Women’s rights are violated across the world. Irrespective of nationality, culture, religion and social standing, Women are differentiated, subjected to violence, tortured and, in the most extreme cases, executed by their own fathers, sons, brothers and husbands. Human rights violations against women are universal. Many females are victims of male violence. Violence against women is a characteristic shared by all patriarchal societies [1].

Women across the world are traded as cheap labor, catalogue brides and forced prostitutes. More than two million girls aged between 5-15 are sold as prostitutes every year. Unfortunately the bodies of females are being mutilated and sold because of new reproduction technologies. Prenatal determination of a baby’s sex through ultrasound has led to the increase abortion of female fetus especially in developing countries. In addition to this, girls are systematically neglected. They are breast fed for a shorter period, less likely to be inoculated, receive less to eat and have to work much harder [1].

Moreover, girls and women are abused and raped on a daily basis and approximately 75% of rapes are carried out by offenders that know their victims socially but unfortunately only 10 and 30% of these crimes are reported to the police. Women and girls are refused the right of autonomy. In many countries, women are refused the right to contraception. The genitals of 150 million women and girls have been mutilated which is increasing by 2 million each year. Women and girls are refused the right to take part in public life by law, be it legal or religious. In career terms, women and girls are at a disadvantage [1].

The objective of our case study was to illuminates some common issues and dilemmas encountered by females of low socioeconomic status living in a developing country Pakistan.

Nasreen is a 55 years old female who migrated from Bangladesh to Pakistan when she was 2 years old. She belonged to a low socioeconomic background and lived in a squatter settlement of Karachi, Pakistan where the basic necessities of life were lacking. They were altogether 9 sisters and 5 brothers and she was 2nd amongst her siblings. Her father was the only bread earner of the family with a monthly income of Rs 8000 ($ 81.19).

She and her sisters were deprived of education while her brothers were allowed to study till higher secondary. Her childhood was whipped from her, as she was involved in all the domestic chores from cooking to baby sitting as her mother was in poor health as a result of less spacing between the children. Due to several comorbid her mother died when Nasreen was only 10. Her father couldn’t cope up with the monthly expenditures so she was forced to step out of the house and start working where she faced the horrible reality of the outside world. She faced physical and verbal harassment at different occasions but unfortunately she never raised her voice against all her sufferance. She was fulfilling a dual responsibility that is during the day working at other people’s houses and during the night fulfilling the duties of her own house which was a bit too much for a 10 year old.

At the age of 15 she was forcefully tied in a knot with a 40 year old. She tried to raise her voice against this injustice but everyone paid a deaf ear. Her husband was indulged in all sorts of illegal acts such as alcohol, drugs, womanizing and domestic violence. She was gravely tortured at the hands of her husband both physically as well as sexually. A time in her life came when she decided to knock at the door of the law giver but unfortunately she suffered harassment and disappointed from there as well. At that point she just gave up and left everything in the hands of the Almighty. She had seen her mother suffering due to lack of family planning so she decided to avail the family planning services but due to lack of resources she couldn’t afford to access this facility therefore she gave birth to 8 children. All her deliveries were conducted at home by unprofessional traditional healers and due to lack of proper sterilization of instruments she developed vaginal infections accompanied with severe pelvic pain which ruined the quality of her life. Due to lack of resources she lost one of her son who suffered from diarrhoea at the age of 3.

Her husband was a drug addict and thus developed Hepatitis C. His conditions started deteriorating with the passage of time for 15 years Nasreen took care of him. To bear the expenses of his medicines she started working and therefore was the only bread earner of the family. After his death she decided to get all her children enrolled at a government school and all of them acquired education till graduation. Currently her daughters are teaching at a government school and her sons are into administrative work at some private company. Slowly and gradually with her hard work and devotion all her children were settled, married and are living happily with their children.

Due to her bitter experience in the past she did not choose to rely on anyone not even on her own sons and therefore decided to continue her work. Today she is living on her own and is proud at the fact that she is not a burden on anyone. She works at a school as a supervisor of maids, she has a better living now. Although she has suffered a lot of hardships in her life but her biggest achievement was that today her children respect and acknowledge her for giving them the confidence of leading a dignified life.

