THE SOCIAL COSTS OF VIOLENCE AGAINST WOMEN AND GIRLS ON SURVIVORS, THEIR FAMILIES AND COMMUNITIES IN PAKISTAN

Past research on gender-based violence (GBV) in Pakistan discusses intimate partner violence (IPV) and non-partner sexual violence (NPSV) but lacks a comprehensive analysis of violence against women and girls (VAWG) and its wider costs and impacts. Our study on the social costs of VAWG aims to fill this gap. Through in-depth interviews (IDIs) and focus group discussions (FGDs) in rural and urban Pakistan, we explore the types of VAWG that manifest in communities and examine the negative impacts these have on survivors, their families and communities. Our findings reveal that, in addition to the mental health impacts of VAWG on survivors (such as anxiety and suicidal ideation exacerbated by stigma Corresponding author 2 Merino, Mueller, Milne, Ghaus, Duvvury, Scriver and isolation), a number of social and economic impacts are borne by survivors as well as their relatives and communities. Social norms and institutions that condone and reproduce gender inequity contribute to the acceptance and normalization of VAWG. Lack of service provision and shelter for survivors and social stigma around seeking help heightens the impacts faced by survivors, their families and their communities.


Introduction
Violence against women and girls (VAWG) is a widespread issue in Pakistan. According to the Pakistan Demographic and Health Survey (PDHS) conducted in 2012-2013, 39 percent of ever-married women age 15-49 years have experienced physical or emotional intimate partner violence (IPV) in their lifetime; emotional IPV is more common (32 percent) than physical IPV (27 percent) (National Institute of Population Studies -NIPS/Pakistan and ICF International, 2013). Women's experience of each type of IPV increases with age and number of children, but the reported incidence of IPV was lower among more educated and economically better-off women (National Institute of Population Studies -NIPS/ Pakistan and ICF International, 2013). One quarter of women experienced control in the form of their husbands' jealousy or anger if they talked to other men, and 16 percent reported that their husbands insisted on knowing where the wives were at all times(National Institute of Population Studies -NIPS/Pakistan and ICF International, 2013). There are no official statistics on the prevalence of non-partner sexual violence in Pakistan.
Research also shows that customary practices, such as bride exchange (watta satta) and honour killing (karo kari), remain prevalent in Pakistan and contribute to the high levels of VAWG women experience (Ballantine et al., 2017;. Women also experience violence in public spaces. A rapid assessment by the Social Policy and Development Centre (SPDC) found that 85 percent of working women, 82 percent of female students and 67 percent of other female commuters experienced harassment at least once while commuting during the past 12 months in Karachi (Social Policy and Development Centre (SPDC), 2014).
A number of studies examine the influence of patriarchal norms on the incidence of VAWG in Pakistan. Social norms that give men decision-making authority in their household and view women as socially and economically dependent on men underlie the The Social Costs of Violence Against Women and Girls on Survivors 3 high prevalence of VAWG and its broad acceptance in communities (Ali and Gavino, 2008). Gender unequal social norms promote the idea that a woman's father, husband, brothers or sons are responsible for protecting the family's honour. These social norms legitimise men's control over women (and their sexuality) in the household Ghaus and Kazi, 2012;. While the influence of patriarchal social norms cuts across all social strata in Pakistan, women in rural areas and women from specific tribal groups are more susceptible and considered to be at higher risk of VAWG. 1 Research also suggests that violence is seen as an appropriate and legitimate mechanism to control women. Men internalise violence as a natural part of their masculine identity and of their interaction with their spouses (Aurat Foundation, 2012). Forty three percent of women in Pakistan believe a husband is justified in beating his wife for at least one of the following reasons: if she burns the food, if she argues with him, if she goes out without telling him, if she neglects the children, if she refuses to have sexual intercourse with him and if she neglects her in-laws (National Institute of Population Studies -NIPS/Pakistan and ICF International, 2013). The study also reported that participants perceived verbal abuse and abusive language toward a spouse as the prerogative of a husband (Fikree, Razzak, and Durocher, 2005). Women are also conditioned to accept violence from an early age and see submitting to their husbands as a religious imperative (Qaisrani, Liaquat, and Khokhar, 2016).
The perception that IPV is a private matter and a legitimate practice affects prevention and reporting of VAWG that takes place among spouses and family members. Despite the relevant laws, the state has little authority over cultural practices, such as violence that harms women, as domestic violence is considered a private matter, and spousal abuse is rarely considered a social crime. Divorce is discouraged and women feel unable to dissolve even abusive marriages (Ali and Gavino, 2008). The studies cited above suggest that social norms obscure the ability of women and men to identify what constitutes violence, which may affect women's ability to report violence and community's willingness to act to prevent VAWG and to support women and girls who experience it. Fifty-two percent of Pakistani women who had ever experienced domestic violence never sought help nor told anyone about the violence they had experienced (National Institute of Population Studies -NIPS/Pakistan and ICF International, 2013). Among women who ever sought help for violence, more than half were divorced, separated, or widowed (53 percent) and one third were currently married (34 percent). Similar percentages of women in rural and urban areas have ever sought help for violence. Most women (74 percent) sought help from the woman's own family after experiencing physical violence; 22 percent sought help from their husband's family. Less than one percent of women sought help from each of the following formal sources: police, medical professionals, lawyers, and social work organisations (National Institute of Population Studies -NIPS/Pakistan and ICF International, 2013).
While these studies shed light on the social norms that perpetuate VAWGparticularly IPV -and the impacts on survivors, few focus on impacts for families and communities. Our study addresses this evidence gap by exploring the social costs of VAWG -the social, economic and health-related (physical, emotional and mental health) impacts on the women and girls who experience it, as well as their relatives and communities. Social costs at each of these levels accrue and have serious consequences on an individual's well-being and capabilities, social cohesion and participation in the community. We hypothesise that, over time, many of these impacts can also be translated into larger societal-level economic cost.

