




































 

Muhammad Muneeb 33 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Original Article 

Impending Early Marriage Leading to Depression,  

Anxiety and Stress: Woes of Female Medical  

Students at Hyderabad 
Muhammad Muneeb1, Aatir H. Rajput2, Tahir Hanif3, Anam Shaikh4, Abid Ali5 and Sadia Khan6 

Liaquat University Hospital 

LUMHS Research Forum 

Sir Cowasjee Jehangir Institute of Psychiatry, Hyderabad  

Liaquat University of Medical & Health Sciences, Jamshoro 

Combined Military Hospital (C.M.H.), Hyderabad 

Corresponding email: Muhammadmuneebchauhan@gmail.com 

 

Abstract 

Background Pakistan, like the rest of south-east Asia, is plagued with old trends and traditions that target the fairer 

sex in particular. Marriage tops all charts in this regard and every parent in our increasingly misogynistic society 

wishes to marry off their daughter as soon as possible. Doctor brides however have always been seen positively. 

Parents wish to benefit from this factor and get their daughters married even before they graduate. Objective 

We hypothesize that the fear of an impending marriage leads to depression, anxiety and stress among female 

medical students. This study hopes to gauge the psychosocial and psychosomatic effects. Methodology 

This observational cross sectional psychosocial analysis was carried out on a total of 100 female medical students of 

Liaquat University of Medical & Health Sciences and ISRA University from March to June 2014. Informed consent 

was obtained and complete anonymity guaranteed. “Google docs” was used to collect data via online structured 

questionnaire forms. The data obtained was analyzed in SPSS. v. 16.0. Results 

43 percent of the sample confessed that their families had, at least once, been approached for purpose of marriage. 

16 percent admitted that they had themselves received marriage proposals. 88 percent of the sample held negative 

views regarding early marriage before graduation. Upon inquiry, 78 percent of those who had encountered prospects 

of marriage before graduation admitted to have felt depression, anxiety and stress along with mild psychosomatic 

symptoms. Conclusion Females constitute a significant majority of medical students in Pakistan and early marriage 

is known to adversely affect the prospects of a successful career. On the basis of our result, we conclude that even 

the fear of impending marriage is inducing depression, anxiety and stress among female students and can potentially 

harm their education and health. 

 

Keywords 

Psychosocial, psychosomatic, marriage, depression, anxiety and stress. 

 

Introduction 

Pakistan, like the rest of south-east Asia, is plagued 

with age old trends and traditions that target the fairer 

sex in particular. Marriage tops all charts in this 

regard and every parent in our increasingly 

misogynistic society wishes to marry off their 

daughter as soon as possible. It used to be that she 

only needed to be fair, from a good family, charming, 

and pliable. Now it seems the perfect bride for the 

darling son of this or that family – must also be a 

doctor. Gone are the days when too much education 

was a boon on the backs of the bride-to-be, a 

consternation that suggested the chance for possible 

rebellion; the desire to overturn age old traditions. 

Today, the doctor bride signifies status, not simply 

the cache of brains in addition to beauty, but rather of 

the incredible largesse of having the option to work, 

to make lots of money, and then to forego it all in the 

path of devoted wifehood and motherhood. In this 

misogynistic equation a man who can boss a woman 

around is quite manly, but a man who bosses a doctor 

around is the manliest. (Rafia. Z, 2013). More than 

70 percent of Pakistan’s medical students are women 

but few go on to practice, according to the 

government body that regulates medical profession, 

Pakistan Medical and Dental Council (PMDC). 

However only 23% of the nation’s doctors are 

women. (Zohra. B, 2015).  

 

While no figures are officially kept in Pakistan of the 

numbers of doctors that are lost to the bridal belt of 

wife and motherhood, sources suggest that of 

132,988 practicing doctors registered with the 

Pakistan Medical and Dental Council, 58,789 are 

http://www.aeirc-edu.com/
mailto:Muhammadmuneebchauhan@gmail.com


 

Muhammad Muneeb 34 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

women. Of 28, 686 specialist physicians in the 

country, a paltry 7,524 are women. The percentage of 

female medical students may be high enough, but the 

bridal market places more urgent demands, promises 

more stability and social acceptance than the job 

market. (Rafia. Z, 2013) 

 

In a poor country, where healthcare is inaccessible to 

millions, female students, especially those that attend 

public universities take up already meager resources. 

When these girls do not practice they take away 

income generating opportunities from others who 

would utilise them. On another scale, the lost doctors 

represent an expenditure on healthcare that produces 

a net loss in that the benefits of the education are 

never dispersed into the general population. The 

problems are not Pakistan’s alone. In post-apartheid 

South Africa, a country where Indian Muslims 

present a significant demographic, rumors have been 

circulating about the application of unofficial quotas 

that reject applications from female Indian Muslim 

students because too many of them fail to practice 

medicine after marriage and motherhood. While 

administrators of medical schools insist that they do 

not exist, the issue remains a contentious one even in 

that country. (Rafia. Z, 2013) 

 

The educational burden of medical school alone is 

stress worthy but when coupled with the fear that all 

their efforts and their hard earned degree shall go in 

vain and they will be wedded off at a tender age. We 

hypothesize that the fear of an impending marriage 

leads to depression, anxiety and stress among female 

medical students and this study hopes to gauge the 

psychosocial and psychosomatic effects.  

