Hamid et al. BMC Public Health 2010, 10:164 http://www.biomedcentral.com/1471-2458/10/164 R E S E A R C H A R T I C L E Open Access Security lies in obedience - Voices of young women of a slum in Pakistan Saima Hamid1,2*, Eva Johansson1,3, Birgitta Rubenson1 Abstract Background: Existing literature shows that young people, especially women, have poor knowledge about sexuality and reproductive health. Many of the difficulties young women experience are related to beliefs and expectations in society making them more vulnerable to reproductive ill health. The objective of this study was to explore how young women living in a slum in Islamabad are prepared for marriage and how they understand and perceive their transition to marriage and the start of sexual and childbearing activity. Methods: Twenty qualitative interviews and three focus group discussions were conducted with young women residing in a slum of Islamabad. Content analysis was used to explore how the participants represented and explained their situation and how decisions about their marriage were made. Results: The main theme identified was security lies in obedience. The two sub-themes contributing to the main theme were socialization into submissiveness and transition into adulthood in silence. The theme and the sub-themes illustrate the situation of young women in a poor setting in Pakistan. Conclusion: The study demonstrates how, in a culture of silence around sexuality, young women’s socialization into submissiveness lays the foundation for the lack of control over the future reproductive health that they experience. Background Although teenage marriages are on the decline in Pakistan, one out of six women aged 15-19 years is married [1]. Strong societal, cultural and religious expectations are attached to the sexual innocence and ignorance of women as a sign of purity and virginity, with marriage marking the beginning of sexual relations and childbearing [2]. There is great societal pressure on parents to arrange mar- riages for their daughters [2], with marriages traditionally arranged by families with minimal involvement of the couple [3]. In the 2002 Adolescent and Youth Survey of Pakistan, 80% of women and 85% of men reported being married to relatives [4]. Marriage initiates new living arrangements and many new relationships, including the husband and his family, and most women find mother- hood the main focus of their new life at the expense of personal or relationship development in other areas [3]. Existing literature shows that young people, especially women, have poor knowledge about sexuality and * Correspondence: saima_hamid@yahoo.com 1Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden reproductive health [5-10]. A community-based study by Sajan & Fikree (2002) in the squatter settlements of Karachi found a high prevalence of gynaecological morbid- ity among young married women. Women who began sexual activity in their teens, as compared to women who started after 25 years of age, reported a greater burden of reproductive ill-health. This affirms the risks associated with early marriage and the need to improve and broaden reproductive health services and education [11]. In an ear- lier study the authors interviewed newly married young women in the same slum area about their experiences of marriage. A narrative analysis of the interviews revealed the submissive nature of the respondents [12]. The sub- mission described by participants was instilled in the young women through the impact of diverse levels of the family, community and society on their lives: their parents deciding about their marriage, often without their consent, the extensive demands placed on them by their parents- in-law and the pervasive societal expectations for them to be obedient in all spheres of life. Many of the difficulties young women experience are related to societal beliefs © 2010 Hamid et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.