Methods
The qualitative research presented in this paper is part of a larger multi-country mixedmethods study investigating the social and economic costs of VAWG in Ghana, South Sudan and Pakistan led by the National University of Ireland-Galway (NUI Galway), the International Center for Research on Women (ICRW), and Ipsos MORI. 1 In Pakistan, participants in the quantitative survey were asked whether they would consent to a follow 1 This study combines qualitative and quantitative methods to generate knowledge and evidence on the economic and social costs of VAWG in Ghana, South Sudan, and Pakistan. The quantitative component included a nationally representative survey that contained several modules to identify IPV and SV, as well as harassment in public and workspaces that will allow the authors to calculate the prevalence of these forms of violence and their cost to businesses and society.
The Social Costs of Violence Against Women and Girls on Survivors 5 up qualitative interview. The qualitative sample was selected from among those who consented to be interviewed in Karachi, Islamabad and Sargodha. Participants for the qualitative sample were selected based on their experiences of violence, age and location of residence (urban/rural) and included survivors of IPV and non-partner sexual violence (NPSV), as well as women who did not report experiencing violence in their lifetime and men (Table 1). A total of 24 participants took part in in-depth interviews (IDIs) that probed the social and non-monetized economic costs of VAWG. Eight groups of six to 10 women and men were recruited for the focus group discussions (FGDs) to explore gender norms and perceptions of VAWG. Following the safeguards delineated in Researching violence against women: a practical guide for researchers and activists (Ellsberg and Heise, 2005), the FGDs with men were conducted in different towns from where the female FGDs were conducted; however, the selected towns had similar characteristics to the towns selected for the female FGDs. Eight key informant interviews (KIIs) were conducted. Key informants were experts from non-governmental organisations (NGOs), the judiciary system and commissions related to VAWG and were selected based on their involvement in addressing and preventing violence against women and girls in Pakistan. Interviews and discussions were conducted in Urdu. IDIs were transcribed, translated into English, and coded and analysed using Nvivo, FGDs were translated into English and coded using Nvivo and parts of KIIs were translated into English.
Ethical approval for the study was provided by the NUI Galway Research Ethics Committee in September 2015 and is renewed annually. In addition, in Pakistan, approval for the research was granted in August 2016 by the National Bioethics Committee.

