Table 2 Themes and sub-themes describing stressful life events of urban adult population of Karachi

Subjected to harassment in public

• Hooting by boys in marketplaces.

• Touching young females while crossing by.

• Bikers speeding up towards ladies at bus stand.

• P [1]: “It is very traumatizing when one realizes that a man has touched you in public, deliberately”

• P [16]: “Bikers scare us leaving unforgettable memories when they come at full speed and cross by us in public and hooting remarks on us”

Male child preference

• Giving boys freedom to go anywhere and come at whatever time without questioning at home.

• Liberty to boys to go out alone.

• Females are instructed to speak in lower voices which males aren’t.

• P [5]: “At home, I am usually asked where I was if I stay out of the home after sunset for giving tuitions, but never from my brother. It’s a persistent stress and threat to individuality”

• P [7]: “I can’t scream even when I am in pain. I have been taught since childhood ‘girls don’t shout’. I feel inferior”

Unmarried middle aged daughter

• Due to cultural issues, worried about letting a daughter marry who is above 25 years of age.

• Future insecurities about unmarried daughter while having daughter in law at home.

• Monetary support for unmarried daughters while parents are retired.

• Wondering about security issues of unmarried daughters of elderly parents after them.

• P [17]: “I feel anxious thinking about what my daughter’s life will be if we aren’t alive. She’s already 25. I have become obsessive in thinking how can I find my daughter a match”

• P [1]: “In our society, it is difficult for lonely girls to survive. Parents retire, brothers marry and sister in laws are unpredictable. If one won’t marry, one will have to be dependent on their mood and privacy to talk to brothers”

Being a mother of an infant(s)

• Due to cultural issues, worried about letting a daughter marry who is above 25 years of age.

• Future insecurities about unmarried daughter while having daughter in law at home.

• Monetary support for unmarried daughters while parents are retired.

• Wondering about security issues of unmarried daughters of elderly parents after them.

• P [17]: “I feel anxious thinking about what my daughter’s life will be if we aren’t alive. She’s already 25. I have become obsessive in thinking how can I find my daughter a match”

• P [1]: “In our society, it is difficult for lonely girls to survive. Parents retire, brothers marry and sister in laws are unpredictable. If one won’t marry, one will have to be dependent on their mood and privacy to talk to brothers”

Being a mother of an infant(s)

• Difficulty in maintaining work and home responsibilities with infant.

• Disturbed routine of self and added responsibilities of the infant.

• Focus of family is the infant and mother feels neglected.

• P [9]: “Life with children is tough for working women. We have to meet expectations everywhere be it home, office, neighborhood”

• P [11]: “I stay awake all night. I can’t have rest in the day too as I have a lot of things to handle singlehandedly. My husband thinks it is only a mother’s responsibility to take care of the kid. He is only for breadwinning”

Robbed/theft

• Mobile snatching on the streets.

• Robbery at home and in banks.

• Theft in public transportation such as buses and threats to kill if not surrendered.

• P [2]: “I never use my mobile phone when I am in a less busy street. I will be caught by snatchers”

• P [8]: “Even in public bus, I had been a victim twice where all passengers were robbed. I had great loss from that and have stopped using buses”

Missed an opportunity because of nepotism

• Despite of capability, unable to get at a good job.

• Individuals without qualification get selected because of political backing.

• Easier for rich to bribe selection committee.

• P [10]: “Despite of a degree, I have lowpaid job. It is definitely suicidal for a graduate young man to be a driver, like me”

• P [13]: “I have been a brilliant student, but a rich man’s son was more of a value than my talent”

Extortion or illegal demands of money by force

• To run a business safely and personal security, giving away money to political parties by force.

• “Bhattas/Chanda” as locally pronounced to be given to local influential people in an area for various unrelated activities

• P [15]: “Making more money lawfully is also a trouble in this country. One has to give away it at once when demanded by influential people”

• P [17]: “Nearly a quarter of my husband’s salary goes in chandas (donation) which political party people collect by force in the name of good.”

Lack of respect to females/lack of empowerment

• Not taking input from females in important decisions of the family or their own life such as marriage.

• Not allowing females to attain employment or even if allowed, not outside the area of their residence.

• To bear maltreatment by males in virtue of good character of a female.