We conducted a case study and enrolled a 55 year old female Nasreen who worked as a maid at a private school in Karachi, Pakistan. It was purposive sampling. After acquiring an informed consent an eight hours exploratory interview was conducted in 4 sessions at the premises of the school. The duration of each interview was 2 hours. Data was collected by conducting in-depth interview in Urdu by using a semi structured interview guide. We maintained complete confidentiality and privacy during the interview and assured the participant that her identity will not be disclosed. For the analysis the interview was transcribed and further translated to English. A categorical analysis was done by identifying nodes, sub nodes and finally categories.

This case study highlights the violation of women’s rights a core problem prevailing in low middle income country such as Pakistan that include; gender discrimination, inequality and domestic violence.

A developing country such as Pakistan is a blend of different cultures and a close observation of all the identical cultures shows that none among them permits a man to use aggressive methods against a woman nor does any of them prohibit woman of her right. In fact, it is the way the males are brought up that empowers them to be violent against woman which is directly linked with ‘external factors,’ including lack of proper education, lack of basic facilities, unemployment and socio-psycho problems and financial miseries. These factors play their negative role so strongly that they leave an everlasting influence on the behaviour of a community, group or an individual who becomes reluctant to grant the rights to their women [2]. Moreover some studies suggest that 30% of boys exposed to inter parental violence will grow up to be violent themselves [3]. Hence, a woman is not only deprived of her rights but also treated as an inferior gender with constant oppressiveness and suppression. Hence to bring awareness, we need to completely change the social environment of those individuals, as well as communities, who are involved in violence against the physically fragile gender and denying them their basic rights [4].

There are communities in low middle income countries that are famous for their conservativeness and strictness. They pressurize their women by not giving them their rights where girls are not allowed to go to school to acquire education as was also evident in our case study. From birth to death, a girl is not allowed to take her own decision. Young age marriages are one of the proof of these violations as was the case with our study participant. Females are not allowed to decide for their marriage and if the adults of the family do not find an appropriate proposal then they get the girl married to a very old age person without her consent [5].

In Article 25(1) of the 1973 Constitution of Pakistan it is stated, “All citizens are equal before law and are entitled to equal protection of law.” Article 25(2) states, “There shall be no discrimination on the basis of sex alone.” [6].

According to Islam a female has all the right to decide for her marriage. Moreover no one is allowed to decide for her fate. Despite the universal protection of Islam and the rights given by the constitution of Pakistan, women are the being abused by some dreadful elements of our society. With a high workload from dawn to dusk, she is paid far less than what males get doing less work. Moreover, in our male dominant society, frequently there have been incidents where females are attacked on their piety during work. And if she reports such crimes then as a punishment, she is rusticated from her job [6].

Furthermore, majority of the females are not allowed to decide on the number of babies they want. Family planning is considered against Islam in a typical conservative society. In case of any medical emergency, when no female doctors are available for her help, the relatives allow her to die rather than to be provided aid by a male doctor.

There are NGOs like Aurat Foundation in Pakistan which was formed in 1986 they are working enthusiastically for the rights of women. The organization has its own information and publication department that explains the people the true realities women are facing in Pakistan [6].

Given the above case story and some facts we conclude that the women in Pakistan as well as in few other low middle income countries do not possess their due right that is guaranteed to them by the Constitution and Laws. Unfortunately the state is unable to protect the women from merciless social customs prevalent in our society. Wicked practices are being carried out on women; therefore there is a great need to voice against anti-women practices rather than forming laws over laws. The only need is to wake people for the Protection of Women Rights.

This case study was conducted as a part of the course Ethics, equity and rights in health in MSc Epidemiology and Biostatistics at Aga Khan University Hospital Karachi. We would like to thank the course director Ms Kausar S, Khan and facilitator Mr Sohail Bawani. The consent was taken from the participant to publish her story but her identity has not been revealed upon her request.