The Lady Health Workers Programme is a major public sector initiative to provide reproductive health care to women in Pakistan, employing almost 100,000 women. This qualitative research study is based on interviews with LHWs and community members in four districts to explore dimensions of women’s empowerment. They are analysed in terms of how context and circumstance can positively shape the LHW experience. Four possible trajectories are illustrated based on case studies. The study finds that LHWs access valuable resources through their training and enjoy enhanced agency and status in their own lives. Community members are also drawn into this positive cycle and some of the rigidities of gender segregation and social hierarchy are overcome through the Programme. The fact that this is a state programme and widely publicized is a major support to the work of LHWs; so is the broader context of social change underway in Pakistan. However the level of poverty and personal crisis that an LHW may have to contend with can undermine these advantages. The study suggests that further research into the effects of employment on women’s empowerment throughout her life cycle would reveal how an LHW may increase her agency over time. The study concludes that the role of the state as a support to broader social change and women’s empowerment is critical.