Background Each year nearly 1.2 million people die and millions more are injured or disabled as a result of road traffic injuries. Wearing helmets is the single most effective way of reducing head injuries in motored two wheeled vehicles.

Objective The objective of the study is to identify the knowledge, attitudes and practices of women pillion riders in the two major cities of Pakistan, Karachi and Lahore.

Method This is a case-control study, in a selected female population. The inclusion criteria were working women and students between the ages of 18 and 45 with 10 years of education. A questionnaire was distributed focusing on awareness of helmet use and reasons why they are not used.

Results The results are derived from the sample size of 400. Among the many reasons for not wearing a helmet in the female Pakistani population, it emerged that while most of them were aware of the importance of helmets and their protective role, they had not thought that it was important for them as a pillion driver. Some respondents also thought they were not very fashionable and others blamed the hot and humid climate. Most of them thought that if there was a risk of being penalised they will probably wear them.

Conclusion Our study is still in the process of data analysis, but it is very clear that the use of helmets especially in females is near to none.