Maternal suicidality in Pakistan: Developing a critical feminist grounded theory to inform suicide prevention programs

South Asia has the highest rate of suicide fatalities for women globally. However, the underlying factors and processes that contribute to suicidal behavior among women in Pakistan remain underexplored and existing interventions worldwide are dominated by Western-informed suicide theories. We employed a decolonized form of grounded theory, informed by critical feminist theory and Pakistani feminist scholarship, to explore the experiences of suicidal thoughts and behaviors among 12 mothers with a chronic history of suicidality in rural Rawalpindi, Pakistan. Data were collected using in-depth interviews and analyzed in Urdu by female Pakistani scholars. Results generated a grounded theory of suicide among women in Pakistan characterized by four key dimensions: susraal (in-laws’ home) creates an intolerable and lonely ecosystem; struggle negotiating the morality of motherhood vis-a-vis psychological and social suffering; diminished sabr (patience), unresolved grief, and longing for sukoon (peace); and religious faith anchoring women’s value for her life and afterlife. Women's suicidal thoughts and behaviors were largely contextualized by their positionality within their susraal characterized by neglect, invalidation, abuse, and loneliness. Resulting from these dynamics were feelings of abandonment, resentment, disrespect, and helplessness, reducing women’s threshold for maintaining sabr. While suicide attempts were prompted by anger and the desire to escape, women described that suicidal death threatened their relationship with Allah and peace in their afterlife. Among women’s reasons for living, a unique duty toward their children was the strongest reason followed by trust in Allah's plan. This study advances suicide theory, providing a decolonized approach to illuminate insights into the complex and context-specific factors that influence suicide among women in Pakistan. Findings can help guide the development of culturally appropriate suicide prevention interventions sensitive to Pakistan’s unique sociocultural and religious context and ultimately, reduce the burden of suicide.