I lived in Karachi and while I realize that comparing India and Pakistan can start fights, the fact is the subcontinent has a lot of similar characteristics. In a broad brush, Pakistan and Karachi is likely cleaner than large Indian cities (astonishing after you see the level of pollution and trash in Karachi) while the security environment is worse in Pakistan. I know India is bad for women travelers, I don’t think that Pakistan is better so much as women travelers basically don’t try it alone; there are no yoga retreats or gurus or backpacking infrastructure. Rape and assault of local women was a constant drumbeat in the news.
My gut has never recovered, and while I was there low-grade discomfort was the norm and true good poisoning happened about once a month. Sweats, shits, vomits, sleeping hugging the toilet. The smell of the city was unreal when the wind came off of the lagoon where sewage and runoff drained (most of the time); the sky was a flint gray and filled with small raptors (kites) scavenging carrion and garbage. I went to a city beach and it was covered in garbage and it seemed to be garbage with a layer of sand mixed in all the way down. People offered camel rides and horse rides and the animals shit on the beach. No one was swimming, exactly, but lots of wading in oil-slicked surf with garbage and the occasional visible turd floating by.
The homes in elite areas and dedicated military housing were clean and tidy with well-maintained streets and gardens. There is an awe and love of the military, which maintains British customs and unit naming conventions and order. It is everything the rest of Pakistan is not and almost all Pakistanis save the Islamists love it deeply. After military bases, madrassas and rigorous Islamic schools are also the cleanest and most orderly oases. The local unauthorized shrines and mosques are oases of tolerance but also complete chaos and grime. One can see the appeal of militant nationalism or Islam.
Eid-Al-Adha, when Muslims sacrifice, is a time of joy and celebration and fun but to an outsider is a horror movie. The animals are simply slaughtered in the street with a dull knife and entrails left behind foe dust men in some neighborhoods and dogs or kites in most. I saw the city of 20 million from a rooftop in the late afternoon and understood what the sack of Jerusalem must have looked like after the first crusade when you read about knights wading through blood.
Provincial cities were if anything dirtier. Only the desperately poor villages of straw and mud huts were tidy. Almost every town and neighborhood flew flags on every rooftop declaring loyalty to one or another political party or Islamic school. You did not see different flags next to each other.
I understand some of the high mountain villages and towns in the north, in Gilgit-Baltistan are truly lovely and pristine. One of the most beautiful, sophisticated, smart, and tolerant women I have met anywhere hailed from there; they share much with Tajiks and other Central Asians. Quite safe and welcoming if you can get there, which is the whole rub. But I cannot recommend Karachi or Sindh for much all. And I didnt love what I saw of Punjab. Lahore is quite historical and has good food.