TRUST, MEDIATION, AND EMOTIONAL LABOR IN PAKISTAN’S PUBLIC HEALTHCARE

This thesis explores how Pakistan’s stateled family planning initiatives are deeply shaped by the social worlds they operate in. Centered in Lahore, it examines how Family Planning Field Workers (FPFWs) sustain these programs through everyday acts of trust-building and emotional labor. The study argues that the success of reproductive governance depends less on top-down policy and more on how these women navigate relationships, negotiate mistrust, and humanize state services within their communities. Based on ethnographic fieldwork conducted in Lahore between 2024 and 2025, the research draws on in-depth interviews, participant observation, and shadowing of workers in the field. The analysis is informed by the works of Knud Ejler Løgstrup, Arlie Russell Hochschild, Judith Butler, and Michel Foucault. Together, these frameworks help conceptualize trust not just as an outcome but as a process, a form of emotional and moral work that holds the state’s healthcare infrastructure together. The findings show that FPFWs work within conditions of uncertainty: low pay, bureaucratic neglect, and community skepticism. Yet, they build and sustain trust through emotional strategies like empathy, humor, patience, and silence, that allow them to bridge the distance between state authority and local realities. This labor is deeply gendered; women bear the social and emotional weight of making state-led health programs function, often at personal cost.

Ultimately, the thesis argues that Pakistan’s family planning system is upheld not only by policy frameworks but by the relational and affective labor of its female workforce. By foregrounding emotion, gender, and trust as core to governance, the study reframes public healthcare as a social process sustained by everyday human relationships. These insights point to the need for policies that recognize and support the emotional and ethical dimensions of frontline reproductive care in Pakistan and beyond.