WOMEN’S access to healthcare in Pakistan is shaped not only by poverty, but also by the intersection of documentation, marginalisation and gender. After more than a decade of work in one of Karachi’s largest informal settlements, it has become evident how the absence of identity documents interacts with restrictive social norms and institutional power imbalances to systematically exclude women from public services. Insights from a community-based maternity home reveal that women’s avoidance of healthcare is less about awareness and more about fear, administrative exclusion, and the everyday costs — financial, social, and emotional — of navigating systems that were not designed with them in mind.

Women consistently report feeling safer and more willing to seek care when maternity services are located within their own communities. Proxi­mity reduces travel costs, but more importantly, it limits exposure to spaces where women anticipate scrutiny and judgement. Despite this, reliance on traditional birth attendants, or dais, and home bir­ths remains widespread. These choices are oft­en dismissed as backward or uninformed. In reality, they reflect rational decision-making in an envir­o­nment where institutional healthcare is frequen­tly experienced as punitive rather than protective.

Documentation, fear and gender keep women from accessing healthcare in Pakistan.

Home births are not chosen because women are unaware of the risks. Families are acutely conscious of the dangers of maternal and infant mortality, unhygienic practices, and delivery-related complications. What........

© Dawn