 

Methodology 

This observational cross sectional psychosocial 

analysis was carried out on a total of 100 female 

medical students of Liaquat University of Medical & 

Health Sciences and ISRA University from March to 

June 2014. Informed consent was obtained and 

complete anonymity guaranteed. “Google docs” was 

used to collect data via online structured 

questionnaire forms. The data obtained was analyzed 

in SPSS. v. 16.0. Information was also gathered from 

online reports and news periodicals.  

 

Results 

Majority of the sample validated the claims made by 

most reports and confessed to have received marriage 

proposals during their university life i.e. they were 

found marriage worthy by men even before they had 

graduated.   

 
Figure 1: A significant proportion of female medical students reported to have received marriage proposals 

even before graduation. 

43 percent of the sample confessed that their families had, at least once, been approached for purpose of marriage. 

16 percent admitted that they had themselves received marriage proposals. 

 
 

Figure 2: Ethical norms of the country dominated our result trend with most proposals being made to the 

family and not directly to the individual students. 

88 percent of the sample held negative views regarding early marriage before graduation.  

63%

37%

Ever Received A Marriage Proposal at University

Yes No

43%

16%

Family Self

Mode of Approach

http://www.aeirc-edu.com/


 

Muhammad Muneeb 35 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

 
Figure 3: The majority of girls wished to continue their medical education and practice their profession. The 

admitted to be well aware of the consequences of marriage and hence saw it as contradictory to their present 

interests. This coupled with the burden of responsibilities they would shoulder after marriage made them see 

marriage as a negative entity 

Upon inquiry, 78 percent of those who had encountered prospects of marriage before graduation admitted to have 

felt depression, anxiety and stress along with mild psychosomatic symptoms. 

 
Figure 4: The psychological distress that the female medical students are faced with, is evident in this figure. 

Depression is the mainstay of the symptoms while anxiety and stress too follow immediately. 

The self-admitted psychosomatic symptoms that female medical students felt due to the impending feeling of 

marriage are described in the figure below. Fatigue, Back-ache and abdominal pain were the most prominent among 

the lot. 

 
Figure 5: The top 5 symptoms were fatigue, headache, backache, abdominal pain and shortness of breath. 

 

12%

88%

Views regarding Early Marriage

Positive Negative

88%

81%
78%

Depression Anxiety Stress

Troubles Encountered

84%
75%

67% 64%

34%

12% 11% 9% 4% 4% 4%

Psychosomatic Symptoms

http://www.aeirc-edu.com/


 

Muhammad Muneeb 36 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Discussion 

Many women in the developing world are subject to 

marriage at an early age. Most such women have 

little choice in the age at which they marry, or whom 

they marry. Rebeca. J, 2013 in her article, examined 

patterns and trends of early marriage in the 

developing world. The incidence varies widely, from 

a high of 70 per cent in south Asia to a low of 30 per 

cent in South East Asia. Women who marry young 

tend to have less decision-making power in the 

household. They are also more likely to experience 

domestic violence. (Rebeca. J, 2013). Hence 

justifying the fear of early impending marriage. 

 

The average age at marriage of women has been 

rising in most developing countries including south 

Asia. (Caldwell J.C, 1983). The rise in the age at 

marriage of women was explained by a marriage 

squeeze resulting from changes in the age structure of 

the population with mortality decline, an increasing 

concern of parents of daughters to secure sons-in-law 

with education and urban occupations, and a growing 

concept of child dependency. There was no evidence 

of the rise being a conscious effort to control family 

size. In the immediate future some women will 

probably remain unmarried, (Caldwell. J.C, 1983) 

and it is this fear that is driving the all parents of 

daughters to get them married early and it is the more 

likeable ones (i.e. doctors) that get married the 

earliest.  

 

It is a general perception in Pakistan that uneducated 

people do not allow women to work and girls should 

be provided education to make them an effective part 

of society. But the fact highlighted by our study is 

that even the educated men and their families force 

their wives to stay home as housewives and abandon 

their medical practice and their duty towards 

humanity. Ikram. J, 2014, too validates our claims in 

his report that states that the elite class too preferred 

that female medical students should marry and serve 

their in-laws instead of doing their duty as a doctor. 

The problem thus lies at many levels (i.e. personal 

and societal) and the practice of young female 

medical students being approached and coerced for 

marriage is not only distressing for the primary 

victims (i.e. the female medical students) who suffer 

depression anxiety and stress but also the society at 

large who suffers from the dearth of doctors available 

to them. PMDC statistics that were quoted by the 

then president of PMDC state that “70 percent of the 

female students did not practice medicine after 

becoming doctor and completing their studies” 

(Faheem A, 2012). The discussion on the problems 

can continue forever and the evidence too is endless, 

suggesting that early marriage may lead to a myriad 

of issues including poverty (Otoo-Oyortey N, 2003), 

low quality of life (UNICEF, 2005) and poor 

reproductive health (Prakash R. et al, 2011) and 

increase in infant mortality rate (Finlay JE, 2011). 

