Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age - a life course perspective

A cross-sectional catchment area survey of 525 women aged 18 to 35 years living in Islamabad and Rawalpindi. The effect of gender disadvantage was assessed as a latent variable using structural equation modelling. Indicators were parental gender preference, low parental care, parental overprotection, limited education, early age at marriage, marital dissatisfaction and low autonomy. Psychological morbidity was assessed using the 20 item Self Reporting Questionnaire (SRQ).Gender disadvantage was independently predictive of psychological morbidity. Among married women, socio-economic status did not predict psychological morbidity, and the effect of education was mediated through gender disadvantage rather than socioeconomic status (SES). The women's own preference for a male child was strongly predicted by their perceptions of having been disadvantaged by their gender in their families of origin.The high prevalence of psychological morbidity among women in Pakistan is concerning given recently reported strong associations with low birth weight and infant stunting. Social action, public policies and legislation are indicated to reduce culturally embedded preferences. Neglect of these fundamentals will entrench consequent inequities including gender bias in access to education, a key millennium development goal.Women in Pakistan are particularly likely to suffer from depression and other common mental disorders. Prevalence in men is similar to that in other regions, but that in women is strikingly high; commonly more than half have clinically relevant symptoms [1-4]. Women in Pakistan are two to three times likelier than men to suffer from common mental disorders [5], compared with a typical female to male gender ratio of 1.5 to 2.0 elsewhere [6,7]. Socio-cultural rather than biological factors must be implicated. In this paper we focus upon the role of gender disadvantage, arising from the culturally determined predisposition to think about or behave differently toward