in society

Empower women by promoting education, training, and professional development

Ensure the Health, safety, and well-being of all women and men.

Protection against domestic violence and legislation against Domestic violence

Equal representation in public and private sector

5

Ejaz (2011)

Gender Discrimination and The Role of Women in Pakistan[v]

To review the practices of gender discrimination, its contributing factors and recommendation to make women powerful in society.

Pakistan

Desk review, narrative research

In Pakistan as Muslim society gender discrimination, it is in the most hideous form

Islamic values and laws were fabricated and presented as subliminal messages.

Some writers use their venomous words to disgrace and degrade women openly

Girls passively wait to accept their destiny with anticipation of discrimination, injustice, and unequal distribution of human rights.

Patriarchal society

Low education level.

Discriminatory laws in Pakistan

Unequal Sexual division of labor

Reproductive activities

Cultural Norms and practices

Early and forced marriages

Fabricated Islamic messages

Brainwashing at toddler age and

intergenerational passing of submissiveness by mothers

Stereotype role of women in media.

Women themselves must understand their proper status in the society

Awareness of rights are important for both male and female and they need to respect each other,

Efforts can be made to make people understand the translation of the holy Qur'an.

Unbiased teaching of Islam to provide women with appropriate knowledge making them all-powerful in the society

6

Ferrant (2016)

Does gender discrimination in social institutions matter for long-term growth?[vi]

To estimate the potential income gains associated with gender parity and the cost of the current level of discrimination.

Multicultural study including Pakistan

Cross country secondary data analysis

Gender-based discrimination in social institutions obstructs the economic development and income of the country

The association between low economic development gender disparity is stronger in low-income countries.

Per-Capita income of both and females are reducing because of gender discrimination

High income

countries have lower levels of gender-based discrimination in social institutions

Less access to education

Gender disparity in social

institutions need to be integrated in growth analysis of the country.

More investment on girl education and trainings.

Social institutions should be gender responsive and have gender-transformative policies.

Identify the bottlenecks of gender parity and unlock the growth potential of social institutions.

Dire need to identify which type of institution have greater effect and which intervention will be needed to reduce the gap.

7

Mahmood (2012)

Gender-Specific Barriers to Female Entrepreneurs in Pakistan: A Study in Urban Areas of Pakistan[vii]

To determine gender-specific barriers and its impact for female entrepreneurs in Pakistan

N=160

Females from

Faisalabad Multan Sukkur Sargodha Sialkot

Cross sectional Study

Self-administered survey questionnaire and in-depth interviews

Female entrepreneurs are very

important to economic and social development in Pakistan.

Female entrepreneurship is a grater tool to transform economy of Pakistan.

Female participation in entrepreneurial activities is not only empower them economically but also have positive social influences on women themselves, their families, and their social environment.

Capital unavailability

Lack of finance

Poor knowledge about

loan process

discrepancy in property rights

Culture and local customs

Restriction on mobility

Communication gap with men Limited decision making

role models and guiders

Lack of education

Gender discrimination

Men’s hold on market

Childcare burden

Family pressure

Discrimination

Harassment

For the development of full potential of women there is a need to understand recognize and support them.

Make sure the women participation in economic activities to achieve sustainable goals.

Ensure the provision of finance.

8

Tarar (2014)

Patriarchy, Gender Violence and Poverty amongst Pakistani Women: A Social Work Inquiry[viii]

To find out discrimination and violence against women in Pakistan and its interplay with patriarchy and poverty.

To examine how the patriarchy, us a tool to

N=52

Females living in Shelter home Punjab Pakistan

Descriptive qualitative, Primary research paper Interviews

Women are vulnerable to different types of violence, and this vary by class

There is a relationship between patriarchy, poverty, and gender violence

Poverty appears to be the direct cause of gender violence

Poverty

Patriarchal society

Economical dependency

less access to education

Husband’s drug addiction

Understanding of psychological, social, and gender aspects of violence to eradicate poverty.

Educate and empower women to promote economic, social, and gender equalities as well as to improve the social structure.

Empowerment oriented social workers to focus on victim's strengths, adaptive skills, and competencies to resolve their problems.

9

Kazimi (2019)

Mothers Role and Perception in Developing Gender Discrimination[ix]

To analyze role of mothers in developing child personality and social behavior.

To explore mother role in developing gender discrimination.

N=183

Mothers

Residing in urban and rural Sindh province selected through purposive and random sampling

Mix Method research Design

Survey Questionnaire and narrative inquiry

Urban and rural mothers both have discriminatory behavior

Mother's attitudes towards boys and girls are highly biased and both treated differently.

Mother's discriminative behavior helping in promoting and developing gender discriminated behavior in society especially in rural areas

-Mothers are not aware that they are harvesting the gender gap in society with their discriminative behavior

-Mother can play a role to reduce gender discrimination.

