Coming up with creative ways of making aalu-palak, gobhi and tinda, helping children with school work, making sure the domestic help sweeps clean the corners and dusts the niches, that the school uniforms and the husband’s shirts are pressed. She is up early to see the children off before she has breakfast with her husband. She is every man and his mother’s desire for a perfect wife.

At work, she ensures she is looking every bit professional -- nails manicured, hair neat and regularly dyed, attire and the hemline in keeping with the rest of the female colleagues and is able to fend office politics and male colleagues’ untoward advances. The educated, modern urban Pakistani woman seems to have her life well under control, except that playing these multiple roles -- has started weighing her down.

Dispensing the traditional roles of a wife, mother, daughter-in-law with that of a career-oriented super woman is taking its toll and it’s showing.

"Stress has always been around," pointed out clinical psychologist Dr Asha Bedar but new sources have been added since life has become more complex due to a changed socio-political environment. "I’d say the nature of stress has changed," she said.

"As life becomes more competitive, stress levels also tend to rise," said Dr Murad Moosa Khan, professor of psychiatry at Karachi’s Aga Khan University. He said several studies done on stress in Pakistan point to a third of the country’s population to be suffering the effects of stress where mental health is compromised. "It means they are suffering from mild to moderate clinical anxiety and depression." Women outnumber men by about 2:1 and amongst women, young married women show the highest prevalence of stress, state various studies.

And in this changed environment, gender roles are changing slowly. Women’s stress, said Bedar, was often related to gender roles and expectations -- from family, husband, society, in-laws and for working women, their workplaces, etc.

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The double/triple burden of the working women, the unequal gender relations, including discrimination within the family, said Bedar, was what was weighing them down.

Bedar termed this a "sociological transition" period which are always more stressful as the rest of the society is not in the same hurry to "catch up" with the way the women’s awareness of their right to have a career has.

At the same time, even for her, the complete transformation from a homebody to a career-oriented person has not come full circle; the guilt pangs are always there, even if others are not pointing out her transgressions. This is because women tend to "internalise their stress" said Bedar.

Stress brings with it lifestyle diseases

According to Dr Sania Nishtar, founder and president of an Islamabad-based healthcare reform NGO, Heartfile, stress predisposes to a general lack of well-being. "Sleeping and eating disorders, and behaviour change are common responses to stress," she said.

And she added stress was particularly dangerous if it became "chronic" as it can then lead to pathological outcomes. "It increases heart disease risk, can precipitate musculoskeletal [body aches and pains] and psychiatric problems and can even masquerade as other diseases."

"Absolutely," agreed endocrinologist, Dr Tasnim Ahsan, adding: "Stress also speeds ageing". She explained that stress produces a rush of certain hormones -- cortisol and adrenaline -- which may be good for short periods and may force us to perform better, say in sports or in exams, but after that rush it leaves one drained. And that is what an overkill of this hormone can do if you are perpetually stressed. "You can’t go through life feeling drained."

Ahsan, former head of Jinnah Post Graduate Medical Centre, and who has been married now for 36 years, is certain that behind every successful woman and her career is a supportive family. "My husband certainly was by my side, and we’ve always divided our responsibilities and shared work."

But that may not always be the norm. The middle aged man, who grew up seeing his mother do all the housework, the notion that he could offer a helping hand to his wife often does not occur to most men. And where a man tries, he has to be discrete as he knows the consequences of being termed a wuss often by his own family and friends.

Be easy on yourself

Unrealistic expectations from oneself is an enormous source of stress for a woman. Acknowledging that she does not have to be a super woman and letting go of the need to prove herself to be one can ease some of the emotional burden and help her find a sense of peace.

Other more general ways of making life style changes, said Bedar, that help reduce stress include ensuring time for herself; making the space to express both positive and negative emotions, including excitement, happiness and joy in little things in life by being in the moment (as opposed to constantly living in the past or future); developing a passion for this or that, having fun, working for a cause or indulging in a hobby and have a purpose in life. Healthy and fulfilling relationships, having a good balance between work (whether professional work or household responsibilities) and life, and importantly self-care (as opposed to always taking care of others) are also constructive, long-term stress prevention and management factors.

To that list, Khan added, eating healthy, keeping the weight down, doing regular physical exercise and getting good sound sleep in the night. "No sleeping pills, no smoking or alcohol and practising some form of regular relaxation like yoga, meditation, deep breathing etc, or turning to spirituality" will help alleviate stress.

The key to managing stress, he said, was to lead a balanced life. "Too much or too little of anything is bad for us," he said adding that people must strive to maintain a balance between different aspects of their lives -- social, physical, financial, spiritual, occupational, family, personal. "Whenever there is imbalance, stress will result."

Structural changes

"Unless women’s work is recognised and men meet them half way, the Pakistani urban woman will continue to feel burdened," said Aurat Foundation’s director, Mahnaz Rehman. She said significant "structural changes" at the workplace, in traditional practices and in breaking stereotypes was required. "It may take a while but we are making some headway, albeit slowly," she said optimistically.

An important aspect of workplace stress for women and which is often not talked about is sexual harassment at the workplace, pointed out Ayesha Khan, senior researcher at the Collective for Social Science Research. Having done research on women’s empowerment and how it is linked with paid work, she said this was prevalent in banks and corporations "as is discrimination against women in terms of equal pay and opportunities for promotion".

Even Ahsan acknowledged that sexual harassment, especially of female nurses, was found at hospitals. "But often it is not made public as it can close the doors for many aspiring young women."

While there is the anti sexual harassment law (Protection Against Harassment of Women at Workplace Act 2010) as well as a code of conduct for organisations developed by AASHA -- Alliance Against Sexual Harassment that organisations can adopt against workplace sexual harassment, Khan lamented "rigorous enforcement" by employers remained missing.

"By virtue of sheer numbers, women’s presence is so low in the formal sector that they are not able to leverage their value to press for better conditions and rights," she said. And when women leave work, say for childbirth, they often cannot return to work under conditions that allow them to "enjoy flexible timings and balance childcare with work," she said.

Khan said till Pakistani employers do not realise (and which their counterpart in the west are slowly realising) that women are "too valuable to the economy to risk losing them at the prime of their careers" and that changes must be made to facilitate their continued productivity, women will continue to be short-shrifted at their workplace.

But Khan observed that in the long run, it is "women’s paid work" that will make gender relations more "equitable" though it has yet to happen in both the formal and informal sectors.

"Women in the informal sector (representing more than 70 per cent of the women workforce in the country) have the numbers but they have to get organised, as they have in India, in order to lobby for better wages and work conditions. In the formal sector in Pakistan, their numbers are too low," she asserted.

"No change happens without pressure from our side and resistance from men who benefit from the status quo. There is already a religious extremist backlash to the presence of women in the public sphere, so we have to dig in our heels simply to retain the territory we have gained," she concluded.