Domestic violence is a persistent public health issue worldwide; it is especially prevalent in Pakistan. Although women's roles are changing in the contemporary era, patriarchal ideologies dominate the social and family structures. Patriarchal notions continue to perpetuate traditional gender roles. The purpose of this study was to explore how the influence of the patriarchal attitudes has played a prominent role in perpetuating domestic violence in the Pakistani family. This study focused closely on two particular social determinants that contribute to domestic violence. These two determinants were rigid gender roles and the social norms that are conducive to or permissive of violence in the home. In addition, this study shortly discussed the rest of the determinants of domestic violence in the Pakistani context according to the WHO domestic violence determinant list.

Domestic violence is a persistent public health issue worldwide; it is especially prevalent in Pakistan. To the research study conducted on domestic violence by Fikree, Razzak, & Durocher (2005), significant outcomes had been found. The authors identified in their findings that “Nearly all men (94.9%) reported perpetrating some type of verbal abuse during their marital life; using abusive language being the furthermost common (90%). The lifetime prevalence of marital physical abuse was 49.4%; slapping, hitting or punching most often reported (47.7%)” (p. 52). Moreover, the problem representativeness and severity is somehow hidden from the public. This is supported by the results of Fikree and Bhatti (1999) study. The study mentioned statistics from the Human Rights Council of Pakistan indicating that during 8-month period, out of 372 women who reported domestic violence, 272 breathe their last breath as a consequence of beating.

In Pakistan, although women's roles are changing in the contemporary era, patriarchal ideologies dominate the social and family structures. Patriarchal notions continue to perpetuate traditional gender roles. Though women play an important role in the household, they are remaining under the authority of their husbands, often as unequal partners in the relationship. The World Health Organization (WHO) has identified a number of determinants of domestic violence. These determinants include poverty, low education, limited access to divorce, absence of social support networks, political stability, and war (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). However, these are merely underlying issues of a greater structural problem.

The purpose of this study was to explore how the influence of the patriarchal attitudes has played a prominent role in perpetuating domestic violence in the Pakistani family. This study focused closely on two particular social determinants that contribute to domestic violence. These two determinants were rigid gender roles and the social norms that are conducive to or permissive of violence in the home. In addition, this study shortly discussed the rest of the determinants of domestic violence in the Pakistani context according to WHO domestic violence determinant list.

This study investigated domestic violence determinant in the Pakistani context according to WHO domestic violence determinant list. This was through reviewing the published literature. To conduct this literature review, the CINAHL and Google Scholar search engines had been used. The search had been performed using the following keywords: Domestic violence, Pakistani family, gender roles, and social norms.

Though Pakistani family structure has changed over time, traditional gender roles and patriarchal values continue to pass from each generation to the next one. In each new generation sons and daughters learn early on what is foreseeable and socially acceptable in the family. Boys are taught that they have familial, social, financial and professional roles. This includes the man's responsibility to choose and court a woman. This is in order to establish his family (Schilcher, 1988). In addition to being the family's head, he is tasked with protecting the women of the family. This is the concept of agency, wherein males must act masterfully, assertively, competitively and dominantly (Eagly, 2009; Wood &Eagly, 2013). Besides, socially they are expected to personify strength, dominance and diplomacy, while providing economical security and protecting their family inheritance. Men are taught to be more forceful and less fearful than women (Costa Jr., Terracciano, & McCrae, 2001; Bhanot & Senn, 2007). Emphasizing these values stresses the patriarchal concept where a man's expression is law, and one that women must comply with. This is, of course, regardless to her opinion whatever it is.

These traditional gender roles and patriarchal values lead to a higher opportunity for the presence of domestic violence. For sure, this is limited for the families that hold such cultural beliefs and which, at the same time, form the majority of the Pakistani families. Bhanot and Senn (2007) stated that “Studies have shown positive correlations between the presence of more patriarchal social structures and higher rates of violence against women” (p.26). Thus, domestic violence becomes almost a definite result in such cultural atmosphere. However, while modernization may have erased some cultural norms, rigid traditional gender roles still are sustained and expected. Similarly to Pakistani families situation is the situation of the families in many developing countries. In these countries, daughters are taught that their primary role is to bear children, to mother, to be submissive and passive, to be domestically competent, and to serve and please their husbands (Al-Mutawah, 2005). Moreover, Bhanot and Senn (2007) stated that “Traditional gender roles facilitate violence against women by making men more powerful and women more powerless” (p.26). In addition, women exemplify the family's reputation and honor. Therefore, if a woman disobeys her husband, she is considered in violation of the norms of the patriarchal family. In this case, she presents the risk and the challenge for the tradition. The usual result of that is a punishment which certainly includes some shape of domestic violence.

Ultimately, the patriarchal system defines and determines gender roles in the Pakistani family; consequently producing the rigid gender norms that can perpetuate and justify domestic violence, which includes physical, sexual and psychological abuse (Bhanot & Senn, 2007). In similar situation within the Arab countries, Haj-Yahia and Edleson (1994), as cited in Haj-Yahia (2003), argue that Arab men who hold traditional and conservative views of women's status in the home are more likely to resort to violence to solve marital conflicts. These patriarchal attitudes lead to the justification and acceptance of violence. Consequently, this sanction a system that makes allowances for and generates violence between men and women. As a result of that, violence becomes an accepted action within the family structure in countries such as Pakistan and Arab world.