Discriminatory child rearing practices

Son preference

Pro male behavior

Patriarchy

Lack of participation in decision making.

Violation of property rights.

Women education and adult education programs for the awareness of the consequences of mother behavior

Provision of equal rights and opportunities for both men and women

Mother education for gender parity in practices.

Schools can play a role and should focus on this problem and guide parents.

Use of Media especially television for developing awareness among mothers

10

Atif (2016)

Son Preference in Pakistan: A Myth or Reality[x]

To study the relationship between various demographic characteristics and desire for son

N=506

Married females of Childbearing age from Peshawar, Pakistan

Cross-sectional Study

Survey questionnaire

Significant relation between sons desired and female

education, husband’s education, and socioeconomic class.

No significant impact of religion on desire for sons.

Significantly higher desire

for infinite number of sons than daughters, or want at least one son

Dowery

Lack of social support

Couple counseling to reduce gender bias

Girls should be given equal chances to be wishfully borne by their parents, and live with equal right

11

Rabia (2019)

Gender Inequality: A Case Study in Pakistan[xi]

To explore the perception of male and females on gender inequality in Pakistan

N=357

Male and female College students from Sialkot Punjab, Pakistan

Cross sectional Study

Survey questionnaire

There is gender discrimination in home, in education and at workplace.

Parents give more importance to boys as compared to girls

Women can work outside their home if the income is not adequate.

Mostly backward area people have controversial thoughts about women and more women experienced gender inequality

-Honor killing and practices like acid attacks are very common.

-Son preferences

-Child rearing practices

-Social norms

Government and public both should work to promote education and professional development for women.

Removal of discriminatory attitude

of the society towards the women.

Encourage women participation in economic growth.

Equal opportunity to both men and women at home, education and workplace.

Ensure health, protection, and happiness for all women

Provide protection against domestic violence and mistreatments

12

Shah (2012)

Girl Education in Rural Pakistan[xii]

To identify the barriers of girl’s education in rural areas and recommendations to eliminate these barriers.

N=35

Stakeholders in education including parents and teacher from a rural Punjab, Pakistan

Case study

In-depth interviews

Field notes/ Observations

Muslim girl should be brought up as she can become good wife, daughter, sister, mother and wife.

Poverty and lack of public

education is considerably lower in rural areas

Cultural norms

Child rearing practices

Patriarchy

Religious leaders

Poverty

Co-education

Distance of school

Child labor

Early Marriages

Domestic role of female

Lower status of female in society

Absence of female teachers

Creates proactive policies, essential infrastructures, and necessary resources

Ensure the safety and protection of girls.

Awareness and community sensitization for girl education.

Create girl’s enrollment campaigns at local level with some incentives on enrollments

Partnership between all stakeholders at all levels.

13

Hamid (2011)

An Analysis of Multi-dimensional Gender Inequality inPakistan[xiii]

To investigate multi-dimensional gender inequalities faced by women in the socio-economic and political scenario of Pakistan

Pakistan

Comparison made between male and female

Desk review

Women in Pakistan are suffering from multi-dimensional inequality

The dimensions of family, women identity, health, education, women access to economic resources, employment and participation in politics contribute significantly to the discrimination of women.

Discrimination against women starts from the very beginning

Poor and inadequate health and nutrition facilities for antenatal women and SRHR

Very low women employment in non-agricultural sector and mostly are in informal sector where wages are very low

Patriarchy

Child rearing practices

Poor and inadequate services

Male control over financial and physical assets

Son preferences

Lack of participation in decision making

Low education:

poverty

domestic and farming responsibilities

low access to schools

early marriages

socio-cultural practices.

Unsafe places

Low employment:

Lower education

Social cultural norms

constraints on women’s mobility

Provision of opportunities to women in the form of education, better health, possession of assets, employment and for participation in politics

-Legislation of laws to protect women rights

Creation of gender friendly enabling environment for economic, social, and political participation.

Parents sensitization on right of female child and make sure the active participation of girls at all levels.

Provision of Child Friendly Schools, trainings and skills program for females

Introduction of uniform wages and salaries for both gender

14

Bhattacharya

(2014)

Status of Women in Pakistan[xiv]

To evaluate the role of women in relation to various layer of state and society.

Pakistan

Desk Review

Narrative

Quranic principles are frequently avoided and twisted, especially regarding the status of women

Guardians of the faith take them as customary to 'punish' women and ostracize them

Islam not only gives basic equality to women but also equal legal rights

Patriarchy has caused a total disregard for women in Pakistani society.

Feudal system in society has also caused severe antipathy towards women.

Medieval cultural practice

Women ignorance about their rights.

Anti-Islamic cultural practices and traditions (Haq Bakhshish)

Tribal judicial system

Institutional and individual violence

Patriarchy

Female viewed as inferior.