Results
Participants reported a wide range of acts that can be classified as VAWG, including physical, psychological, sexual, and economic violence perpetrated by partners, other household members, community members, and strangers. These forms of violence were interconnected, and women experienced multiple forms; for instance, often women who reported experiencing economic violence perpetrated by their partner also reported experiencing psychological and physical violence. Because of this complexity, the study does not discuss the impacts of different types of violent acts separately. Instead, it describes the cumulative impacts of all forms of VAWG at the individual, household and community levels. The presentation of results focuses on the social and economic impacts of VAWG and their related costs. As these impacts are mediated by the context, the support available to survivors and their ability to access help, we also include a discussion on help seeking.

Help seeking
The same factors that enable and condone VAWG also affect help-seeking behaviour and contribute to underreporting. Participants in both rural and urban areas mentioned that VAWG survivors rarely disclose the violent behaviour of their husbands to relatives, friends and neighbours, as they do not expect to receive support and may be blamed for the violence committed against them. One person told us, Women are helpless, as they don't discuss [their experience of violence] with their families as they will be blamed. -Rural IDI Respondents in urban and rural areas discussed how violence impacts women's sense of belonging in the community. Some participants remarked that in rural and urban areas, community members' care for IPV survivors, sympathising with them, listening to their sorrows, and continuing to invite them to community events and functions. However, some participants stated that community members still blame women for the IPV they experience, believing that there is something wrong with their character, temperament or behaviour. Most respondents from rural areas believed that no one would act against an IPV aggressor, out of fear of retaliation. In urban areas, respondents stated that their community members do not mediate in cases of IPV; disputes between intimate partners are seen as private matters: Interference by someone outside the family will worsen the situation. The opinion of the family member carries more weight compared to a non-family member. -Urban IDI However, in the case of sexual violence, participants explained that people blame the character of the woman who experienced violence. She is considered less trustworthy, she is not invited to community events and she is not respected in society. Participants stated that community members are hesitant to invite survivors of sexual violence and their families to events, as they are afraid that their daughters might follow in the footsteps of the survivor and/or her family.
Many participants highlighted a lack of services for survivors in their communities and beyond. They saw a need for organizations, staffed by women, where survivors could get help without fear of blame or additional violence, as well as work to change the mindset of people in their communities about violence. One person commented, Why do not we get justice? Where do we go and to whom do we say our grief? There is a need to change the perception and mindset of people. Everybody considers violence to be a bad habit, but no one takes action on it. Survivors, whether of IPV or sexual violence, require counselling but there is no such thing.-Rural IDI Participants did not view existing legal and judicial institutions as viable options for support or justice. They reported that the police and judicial system are not responsive to the complaints of survivors and payments might have to be made to get a case registered, especially in cases of sexual violence. Largely, they felt the government needed to take more action to prevent and respond to VAWG and provide resources for survivors. One respondent pointed out, There is no support system within the community. People in the community are largely poor, they cannot do anything. If families of survivors take the case to the police, they demand money to register the case. The government has to provide some system where the survivor or her family can pursue the case and the aggressor of IPV or SV can be punished. -Rural IDI Additionally, the perception was that it is uncommon for the aggressors to be punished; that they find ways to escape consequences; therefore, expectations of obtaining justice were very low. Male participants in FGDs added that sexist constitutional laws that require women to provide four eyewitnesses to prove rape discourage survivors from coming forward, and from using services that might help their situation.