It has been stated previously in this paper that Kurg et al. (2002) study had identified a few determinants for domestic violence worldwide. Surprisingly, all the determinants are evident in the Pakistani context.

First of all, the poverty ratio in Pakistan is a huge problem. The Asian Human Rights Commission in its website stated that, a study had been conducted showed a huge prevalence for poverty in Pakistan. In fact, every third Pakistani is living his life below the poverty line (Khuwaja, 2012).

Second, the Pakistani low education ratios are very high. The UNESCO (2012) published a Fact Sheet about the education status in Pakistan. It reported that “49.5 million adults are illiterate, two-thirds are women; this is the third largest globally” (p.1). Furthermore, the UNESCO Fact Sheet explained that Pakistan has some of the worst education indicators globally.

Third, the political stability and war in Pakistan are major contributors. These problems are responsible for the low government spending ratio on education. The UNESCO Institute for Statistics (2011) reported that only (9.9%) of the government budget goes toward education in the country (Appendix, B). This is, according to the UNESCO Fact Sheet (2012), very low in comparison comparing to military share of the budget. In fact, the régime of Pakistan spends about 7 times more on military than on education.

Fourth, the limited access to divorce for Pakistani women is another major problem. This problematic issue leads to more suffering from domestic violence. Eventually a question arises, why a Pakistani woman tolerates abusive behavior from her husband and remains married to him? The answer to this question consists of two points, the lack of professional expertise and the social stigma attached to divorced females (Yefet, 2011).

Finally, the absence of social support networks for women which is the last determinant according to WHO determinant list for domestic violence. Surely, this absence of social support networks for women exists in Pakistan. Thus, even with the few initiatives which take place recently like the British Pakistan Foundation's Women's Network, it remains one of the areas which are in need for a lot of work (Shah, 2013)

How a community reacts to violence affects, its frequency and severity? In communities where the use of violence is not sanctioned, formal commandments are established to deter and punish the transgressors. Legal prohibitions against such acts affect the perception of its morality in the community and generate social prohibitions (Krug et al., 2002). Yet, even in such societies the problem remains evident (Dichter & Gelles, 2012). On the other hand, in societies like that of Pakistan, where legal and moral sanctions concerning domestic violence are neither enforced nor viewed negatively, there are few legal and social consequences for the perpetrator. Consequently, the social and moral pressure needed for one to intervene on behalf of a victim of abuse does not exist. These entrenched social norms create an atmosphere where women are discouraged or afraid to report acts of domestic violence (Fikree & Bhatti, 1999).

This permissiveness normalize domestic violence in Pakistani society. Ewing and Aubrey, as cited in Haj-Yahia (2003), described that this tolerant view of violence perpetuates the idea that an abused woman called the violence upon herself. Patriarchal ideologies have empowered men to justify abuse by holding women responsible for their own mistreatment. Furthermore, women are blamed for creating the circumstances in which they are abused. According to a National Council of Population Study conducted in the Egypt Arab Republic, which has a similar cultural context as that of Pakistan, men justified domestic violence for reasons including insubordination, not meeting domestic expectations, expressing or seeking financial independence, or even speaking to other men (Ammar, 2000). In societies where domestic violence is problematic, women are conditioned to not only agree to this abuse, but to view it as an acceptable cultural behavior. In a study conducted in Egypt, it has been noted that (86.4%) of Egyptian women even believe that disobedience justifies abuse (Ammar, 2000). This normalization and internalization of violence by both men and women continues the malicious cycle of violence within the patriarchal family structure, as boys and girls grow up to accept violence as a normal aspect of their familial power dynamic.

Domestic violence is a leading public health issue and concern. Yet empirical research, particularly in the Pakistani world, is limited. Thus, further research should be done. Besides, it should be noted that, the social and health consequences of domestic violence are severe to women and their communities. Public health professionals are obliged by ethical considerations to address this problem. Domestic violence diminishes women's autonomy, as it decreases her self-esteem, limits her mobility, and restricts her independence, imprisoning her within the boundaries of the family. This leads to emphasize on another ethical issue raised by domestic violence, which is justice. The unequal nature of patriarchal family structures promotes an unjust atmosphere, where women are denied their right of an equal status within the home, which in turn affects their abilities to participate in the public domain. The home is supposed to be a place of sanctuary, but as long as patriarchal attitudes are constructing and influencing rigid gender roles and socially condoning violence, the abuse will only continue, hindering and obstructing the health and progression of Pakistan.

At the end of this paper, UNESCO (1995) concluded “Statement on Women's Contribution to a Culture of Peace” presented at the Fourth World Conference on Women in Beijing. Their conclusion includes that “Equality, development and peace are inextricably linked. There can be no lasting peace without development and no sustainable development without full equality between men and women” (UNESCO, 1995).