• P [3]: “I am never involved in making decisions for the family despite of being eldest because I am a female”

• P [7]: “When my husband bullies, I can’t even speak about it. It is not understood good in the society. A women’s character is her silence”

Being a victim of state sponsored brutality

• Due to tussles between political/influential groups, common people being abused, beaten or even killed.

• P [2]: “My father had had an accident when two local groups were fighting in public with each other. He has a disability and cannot recover”

Lack of power supplies (electricity)

• Unpredicted load shedding.

• Major electrical failure by electricity providing companies.

• Illegal connections built by others and lack of supply or increased cost to those who pay legally.

• P [15]: “In Karachi, electricity is a luxury. Despite paying high amount of bills, we do not get electricity for 9 h!”

• P [5]: “Electrical failure follows no routine. It becomes worst in the exam days. Utility bills are high yet seldom supply. Illegal connections supply you electricity unconditionally at all times”

Lack of fuel supplies (natural gas at home, CNG, petrol)

• Limited supply of CNG in week i.e. only 3–4 days. This implies long queue when supplied.

• Difficulties faced by daily wagers of public transport such as rickshaw and taxis.

• Low pressure or no natural gas for cooking which implies maintaining every day routine difficult.

• P [10]: “When CNG stations are closed, passengers are lost because of lack of fuel. When stations open or partially available, it takes ages to get your turn and grab it”

• P [11]: “It becomes impossible to cook food for the family in such low pressure. What could be done in half an hour takes around four hours and sometimes nothing at all!”

Insecure living environment

• Abduction for money.

• Shot in robbery.

• Bomb blast incidences.

• Joblessness despite of qualification.

• P [15]: “I am alive today. Don’t know whether I will be kidnapped or shot dead like my friend was, just for money”

• P [13]: “There is no future in Pakistan. No jobs, no security, no laws, no ethics. The world is way organized and humanitarian than it is!”

Lack of water and sanitation facilities

• Waste collection and disposal practices are poor in general.

• Overflowing drains and open stagnant water creating problems for passers-by as well as to local residents.

• P [14]: “There is mixed water supply (sewerage and fresh water) in our area over an year. We complained but no use. Our kids become sick every other day”

• P [12]: “In rainy season, the city becomes a mess. Drains are open, roads have loads of puddles and no one cares about it!”

Received a threat from an influential person

• Threat to life or harm to family in lieu of not doing their work or not giving them money.

• P [4]: “It has become tougher to stay safe these days. You are followed, inquired about and then threatened for well-being of family. Giving money is better than threats and torture”

Destructions due to natural disasters

• Due to floods each year, a great monetary loss is faced by the sufferers.

• Improper preparation of flood plan causes many lives to be lost including cattle which are a source of living for some.

• P [12]: “There is no concept of urban planning. We make no dams despite of floods every year and later cry for a drop of clean water”

• P [5]: “In our area, we expect our river to flood each year. Government makes promises which they do not keep. We lose our cattle, homes, farms and then next year thrive to build it again”

Social stigma pertinent to middle aged unmarried females

• Society considers that unmarried females do not have a good character hence no one marries them.

• Stigma with respect to inability to give dowry.

• P [20]: “Society and relatives think I don’t have a good character just because I didn’t get married even by 40s”

• P [3]: “My parents started gathering things to be given to me as dowry but those who come to choose me never find it enough”

Direct experience of suicide bombing

• Bomb blasts are traumatizing event both physically and psychologically.

• Disabled victims bear the burden of event for lifetime.

• Damage of personal property and loss of loved ones in bombing.

• P [4]: “I had witnessed a blast myself. I was praying and all of a sudden couldn’t hear anything. I was all numbed. When I recovered, all I could see was people over people. I could smell blood and flesh. To my living memory, I can’t ever forget that!”

Get to know about Suicide Bombing event on news, neighbors, city

• Stress produced by repeated coverage of the event on the television.

• Fear of future of children and loved ones.

• Feeling hopeless for betterment of country’s condition.

• P [9]: “I have left watching news. All it covers is disturbing. When I hear about a blast on the TV, I instantly get horrified. I rush to my phone and start calling to my family members outside just to know they are safe!”

• P [2]: “It is worst to hear that a loved one has passed away in a bomb blast and when he’s so young and only one to support family”