Intersecting sociocultural, gendered, and structural barriers to rehabilitation access in Pakistan: a qualitative study

Access to rehabilitation services in Pakistan may be influenced by sociocultural stigma and gender inequalities, which can disproportionately affect people with disabilities, particularly women with disabilities. However, limited qualitative evidence exists on how societal attitudes, gender norms, and systemic barriers intersect to shape rehabilitation access in the Pakistani context. This study explores how societal attitudes, gender norms, and systemic barriers intersect to restrict equitable access to rehabilitation services. A qualitative exploratory research design was employed to conduct a secondary analysis of data collected from rehabilitation facilities in Pakistan. The dataset consisted of seven focus group discussions ( n = 55) with adult patients receiving rehabilitation services, along with caregivers of children and individuals requiring rehabilitation support. The data were gathered via semi-structured guides. The recorded data, transcribed, translated, and analyzed using inductive and deductive thematic analysis. The socioecological model, Goffman’s stigma theory, and intersectionality theory were used to analyze the data through intersectionality lens. The findings highlighted multilevel barriers to equitable rehabilitation access for people with disabilities in Pakistan. At the individual level, participants reported stigma, stereotyping, and psychological distress that undermined the seeking of rehabilitation services. At the interpersonal level, social isolation, limited family support, and gendered caregiving burdens further constrain participation in accessing rehabilitation services. At the community level, inaccessible infrastructures, including uneven sidewalks, the absence of ramps, poorly maintained pathways, limited public transport, cultural misconceptions, and restrictive gender norms, constrain mobility and delay in seeking rehabilitation services. Health system barriers in rural areas included inadequate rehabilitation facilities, insufficiently trained staff, gender-insensitive care, and discriminatory attitudes, which collectively limited access to rehabilitation services. Intersectional analysis revealed compounded disadvantages for women and rural participants, where gender, geography, and disability status intersected to intensify inequities in access to rehabilitation. This study highlights that stigma, gender norms, and systemic barriers influence equitable access to rehabilitation services in Pakistan. Women with disabilities and female caregivers experience compounded disadvantages shaped by the intersection of gender, geography, and disability. Addressing these inequities requires the implementation of disability inclusive laws and policies, inclusive training for rehabilitation staff, and stronger integration of rehabilitation within public health priorities to ensure equity and meaningful participation for people with disabilities.