Feudal system

Violence at home

Honor killing

Selling of Bride

Dowery

Acid Attack

Frequent training and awareness programmers are needed to be arranged periodically to make women aware of their rights

Public, as well as private sectors, should be established to provide job opportunities to rural women so that they can earn income

Laws need to be reviewed and adequate implementation of laws to provide a safe and secure environment for women

Education and awareness of men and women both are very important

15

But (2016)

Social Policy and Women Status in Pakistan: A Situation Analysis[xv]

To review status of women and social policies in Pakistan

Pakistan

Desk Review

Descriptive research

Govt. is unwilling to improve women status in country.

Women face poverty, lack of access to health and education services

There is unavailability of domestic policies to protect women from violence and gaps in implementation

The is a high ratio of gender inequality and sone preference in rural and urban areas

- Property rights is often transferred to the male members of the society

-Political instability worsen the situation and increase the gender gap.

lack of gender friendly policies and implementation.

Patriarchy

No property rights

Gender Based Violence-

No equal rights

Sexual abuse/rape

Health

inaccessibility of health facilities

Cultural norms and taboos

poverty-lack of services

domestic violence

Education

-Child Marriages

-lack employment opportunities

-sex segregation

-school distance

Domestic chores

Co-education

Son preference

Parents illiteracy

Employment

-Narrow job opportunities

-home responsibility

-small industries

-traditional division of labor

-temporary positions

Provision of equal rights for women.

Awareness and education to both males and females about equal rights

Actual Islamic practice should be followed.

Proper allocation of budget for women empowerment

Table 2 shows the total number of IDIs that were conducted in all selected sites.

Categories	Chitral	Gilgit	Sindh	Total
Gynecologists	2	5	3	10
Administrators/HoDs	2	6	3	11
LHV/CMW/Nurse/LHW	4	7	6	17
Total	8	18	12	38

Table 3 shows the total number of FGDs conducted in all study sites.

Categories	Chitral	Gilgit	Sindh	Total
Married Men	2	6	2	10
Married Women	3	6	3	12
Adolescent Boys	4	8	2	14
Adolescent Girls	3	6	2	11
HCPs	2	6	2	10
Total	14	32	11	57

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[ii] Delavande, A., & Zafar, B. (2013). Gender discrimination and social identity: experimental evidence from urban Pakistan. FRB of New York Staff Report, (593).

[iii] Alam, A. (2011). Impact of gender discrimination on gender development and poverty alleviation. Sarhad J. Agric, 27(2), 330-331.

[iv] Bukhari, M. A. H. S., Gaho, M. G. M., & Soomro, M. K. H. (2019). Gender inequality: problems & its solutions in Pakistan. The Government-Annual Research Journal of Political Science., 7(7).

[v] Ejaz, S. S., & Ara, A. A. (2011). Gender Discrimination and the Role of Women in Pakistan. Journal of Social Sciences and Humanities, 50(1), 95-105.

[vi] Ferrant, G., & Kolev, A. (2016). Does gender discrimination in social institutions matter for long-term growth?: Cross-country evidence.

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[viii] Tarar, M. G., & Pulla, V. (2014). Patriarchy, gender violence and poverty amongst Pakistani women: A social work inquiry. International Journal of Social Work and Human Services Practice, 2(2), 56-63.

[ix] Kazimi, A. B., Shaikh, M. A., & John, S. (2019). Mothers Role and Perception in Developing Gender Discrimination. Global Political Review, 4(2), 20-28.

[x] Atif, K., Ullah, M. Z., Afsheen, A., Naqvi, S. A. H., Raja, Z. A., & Niazi, S. A. (2016). Son preference in Pakistan; a myth or reality. Pakistan journal of medical sciences, 32(4), 994.

[xi] Rabia, M., Tanveer, F., Gillani, M., Naeem, H., & Akbar, S. (2019). Gender inequality: a case study in Pakistan. Open Journal of Social Sciences, 7(03), 369

[xii] Shah, S., & Shah, U. (2012). Girl education in rural Pakistan. Revista Internacional de Sociología de la Educación, 1(2), 180-207.

[xiii] Hamid, A., & Ahmed, A. M. (2011). An analysis of multi-dimensional gender inequality in Pakistan. Asian Journal of Business Management, 3(3), 166-177.

[xiv] Bhattacharya, S. (2014). Status of women in Pakistan. Journal of the Research Society of Pakistan, 51(1).

[xv] Butt, B. I., & Asad, A. Z. (2016). Social policy and women status in Pakistan: A situation analysis. Orient Research Journal of Social Sciences, 1(1), 47-62.

Perpetuation of Gender Discrimination in Pakistani Society: Results from a Qualitative Study Conducted in Three Provinces of Pakistan

Status:

Version 1

Abstract

Figures

Summary

Background

Methods

Study Design

Participant Selection

Data Collection

Data Integrity

Results

Discussion

Strengths of the study

Limitations

Conclusion

Abbreviations

Declarations

References

Tables

Supplementary Files

Status:

Version 1