Effects on women and girls who experience violence
Participants were asked to identify physical, psychological, economic and social effects of VAWG on those who experience it, their relatives and their communities. All participants discussed individual-level effects on the women and girls who experience violence; many recognized effects on households. However, few noted effects at the community level.

a.
Individual level impacts on the women and girls who experience VAWG Social isolation and limited mobility emerge as the most significant social consequences of VAWG for women. Unwanted sexual contact and sexual harassment on the street and in public spaces was a contributing factor to limited mobility. In some cases, participants said that women stopped leaving the house due to fear of experiencing this violence, and in others, it was used to justify husbands' control over wives' mobility.
It is said by husbands as well as by elders that if you go out without telling your husband or without his permission then anything can happen to you; otherwise, you are safe. So, we have to keep this in mind. This is also a torture.

-Rural IDI
Additionally, participants pointed out that women suffered from depression, anxiety, and low self-esteem as a result of VAWG, which led to social isolation. Stigma associated with experiencing VAWG also damaged women's social and familial ties. In the case of sexual assault or rape, this isolation was directly tied to not being able to tell anyone about their experiences for fear of further violence, as participants reported that survivors of rape or sexual assault could be murdered by male family members in the name of honour. This situation is best reflected in the following observation: [Violence] leaves a bad impact on women. She cannot go out to functions or to meet people. She is often confined at home and unable to face people. -Rural IDI Survivors of VAWG, particularly survivors of NPSV and those who have been divorced, also face social stigma in the form of reduced marriage prospects. This finding means that, should women desire to re-marry, they would be more likely to be married into households of lower social status. This result may also imply that women would marry farther away from their families which is a risk factor for further violence.
In such cases of rape, the girl gets married to any man; he could be much older than her, she could be his second or third wife or he might not have any source of income. Women's ability to use resources independently is curtailed by limits on their mobility, economic neglect, and physical and psychological IPV. Women who are not able to independently visit shops and businesses are not able to freely use their resources. Participants also commonly discussed economic neglect -husbands' failure to provide for household expenses. Lack of economic support impeded women's ability to purchase household needs such as food, healthcare, and children's school fees. Finally, women who were unable to earn their own income were not able to exercise financial autonomy through use of resources. The ability of women and girls to access education is also impeded by VAWG. Several participants described a lack of value placed on girls' education. One woman described her husband's refusal to allow her daughter to continue her education, preferring to marry her off instead. In rural areas, stigmatisation of household members, especially of other female members of the family, and after an incident of sexual violence, was a common impact. While not as commonly mentioned in urban areas, some urban participants mentioned that the survivor and her family fear that taking legal action would give the family a bad reputation and threaten the safety of other household members. In cases of sexual violence, both the survivor and her family become socially isolated and marriage prospects for unmarried girls within the household decline. Participants believed that this stigmatisation occurs because people suspect that a woman who experiences IPV, and her family by extension, is to blame.

People not only consider a girl who experienced sexual violence suspicious but also see other women and girls of the households doubtfully. It becomes very hard for her as well as her sisters to get married…People blame the character of a woman or girl as a cause of sexual violence. She is considered less trustworthy. -Rural IDI
Respondents discussed how stigma faced by relatives of a survivor of VAWG and social pressure to uphold their "honour" may cause them to condemn the survivor publicly and perhaps even murder the survivor in an "honour killing". Beyond this, these murders also invoke fear in other family members in the household, especially women, perpetuating their social isolation. In rural areas, respondents specifically mentioned that as a result of sexual violence, women are often killed by family members. If they are not killed, they return to their marital home.
There are very severe effects of sexual violence. First of all, she is not allowed to live and is killed. If she survives, she is confined to a corner in the house. If she is married, then her inlaws don't allow her to live with them and she has to move to her parents' house. The family remains in trauma that never ends. -Rural IDI In both urban and rural areas, participants explained that household dissolution as a result of VAWG occurs when a woman leaves her husband to escape violence or is kicked out of the home by her husband as a continuation of violence, or when a woman breaks ties with her parents and siblings as a result of her marriage/IPV. In both urban and rural areas, while women did mention leaving their marital home to stay with their parents, many mentioned that women are afraid to get a divorce after experiencing IPV because they fear losing access to their children. Women shared that after divorce, children (both boys and girls) usually stayed with the husband and his family. One woman explicitly lamented the common notion that women have no rights to their children.

