God should give daughters to rich families only: attitudes towards childbearing among low-income women in Punjab, Pakistan.

We evaluated perceptions and experiences of bearing sons and daughters among 42 women in Punjab, Pakistan, with special emphasis on son preference, changes in women's status within the marital family and resulting health effects. Data were collected through repeated, in-depth interviews in Urdu or Punjabi in an urban area in Lahore and a village 40 km. outside of Lahore. For triangulation purposes, four focus group discussions were performed with additional women, as well as in-depth interviews with eight mothers-in-law, three traditional practitioners and three medical practitioners. In general, these women felt that they had limited control over their lives, and this was exemplified by early marriages, high expectations on newly wed women to conceive and poor access to contraceptives. Women frequently expressed a strong preference for sons, mostly for economic reasons, reflecting women's subordinate position in society and the low economic value placed on women's work. Mothers of sons mainly discussed health problems during pregnancy and health effects of repeated childbearing. Mothers of daughters and women without children spoke of harassment in the family as well as in society. The results should be of importance in the public health planning in Pakistan as well as for those engaged in women's health issues internationally.