Key Social Norms Take-aways This study shows that patriarchal social norms shape how women recognize, tolerate, and respond to domestic violence in Pakistan. Women were more likely to identify physical violence as abuse than sexual or psychological violence, and many remained silent because of expectations that women preserve family harmony, obey male authority, and avoid bringing shame to their families. The authors emphasize that women’s silence reflects social pressure and limited autonomy rather than acceptance of violence itself.

Objectives To examine how pregnant women in Hyderabad, Pakistan define violence against women (VAW), how they respond to domestic violence, why they remain silent, and how these perceptions reflect prevailing gender norms.

Methods This community-based cross-sectional study surveyed 1,325 pregnant women using a modified WHO domestic violence screening instrument with open- and closed-ended questions adapted from Pakistan’s National Gender Indicators for Violence Against Women. Social norms were assessed through women’s definitions of VAW, responses to abuse, willingness to disclose violence, and reasons for remaining silent. Qualitative responses were analyzed using content analysis, while quantitative analyses included descriptive statistics, chi-square tests, and odds ratios.

Results Fifty-one percent of women reported experiencing violence before or during pregnancy. Physical abuse was most commonly recognized as VAW (47%), while controlling behaviors (21%), conflict with in-laws (22%), emotional abuse (28%), and verbal abuse (8%) were identified less often. Only 0.4% considered sexual abuse to be VAW. Most women responded to abuse by remaining silent or verbally resisting, and none sought professional or legal help. Fear of escalating violence, respect for elders and in-laws, helplessness, concern for children, lack of social support, and beliefs about husbands’ sexual rights were the most common reasons for silence. Older women and women with previous pregnancies were more likely to resist abuse, while women with fewer economic resources were more likely to remain silent.

Conclusions The study concludes that harmful gender norms, women’s economic dependence, and limited support systems sustain tolerance of domestic violence and discourage help-seeking. The authors recommend interventions that transform social norms around gender and violence, improve women’s education and economic opportunities, increase recognition of all forms of VAW—particularly sexual violence—and strengthen community, health system, and legal responses to support survivors.