showed that women in consanguineous marriages are more likely to face psychological domestic abuse. however, findings in this study also reported the prevalence of domestic violence within the larger pakistani population as well. increased urbanization another factor given for the rise in domestic violence has been due to increased urbanization. as people move from villages and increasingly live apart from an extended family, assaults are less likely to be prevented by the intervention of family members, who in past times often intervened in domestic conflicts. in particular, women who move cities or areas after marriage away from their respective family are more at risk for domestic violence. these women are left without parental or familial support as the only contacts they have are now limited to their husband and husband's family. violent spousal relationships are perpetuated by isolation of the victim and lack of social support. impact on women physical and psychological health outcomes domestic violence leads to increased risk towards certain health outcomes like major depression, dysthymia, conduct disorder, and drug abuse. moreover, because women are primary caretakers in pakistan, children also face increased risk for depression and behavioural problems. zakar et al. found in their study that of those interviewed (373 women from pakistani hospitals) including women who had experienced severe domestic violence, 54% reported poor current mental health. associated with this self-reported statistic of women in a poor state of mental health was also a high prevalence of mental health disorders with anxiety and depression being the most common. in particular, physical violence has long-term, negative psychological impacts on women with stigma against mental health serving as an impediment to treatment. at times, physical violence may cause permanent disfiguration of the body causing physical ailments that lead to a variety of psychological disorders like depression. furthermore, women are often unable to receive treatment for psychological disorders as mental health within the cultural realm of pakistan is not considered a health matter. mental health illiteracy leads to treatment of mental health disorders superstitiously or not at all. another study that examined domestic violence and pregnancy among pakistani women found that 51% of respondents reported experiencing domestic violence in the six months prior to or after pregnancy. the researchers of this study and others have suggested due to the prevalence of domestic violence in pregnant women that domestic violence be screened for during antenatal care. bargaining power women in domestic violence relationships often have no recourse of escaping due to fear of murder from the perpetrator. a vivid example of this is the practice of watta satta, or bride exchange, whereby a daughter from one family is swapped for a daughter of another in a brother-sister pair. power dynamics between the families follow a revenge-based model. if a husband is harsh on his wife then the mutual threat exists of the husband's brother-in-law being harsh on his sister. these reciprocal threats leave women in positions with little to no bargaining power. this leaves women in a position where they cannot escape a marriage because of cross bride exchange family entanglement. adding to the complexity, divorce is also highly stigmatized within the pakistani culture. bargaining power of women in domestic violence relationships is also minimal due to residence with the husband's family. particularly, in rural areas, if a woman in a domestic violence relationship is living with her husband's family, she has little recourse to seek help or escape. studies on attitudes of domestic violence in pakistan have shown that though these families in rural areas may wish to help their daughter, it is costly to continuously visit her. in other cases, domestic violence perpetrator families have been shown to taunt or ridicule those seeking justice. policy initiatives general legislation against domestic violence in 2009 a domestic violence protection bill was proposed by yasmeen rehman of the pakistan people’s party. it was passed in the national assembly but subsequently failed to be passed in the second chamber of parliament, the senate, within the prescribed period of time. the council of islamic ideology objected to the bill, claiming that in its current form it will increase divorces and argued that the bill considered women and children the only victims of domestic violence, ignoring elderly and weak men. the council claimed that the punishments suggested by the bill were already enacted by other laws and suggested lack of action on these laws as the reason for increase in domestic violence. after the passage of eighteenth constitutional amendment, the matter pertaining to the bill became a provincial issue. it was re-tabled in 2012, but met with a deadlock in parliament because of stiff opposition from the religious right. representatives of islamic organizations vowed resistance to the proposed bill, describing it as "anti-islamic" and an attempt to promote "western cultural values" in pakistan. they asked for the bill to be reviewed before being approved by the parliament. the bill was passed for islamabad capital territory. dowry deaths in 1976 the pakistani government passed legislation on dowry and bridal gifts in an attempt to eliminate the custom but, because of cultural and societal norms combined with government ineffectiveness, such killings over inadequate dowries continue. acid attacks in 1999 the senate of pakistan rejected a resolution which would have condemned the practice of murdering women for the sake of family honour. in 2011 the senate passed the acid control and acid crime prevention bill to repress acid attacks in the country; the senate also passed the prevention of anti-women practices bill. honour killing on april 21, 2001, the national government leader pervez musharraf declared that honour killings were "vigorously condemned" by the government and would be treated as murder. the ministry of women development set up ten crisis centres to help the victims of domestic violence and raise the awareness level of the people on this issue. particularly in 2004, pakistan's criminal law (amendment) act passed that provided legal protection for women against any offense committed by family members for the sake of honour. however, pakistan's legal system has done little to uphold this legislation. the national commission on the status of women reports that pakistan is doing little to bring justice to perpetrators. if the family of the victim forgives the perpetrator, then the perpetrator will be set free despite clear violation of pakistani law. oftentimes, families who are caught in an honour killing case come from rural areas where families must work together in a village on the daily to live. when an honour killing occurs, the family of the victim are highly likely to forgive the perpetrator based on what elders of the village advise them to do. support organizations from both international and internal funding, there are a variety of ngo's that provide support to women who have endured or are enduring domestic violence in pakistan. bedari (funded by united nations development programme) white ribbon campaign pakistan lawyers for human rights and legal aid - lhrla madadgaar national helpline 1098 war against rape pakistan acid survivors foundation pakistan chayn