Introduction Despite the importance of a helmet in prevention of head injuries among motorcyclists, there is limited use of helmet both by drivers and female pillion riders in Pakistan.

Objective The objective of the study is to explore perceptions, barriers, and strategies of women pillion riders regarding the use of motorcycle helmets.

Methods Data was collected from five focus group discussions (FGDs) held with women pillion riders working at the Aga Khan University (AKU). Interviews and focus groups were transcribed verbatim and checked for accuracy before being imported into NVivo2. Written informed consent was taken from each participant before the beginning of each discussion.

Results Some major themes included (1) motorcycles are a risky transport (2) all participants never wore a helmet or never thought about wearing a helmet (3) did not know about the helmet law (4) the most important benefit of helmet use expressed was ‘safety’ Possible barriers to helmet use included (1) a lack of awareness regarding helmet law (2) uninvited attention from people from wearing a helmet (3) the saddle-sided sitting style of women (4) concerns about their looks and discomfort from wearing a helmet. Suggested strategies for implementing helmet use included (1) awareness campaigns through media (2) use of helmets by women police (3) strict law enforcement in the form of fine/ticket.

Significance Publicising and awareness on the helmet law for pillion riders should be the first step towards initiating helmet use among women pillion riders in Pakistan.