 

The solution too can be dual-pronged. We can 

educate parents to not marry off their daughters at an 

early age and thus easing the psychosomatic burden 

that the female medical students carry. In addition to 

that, the students can be made to sign bonds that 

make it mandatory for them to practice their 

profession for at least a certain amount of years. That 

would not only let the females retain a sense of their 

old self after their marriage and give them 

confidence, but also empower them to fight off the 

depression, anxiety and stress.  

 

Another solution that has surfaced just recently is the 

innovative idea of allowing female doctors who have 

discontinued their medical practice due to marriage is 

to work from home by joining platforms such as 

“doctHERS” and others that use video consultation 

setup that facilitates doctor-patient interactions. (Ilyas 

F, 2016).  

 

Conclusion 

Females constitute a significant majority of medical 

students in Pakistan and early marriage is known to 

adversely affect the prospects of a successful career. 

On the basis of our result, we conclude that even the 

fear of impending marriage is inducing depression, 

anxiety and stress among female students and can 

potentially harm their education and health. 

 

Conflict of interest 

All the authors disclosed that there is no conflict of 

interest associated in the preparation of this article. 

 

Acknowledgements 

We would like to acknowledge the intellectual 

assistance and technical support provided by 

LUMHS Research Forum

 

 

 

 

 

 

http://www.aeirc-edu.com/


 

Muhammad Muneeb 37 

  

Annals of Psychophysiology                                                                                                        Volume 3, October 2016                  
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

References 

 Rafia. Z. (2013). The doctor brides. The Dawn 

News. Retrieved from: 

http://www.dawn.com/news/1032070 

 Zohra. B. (2015). Pakistan sees a high rate of 

female medical students, but only few doctors. 

Women in the world in association with the New 

York Times. Retrieved from: 

http://nytlive.nytimes.com/womenintheworld/2015/

08/30/pakistan-sees-high-rate-of-female-medical-

students-but-few-doctors/ 

 Rebeca. J, Rebecca. T. (2013). Early female 

marriage in the developing world. Journal of gender 

and development. Vol 11, Issue 2. Page 9 – 11. 

 Caldwell J.C, Reddy P.H, Caldwell. P. (2013). The 

causes of marriage change in south India. Journal of 

demographics. Vol 37, Issue 3. Page 343 – 361.  

 Ikram. J. (2014). 50pc Female doctors never work 

after graduation. The dawn news. Retrieved from: 

http://www.dawn.com/news/1139557

 Faheem. A. (2012). 70 percent of girls do not 

practice after becoming a Doctor. Aaj News. 

Retrieved from: http://aaj.tv/2012/12/70-percent-of-

girls-do-not-practice-after-becoming-a-doctor/ 

 Oyo-Oyortey N, Pobi S. (2003). Early marriage and 

poverty: exploring links and key policy issues. 

Gender and Development. Volume 11, Issue 2. 

Page 42 - 51. 

 UNICEF. (2005). Early Marriage: A harmful 

traditional practice. ISBN: 92-806-3869-6.  

 Prakash R. et al. (2011). Early marriage, poor 

reproductive health status of mother and child well-

being in India. J Famm Plan Reprod Health Care. 

Doi: 10.1136/jfprhc-2011-0080 

 Finlay JE. (2011). The association of maternal age 

with infant mortality, child anthropometric failure, 

diarrhoea and anaemia for first births: evidence 

from 55 low- and middle-income countries. BMJ 

Open. doi:10.1136/bmjopen-2011-000226. 

 Ilyas F. (2016). From ‘doctor brides’ to practicing 

physicians. The Express Tribune. Retrieved from: 

http://tribune.com.pk/story/969805/docthers-from-

doctor-brides-to-practicing-physicians/ 

 

http://www.aeirc-edu.com/
http://www.dawn.com/news/1032070
http://nytlive.nytimes.com/womenintheworld/2015/08/30/pakistan-sees-high-rate-of-female-medical-students-but-few-doctors/
http://nytlive.nytimes.com/womenintheworld/2015/08/30/pakistan-sees-high-rate-of-female-medical-students-but-few-doctors/
http://nytlive.nytimes.com/womenintheworld/2015/08/30/pakistan-sees-high-rate-of-female-medical-students-but-few-doctors/
http://www.dawn.com/news/1139557
http://aaj.tv/2012/12/70-percent-of-girls-do-not-practice-after-becoming-a-doctor/
http://aaj.tv/2012/12/70-percent-of-girls-do-not-practice-after-becoming-a-doctor/
http://tribune.com.pk/story/969805/docthers-from-doctor-brides-to-practicing-physicians/
http://tribune.com.pk/story/969805/docthers-from-doctor-brides-to-practicing-physicians/

