Intimate Partner Violence, Partner Substance Use, and Health Comorbidities Among Women in Pakistan: A Narrative Review

Abstract

Intimate partner violence (IPV) against women is widespread in Pakistan, and a growing but fragmented literature examines its relationship with substance use both a partner's alcohol or drug use as a risk factor for violence, and the survivor's own subsequent substance use as a hypothesized coping response alongside mental, reproductive, and physical health comorbidities. This narrative review synthesizes Pakistani and regional South Asian evidence on IPV epidemiology, its relationship with partner substance use, its health comorbidities, and the structural barriers keeping affected women from care, while distinguishing empirically supported pathways from theoretical assumptions. Nationally representative data indicate approximately one in three ever-married Pakistani women has experienced IPV, with a husband's alcohol or substance use consistently identified as a risk factor across national, community, and regional South Asian studies. IPV is consistently associated with depression, suicidal ideation, and postpartum depression, though evidence on physical and reproductive consequences remains limited. This review identified consistent, convergent observational evidence for one pathway (partner substance use → IPV) but found no Pakistani or South Asian evidence for the hypothesized reverse pathway (IPV → women's own subsequent substance use), supported only by theoretical reasoning and international data neither specific to IPV nor to Pakistan. This review's contribution is distinguishing these pathways clearly rather than conflating them, and identifying epidemiological, methodological, clinical, and policy gaps to guide future research, clinical practice, health-system development, and policy.