KARACHI: In a lecture hall of one of Pakistan's most prestigious medical schools, a handful of male students sits in the far top corner, clearly outnumbered by the rows and rows of female students listening intently to the doctor lecturing about insulin.

In a country better known for honor killings of women and low literacy rates for girls, Pakistan's medical schools are a reflection of how women's roles are evolving. Women now make up the vast majority of students studying medicine, a gradual change that has come about after a quota favoring male admittance into medical school was lifted in 1991.

The trend is a step forward for women in Pakistan, a largely conservative Muslim country. But there remain obstacles. Many women graduates don't go on to work as doctors, largely because of pressure from family and society to get married and stop working — so much so that there are now concerns over the impact on the country's health care system.

At Dow Medical College in the southern port city of Karachi, the female students said they are adamant they will work.

Standing in the school's courtyard as fellow students — almost all of them women — gathered between classes, Ayesha Sultan described why she wants to become a doctor.

"I wanted to serve humanity, and I believe that I was born for this," said Sultan, who is in her first year. "The women here are really striving hard to get a position, especially in this country where women's discrimination is to the zenith, so I think that's why you find a lot of women here."

For years, a government-imposed quota mandated that 80 per cent of the seats at medical schools went to men and 20 per cent to women.

Then the Supreme Court ruled that the quota was unconstitutional and that admission should be based solely on merit.

Now about 80 to 85 per cent of Pakistan's medical students are women, said Dr. Mirza Ali Azhar, the secretary general of the Pakistan Medical Association.

Statistics gathered by The Associated Press show that at medical schools in some deeply conservative areas of the country such as Balochistan in the southwest and Khyber Pakhtunkhwa province in the northwest, men still outnumber women. But in Punjab and Sindh provinces, which turn out the vast bulk of medical students, the women dominate. At Dow, it is currently about 70 per cent women to 30 per cent men.

In comparison, about 47 per cent of medical students in the US are women, according to the Association of American Medical Colleges.

There are a number of different reasons why men don't make the cut, say students, faculty and medical officials. Medical school takes too long and is too difficult. Boys have more freedom to leave the house than girls, so they have more distractions. Boys want a career path in business or IT that will make them more money and faster, in part because they need to earn money to raise families.

"In our society, girls are working harder. They are just more concentrated on their studies," said Azhar. "Boys also see how hard doctors have to work even after they get their degree. "They do not like to work hard as a matter of fact."

Ammara Khan is fully prepared for the years that it will take to fulfill her dream of becoming a neurosurgeon. She decided she wanted to pursue neurosurgery after watching an operation while volunteering at the Aga Khan University Hospital in Karachi.

"It's like an adrenaline rush, and I knew I wanted to be that and nothing else," she said.