I feel that it is a mother who keeps the baby in womb for nine months and bore all the pain in delivering it. Then why doesn't she have any rights to children? -Rural IDI
Some participants mentioned that the perpetrator threatens them in order to prevent them from reporting the case to police. Even if the survivor and her family are able to report the case, a respondent described how they will then face threats and harassment from police authorities as well. Intimidation is more likely to occur if a survivor belongs to a poor family and is not well connected. Additionally, instead of threats, sometimes the perpetrators offer money to settle the matter outside court instead to protect their reputation in society. Respondents from rural areas highlighted the fact that that the families of sexual violence survivors incur heavy economic costs because of VAWG, most commonly for medical services to treat injuries or trauma. One participant mentioned that they spent about a hundred thousand rupees on medical expenses for her daughter-in-law, who died by suicide after her rape. Family members are subjected to an additional financial burden when filing complaints with the police or seeking legal aid. In urban areas, respondents described the additional cost of picking up/dropping off their daughter at school so that she avoids violence enroute.
A man who raped a girl was arrested by the police but later was released in exchange for money he gave to girl's own family and her in-laws. Here, people are very poor and money matters for them. Pursuing a case of violence, particularly sexual violence, requires money. -

Rural IDI
The responses from key informants also suggest that legal recourse is long and expensive. A lawyer's consultation fee is usually higher in a case of sexual violence because more expertise is required. Travel expenses to court or to obtain records for the case are borne by the households; since the survivor is often accompanied by someone from their family, the travel expense is doubled. Participants also mentioned that households compromise expenditures on food, clothing and children's education due to the reduced budget share (as a consequence of added cost incurred after the violence). Additionally, the stigma attached to rape may force the family to relocate, which further creates hardships along with added financial implications. Some respondents from rural areas described how physical injuries and negative psychological impacts on the VAWG survivors prevents them from properly executing their household and care-giving responsibilities, leading to a reallocation of household chores and childcare duties to other family members. Respondents described that these chores are often taken over by another female member of the household, usually the daughter.

When I become unconscious [as a result of intimate partner violence] my daughter gives me water and rubs my hands and feet. She carries out all of the household tasks when I am severely ill.-Rural IDI
Additionally, parents of the survivor are burdened with caring for the survivor's children, especially when a survivor passes away.

My husband's niece died as a result of constant physical and sexual assault by her husband.
Her parents had to bear the consequences as now they are bringing up her children. -Rural IDI Mental health impacts on children were a common theme during interviews. Respondents in both urban and rural areas stated that boys, in particular, may undergo attitudinal and behavioural changes as they learn to reproduce the violence being carried out against women at home. Negative impacts on their school performance and educational opportunities were also discussed, especially in the case of sexual violence. Women in rural areas mentioned that fathers usually decide whether the children, especially daughters, can continue their education.

Fighting between husband and wife has a very bad effect on children. They will also grow up to do this. -Urban ID I
Key informants described that family members (especially girls) of a sexual violence survivor might opt to abandon going to school in fear that people in the community will talk negatively about her and her family. Additionally, there are restrictions placed on other women of the household, especially as a result of violence, limiting their mobility or insistence on observing purdah (covering the head and face).

c. Community-level impacts
Participants in this study discussed how VAWG affects not only women's sense of belonging in the community but also the community's sense of safety, which in turn restricts women's mobility and reduces women's community engagement, civic participation, and pursuit of economic and educational opportunities.
Participants mentioned how an incident of violence, especially sexual violence, results in a sense of vulnerability among other women and girls in the community that causes them to retreat from public life. In rural areas after an incident of sexual violence, community members feel scared and unsafe. Some women and girls are scared to go out without the permission of their husbands or male members of the family, relegating women to the private sphere and curtailing their civic participation.
Women and girls are scared to go out without the permission of their husbands or male members in the family. They say that they will be safe in this way. -Rural IDI The Social Costs of Violence Against Women and Girls on Survivors 13 Additionally, women interviewed pointed out that there are no places where women can go for leisure or recreation, which further erodes their sense of belonging and ability to participate in the community.
There are no places of entertainment and recreation here. There is a park at a distance from our village where we go with family members. Girls do go to school. We go to hospitals if needed. A wife goes to these places if allowed by husband or elders in the family. -Rural IDI Respondents also described how, as a result of an incident of violence in the community, women are often relegated to the private sphere and unable to access public life. Women who go out alone are seen as "inviting" sexual violence; when sexual violence occurs, it increases feelings of lack of community safety and reinforces the justification for male "protection". This perpetuates a cycle that excludes women from public life and leadership. Respondents described how women and girls who are harassed on the way to school feel unsafe and may change their route; parents worry their daughters are unsafe when they go out and may prevent them from continuing to attend school. This can have long-term impacts on women's pursuit of economic and educational opportunities, yielding a cumulative economic cost to society.
Women and girls in this community normally visit their children's schools, go for religious education, meet relatives and friends, and go to the market. If at any such place she faces harassment then she will change her route. -Urban IDI

Discussion
The types of VAWG identified in this study are consistent with findings of other studies that discuss the prevalence of VAWG in Pakistan. 2 The actions that participants described as violent acts were classified using common classifications in the literature, by type and perpetrator. Types of violence included physical, psychological/emotional, sexual, and economic. Participants identified were intimate partners, other household members (both family of origin and in-laws), community members known to the survivor such as neighbours, teachers, or employers, or strangers. International literature discusses the definitions used in this paper (Garcia-Moreno et al., 2006;Ellsberg and Heise, 2005;World Health Organization, 2013).
This study of the social costs of VAWG in Pakistan uses a framework that builds on the socio-ecological model of abuse (Heise, 1998). We have adapted this model, which focuses on understanding VAWG by studying multiple factors that interact at the individual, household, community and societal levels, to understand the effects of VAWG.
We have also used a life-cycle approach to capture the multiple forms of violence that girls and women experience throughout their lives, from birth through old age (Solotaroff and Pande, 2014). Our study found that VAWG in Pakistan starts in infancy and early childhood and is present throughout women's lives. However, participants in our study did not discuss violence against women who are not married, such as single women, widows and divorcees, in specific terms. The literature on VAWG in Pakistan acknowledges that these groups of women also experience violence (Solotaroff and Pande, 2014); however, the exclusive focus of some studies on IPV leaves these experiences unexplored. This gap is one of the limitations of our study. While not the focus of this paper, the physical, psychological, and reproductive health impacts of this study are consistent with existing literature (Garcia-Moreno et al., 2006;Ellsberg and Heise, 2005;World Health Organization, 2013) as were findings on individual costs of violence in Pakistan (Ghaus and Kazi, 2012).
Our findings particularly highlight how norms that limit women's mobility and create a strong barrier to participation in public life impact women's social and economic agency and heighten the impacts of VAWG. Social norms that relegate women solely to the private sphere underlie both the social and economic impacts of VAWG. The traditional notion that women should not leave the home unaccompanied contributes to the societal judgement of women who do go out alone or work outside the home. These women are deemed to have bad character and are thus considered deserving of the violence they face in public. In turn, this means that women who do not want to be judged or to experience violence choose not to go out, and that men refuse to allow their wives and daughters to leave the house in the name of safety.
Limits on women's mobility outside the home deny them the opportunity to participate in their communities or exercise a political voice. They are also unable to access services or build social networks outside their homes that could serve as protective factors for those at risk of experiencing VAWG and/or seeking help. This creates a vicious cycle wherein women are isolated and unable to seek help, exercise public rights, or build individual or collective agency needed to advocate for an end to the violence they are experiencing.
These limits on mobility also create a vicious cycle of economic abuse. Because women respondents stated that they are not allowed to work outside the home, they are unable to obtain or control their own resources. Instead, they are dependent upon their husband to provide them with money for expenses -to be used as determined by him. Lack of support services and negative perceptions of women who work outside the home make women vulnerable to being trapped in violent relationships and unable to gain the financial resources that would allow them increased agency and potential exits from The Social Costs of Violence Against Women and Girls on Survivors 15 violence. Our findings on the social costs of VAWG at the household level suggest that the lack of service provision for survivors of VAWG places a high cost on their relatives. This expenditure may take the form of direct costs, as survivors may return to their families of origin. While our participants did not directly discuss these costs, there would logically be an increased burden upon the household to provide for an additional person's food, shelter, and healthcare. However, there are additional costs that result from the diminished capabilities and restricted mobility of women and girls as a result of violence, as other members of the household have to perform household chores and forgo economic and educational opportunities instead, particularly young girls in the household. Our findings point to the normalisation of violence among children of survivors. As other studies have demonstrated (Malik, 2012) early exposure to violence can trigger feelings of parental rejection in children and may predispose them to reproducing violence in the future as international studies on masculinity suggest (Barker et al., 2011).
VAWG has immense economic costs that go beyond survivors and their families as the high prevalence of VAWG affects women's ability to be productive and fully participate in their national economies. Although participants in the study did not directly identify these as costs that are affecting their country's economy, they did identify effects on the survivors' ability to attend to work and to be productive at work, defined as absenteeism and presenteeism in the costing literature. 3 Other impacts at the community level identified by participants, often not discussed in the literature, were the diminished feelings of trust and sense of belonging of women as a result of experiencing VAWG and the lack of community and social support services to cope and seek justice.
In addition to the types of violence identified in the study and their social costs, it is noteworthy that participants discussed the extent to which VAWG and some types of VAWG in particular are not recognized as such by some men and women. The missrecognition of VAWG was particularly frequent among participants when they discussed IPV and domestic violence. While many said that sex between partners should never be forced or coerced, a few felt that men had the right to demand sex from their wives, as it was a marital obligation. Respondents explained that marital rape is accepted in Pakistan because sexual intercourse is viewed as the man's prerogative. Additionally, respondents mentioned that it is common for women to face psychological violence from husbands for not executing household chores on time and in a proper manner, and that this situation sometimes escalates to physical IPV. Although many participants recognized these as violent acts, many still consider this expected behaviour for a man. Participants also noted that women are still expected to have restricted mobility. and it is common that men exercise control that results in restriction of women's mobility and lack of autonomy. Control over women and men's ability to maintain that control and order in their household seemed to be key components of the social norms that dictate expectations for men's behaviour.
This kind of environment enables VAWG and negatively impacts women in many ways. To the extent that these behaviours are considered normal, the risk of their occurrence and recurrence is increased. It also contributes to a sense of helplessness in women and girls and affects the power of public discourse to problematise VAWG. Lack of public discourse also affects the ability of NGOs and other stakeholders to conduct advocacy and provide services for prevention and for survivors. Scholars have argued that lack of public resources to combat and ameliorate the effects of VAWG by providing mental health and other services to survivors such as shelters affects the severity of the VAWG and places the costs of VAWG on the survivors, their families and communities. 4 Moreover, the lack of services makes the costs of VAWG invisible to the public/ government.
Finally, miss-recognition also affects the ability of researchers to create reliable measures of prevalence of VAWG and calculate the economic costs of VAWG. This failure does not mean that such studies should not be conducted; rather, it is important to realise that because of misrecognition, researchers always should note that the numbers they may obtain are underestimating the actual size of the problem.

Conclusions and recommendations
The research highlights the impacts of VAWG at the individual, household and community levels. In addition, the research found evidence that missrecognition of some types of violence in Pakistan may affect the ability of women and girls to denounce these acts. This fact has important implications for research that aims to calculate the prevalence and impacts of VAWG, as the prevalence and costs may be underestimated.
The impacts of VAWG that emerge from this particular study argue for government commitment and action to ensure that survivors have access to protection and essential services needed to mitigate the impacts of VAWG, which can have significant and lasting effects. Stigma, constrained mobility and social norms justifying violence limit women's ability to speak out about their experiences and to access services to support them, which undermines the potential of both women and the community at large.